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Goitre (enlarged thyroid, thyroid cyst, colloid goitre, colloid goiter, Plummer disease, Plummer?s disease, follicular adenoma) : Symptoms, Causes, Diagnosis and Treatment

What is Goitre?

Goiters can be any one of several types of growths in the thyroid gland, located at the base of the front side of the neck just below the Adam's apple.

In the case of Graves' disease, the entire thyroid gland becomes enlarged.

Another type, called toxic nodular goiter, results when one or more nodules, or adenomas, develop in the thyroid and trigger excess production of thyroid hormone.

In short, a goiter is any enlargement of the thyroid gland. A goiter may be a temporary problem that will remedy itself over time without medical intervention, or a symptom of another, possibly severe, thyroid condition that requires medical attention.

Goitre is also known as enlarged thyroid, thyroid cyst, colloid goitre, colloid goiter, Plummer disease, Plummer?s disease, follicular adenoma. Goitre belongs under the category of Thyroid disease. Colloid goiter (endemic), Nontoxic goiter (sporadic), Toxic nodular or multinodular goiter are some common types of Goitre. Generally Male, Female are the victim of the Goitre. Seriousness of this disease is Medium.

Symptoms of Goitre are :

  • Difficulty swallowing
  • low-pitched and hoarse voice
  • Swollen, painless lymph nodes in the neck, armpits, or groin
  • Swollen lymph nodes usually occur as a result of infection from bacteria or viruses. Rarely, swollen lymph nodes are caused by cancer.

    Your lymph nodes, also called lymph glands, play a vital role in your body's ability to fight off infections. They function as filters, trapping viruses, bacteria and other causes of illnesses before they can infect other parts of your body. Common areas where you might notice swollen lymph nodes include your neck, under your chin, in your armpits and in your groin.

    In some cases, the passage of time and warm compresses may be all you need to treat swollen lymph nodes. If an infection causes swollen lymph nodes, treatment depends on the cause.

  • Difficulty in breathing
  • Experiencing breathing difficulty describes discomfort when breathing and feeling as if you can?t draw a complete breath. This can develop gradually or come on suddenly. Mild breathing problems, such as fatigue after an aerobics class, don?t fall into this category.

    Breathing difficulties can be caused by many different conditions. They can also develop as a result of stress and anxiety.

    It?s important to note that frequent episodes of shortness of breath or sudden, intense breathing difficulty may be signs of a serious health issue that needs medical attention. You should discuss any breathing concerns with your doctor.

  • Cough
  • When you?re sick or your lungs have become irritated, your body reacts by coughing. This is your body?s defense mechanism to clear out any mucus, allergens, or pollutants so that you don?t keep breathing it in. Coughing is usually nothing to be concerned about. When a cough is a symptom of a cold, it tends to clear up on its own within two or three weeks.

    A lingering cough or a chronic cough not brought on by a recent cold can be an indicator of a more serious condition. Coughs that last longer than eight weeksTrusted Source for adults, or four weeks in children, are considered chronic.

    Causes

    Goitre can be caused due to:

    Your thyroid gland produces two main hormones ? thyroxine (T-4) and triiodothyronine (T-3). These hormones circulate in your bloodstream and help regulate your metabolism. They maintain the rate at which your body uses fats and carbohydrates, help control your body temperature, influence your heart rate, and help regulate the production of proteins.

    Your thyroid gland also produces calcitonin ? a hormone that helps regulate the amount of calcium in your blood.

    Your pituitary gland and hypothalamus control the rate at which T-4 and T-3 are produced and released.

    The hypothalamus ? an area at the base of your brain that acts as a thermostat for your whole system ? signals your pituitary gland to make a hormone known as thyroid-stimulating hormone (TSH). Your pituitary gland ? also located at the base of your brain ? releases a certain amount of TSH, depending on how much thyroxine and T-3 are in your blood. Your thyroid gland, in turn, regulates its production of hormones based on the amount of TSH it receives from the pituitary gland.

    Having a goiter doesn't necessarily mean that your thyroid gland isn't working normally. Even when it's enlarged, your thyroid may produce normal amounts of hormones. It might also, however, produce too much or too little thyroxine and T-3.

    Several things can cause your thyroid gland to enlarge. Some of the most common are:

    • Iodine deficiency. Iodine is essential for the production of thyroid hormones, and is found primarily in seawater and in the soil in coastal areas. In the developing world, people who live inland or at high elevations are often iodine deficient and can develop goiters when the thyroid enlarges in an effort to obtain more iodine. Iodine deficiency may be made worse by a diet high in hormone-inhibiting foods, such as cabbage, broccoli and cauliflower.

      In countries where iodine is routinely added to table salt and other foods, a lack of dietary iodine isn't usually the cause of goiters.

    • Graves' disease. A goiter can sometimes occur when your thyroid gland produces too much thyroid hormone (hyperthyroidism). In someone who has Graves' disease, antibodies produced by the immune system mistakenly attack the thyroid gland, causing it to produce excess thyroxine. This overstimulation causes the thyroid to swell.

    • Hashimoto's disease. A goiter can also result from an underactive thyroid (hypothyroidism). Like Graves' disease, Hashimoto's disease is an autoimmune disorder. But instead of causing your thyroid to produce too much hormone, Hashimoto's damages your thyroid so that it produces too little.

      Sensing a low hormone level, your pituitary gland produces more TSH to stimulate the thyroid, which then causes the gland to enlarge.

    • Multinodular goiter. In this condition, several solid or fluid-filled lumps called nodules develop in both sides of your thyroid, resulting in overall enlargement of the gland.

    • Solitary thyroid nodules. In this case, a single nodule develops in one part of your thyroid gland. Most nodules are noncancerous (benign) and don't lead to cancer.

    • Thyroid cancer. Thyroid cancer is far less common than benign thyroid nodules. A biopsy of a thyroid nodule is very accurate in determining whether it's cancerous.

    • Pregnancy. A hormone produced during pregnancy, human chorionic gonadotropin (HCG), may cause your thyroid gland to enlarge slightly.

    • Inflammation. Thyroiditis is an inflammatory condition that can cause pain and swelling in the thyroid. It may also cause the body to produce too much or too little thyroxine.

    Treatment for the Goitre

    Diagnosis:

    Your doctor may discover an enlarged thyroid gland simply by feeling your neck and having you swallow during a routine physical exam. In some cases, your doctor may also be able to feel the presence of nodules.

    Diagnosing a goiter may also involve:

    • A hormone test. Blood tests can determine the amount of hormones produced by your thyroid and pituitary glands. If your thyroid is underactive, the level of thyroid hormone will be low. At the same time, the level of thyroid-stimulating hormone (TSH) will be elevated because your pituitary gland tries to stimulate your thyroid gland to produce more thyroid hormone.

      A goiter associated with an overactive thyroid usually involves a high level of thyroid hormone in the blood and a lower than normal TSH level.

    • An antibody test. Some causes of a goiter involve production of abnormal antibodies. A blood test may confirm the presence of these antibodies.

    • Ultrasonography. A wand-like device (transducer) is held over your neck. Sound waves bounce through your neck and back, forming images on a computer screen. The images reveal the size of your thyroid gland and whether the gland contains nodules that your doctor may not have been able to feel.

    • A thyroid scan. During a thyroid scan, a radioactive isotope is injected into the vein on the inside of your elbow. You lie on a table with your head stretched backward while a special camera produces an image of your thyroid on a computer screen.

      The time needed for the procedure may vary, depending on how long it takes the isotope to reach your thyroid gland. Thyroid scans provide information about the nature and size of your thyroid, but they're more invasive, time-consuming and expensive than ultrasound tests.

    • A biopsy. During a fine-needle aspiration biopsy, ultrasound is used to guide a needle into your thyroid to obtain a tissue or fluid sample for testing.

    Treatment:

    Goiter treatment depends on the size of the goiter, your signs and symptoms, and the underlying cause. Your doctor may recommend:

    • Observation. If your goiter is small and doesn't cause problems, and your thyroid is functioning normally, your doctor may suggest a wait-and-see approach.

    • Medications. If you have hypothyroidism, thyroid hormone replacement with levothyroxine (Levoxyl, Synthroid, Tirosint) will resolve the symptoms of hypothyroidism as well as slow the release of thyroid-stimulating hormone from your pituitary gland, often decreasing the size of the goiter.

      For inflammation of your thyroid gland, your doctor may suggest aspirin or a corticosteroid medication to treat the inflammation. If you have a goiter that is associated with hyperthyroidism, you may need medications to normalize hormone levels.

    • Surgery. Removing all or part of your thyroid gland (total or partial thyroidectomy) is an option if you have a large goiter that is uncomfortable or causes difficulty breathing or swallowing, or in some cases, if you have a nodular goiter causing hyperthyroidism.

      Surgery is also the treatment for thyroid cancer.

      You may need to take levothyroxine after surgery, depending on the amount of thyroid removed.

    • Radioactive iodine. In some cases, radioactive iodine is used to treat an overactive thyroid gland. The radioactive iodine is taken orally and reaches your thyroid gland through your bloodstream, destroying thyroid cells. The treatment results in a diminished size of the goiter, but eventually may also cause an underactive thyroid gland.

    Possible complication with Goitre

    Surgery to remove some or all of the thyroid gland is usually safe, but as with all operations, there's a risk of complications.

    The risk of complications happening after thyroid gland surgery is estimated to be 1 to 2 in 100.

    Before having the surgery, discuss the risks with your surgeon.

    Infection, nerve damage and parathyroid gland damage are the main complications of thyroid gland surgery.

    Infection

    As with all surgery, there's a risk of infection after thyroid surgery.

    Nerve damage

    The thyroid gland is very close to the laryngeal nerves, which control your vocal cords.

    If these are accidentally damaged during surgery, your voice and breathing could be affected.

    Permanent damage to the laryngeal nerves affects 1 to 2 people in every 100 who have this type of surgery.

    Temporary damage may affect up to 5 people in every 100.

    Parathyroid gland damage

    The parathyroid glands are tiny glands behind the thyroid. They help regulate the amount of calcium in your body.

    If the parathyroid glands are damaged during thyroid surgery, you'll probably need to take calcium supplements for the rest of your life.

    References:

    1 https://www.healthline.com/health/goiter-simple 2 https://my.clevelandclinic.org/health/diseases/12625-goiter 3 https://www.healthhub.sg/a-z/diseases-and-conditions/40/Goitre 4 https://www.medicalnewstoday.com/articles/167559 5 https://www.nhs.uk/conditions/goitre/ 6 https://patient.info/hormones/overactive-thyroid-gland-hyperthyroidism/goitre-thyroid-swelling 7 https://www.webmd.com/women/understanding-goiter-basics 8 https://www.yourhormones.info/endocrine-conditions/goitre/

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