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Goitre

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Goitre

Synonyms Goiter

Diffuse hyperplasia of the thyroid

Specialty Endocrinology

[edit on Wikidata]

A goitre or goiter is a swelling in the neck resulting from an enlarged thyroid gland.[1] The term is also used to
describe an enlarged thyroid.[2] A goitre is associated with a thyroid that is not functioning properly.

Worldwide, over 90% of goitre cases are caused by iodine deficiency.[3] The term is from the Latin gutteria.
Most goitres are of a benign nature.

Contents
[hide]

1 Signs and symptoms


2 Morphology
3 Causes
4 Treatment
5 Epidemiology
6 History
7 Society and culture
o 7.1 Notable cases
8 Heraldry
9 See also
10 References
11 External links

Signs and symptoms[edit]


A goitre, associated with hypothyroidism or hyperthyroidism, may be present with symptoms of the underlying
disorder. For hyperthyroidism, the most common symptoms are associated with adrenergic stimulation:
tachycardia, palpitations, nervousness, tremor, increased blood pressure and heat intolerance. Clinical
manifestations are often related to hypermetabolism, (increased metabolism), excessive thyroid hormone, an
increase in oxygen consumption, metabolic changes in protein metabolism, immunologic stimulation of diffuse
goitre, and ocular changes (exophthalmos).[4] Hypothyroid individuals may have weight gain despite poor
appetite, cold intolerance, constipation and lethargy. However, these symptoms are often non-specific and make
diagnosis difficult.

Morphology[edit]
Regarding morphology, goitres may be classified either as the growth pattern or as the size of the growth[citation
needed]
:

Growth pattern

Uninodular goitre: one thyroid nodule; can be either an inactive or a toxic nodule.
Multinodular goitre: multiple nodules;[5] can likewise be inactive or toxic, the latter is called toxic
multinodular goitre and associated with hyperthyroidism; thyroid cancer is identified in 13.7% of the
patients operated for multinodular goitre. These nodules grow up at varying rates and secrete thyroid
hormone autonomously, thereby suppressing TSH-dependent growth and function in the rest of gland.[6]
Diffuse goitre: the whole thyroid appearing to be enlarged due to hyperplasia.

Size

Class I (palpation goitre): in normal posture of the head, it cannot be seen; it is only found by palpation.
Class II: the goitre is palpable and can be easily seen.
Class III: the goitre is very large and is retrosternal; pressure results in compression marks.

Goitre (Class II)

Goitre with autonomous adenoma


Goitre Class III

Goitre Class III

Causes[edit]
Worldwide, the most common cause for goitre is iodine deficiency, usually seen in countries that do not use
iodized salt. Selenium deficiency is also considered a contributing factor. In countries that use iodized salt,
Hashimoto's thyroiditis is the most common cause.[7] Goitre can also result from cyanide poisoning; this is
particularly common in tropical countries where people eat the cyanide-rich cassava root as the staple food.[8]

Incidence
Resultant Growth
Cause Pathophysiology Treatment and Prognosis
thyroid activity pattern
prevalence
Increased size
Constitutes
Hyperplasia of of thyroid may
over 90%
Iodine thyroid to Can cause be permanent if
Diffuse Iodine cases of
deficiency compensate for hypothyroidism untreated for
goitre
decreased efficacy around five
worldwide[3]
years
Inborn errors of
Congenital
thyroid hormone Hypothyroidism
hypothyroidism
synthesis
Goitrogen
ingestion
Adverse drug
reactions
Autoimmune
disease in which
the thyroid gland is Diffuse Thyroid Prevalence:
Hashimoto's Remission with
gradually Hypothyroidism and hormone 1 to 1.5 in a
thyroiditis treatment
destroyed. lobulated[9] replacement 1000
Infiltration of
lymphocytes.
Hypersecretion of Pituitary
Pituitary disease Diffuse Very rare[10]
thyroid stimulating surgery
Incidence
Resultant Growth
Cause Pathophysiology Treatment and Prognosis
thyroid activity pattern
prevalence
hormone, almost
always by a
pituitary
adenoma[10]
Remission with
treatment, but
still lower
quality of life
for 14 to 21
Graves' Autoantibodies Antithyroid 1 to 2 cases
years after
diseasealso (TSHR-Ab) that agents, per 1,000
Hyperthyroidism Diffuse treatment, with
called Basedow activate the TSH- radioiodine, population
lower mood
syndrome receptor (TSHR) surgery per year
and lower
vitality,
regardless of
the choice of
treatment[11]
Can be
hyperthyroidism
Acute or chronic
Thyroiditis initially, but
inflammation
progress to
hypothyroidism
Overall relative
5-year survival
Usually rate of 85% for
Thyroid cancer
uninodular females and
74% for
males[12]
Benign thyroid Usually Usually Mostly
neoplasms hyperthyroidism uninodular harmless
Secretional
Thyroid
hyperthyroidism,
hormone Diffuse
Symptomatic
insensitivity
hypothyroidism

Sarcoidosis
Amyloidosis
Hydatidiform mole
Cysts
Acromegaly
Pendred syndrome

Treatment[edit]
Goitre is treated according to the cause. If the thyroid gland is producing too much T3 and T4, radioactive
iodine is given to the patient to shrink the gland. If goitre is caused by iodine deficiency, small doses of iodide
in the form of Lugol's Iodine or KI solution are given. If the goitre is associated with an underactive thyroid,
thyroid supplements are used as treatment. In extreme cases, a partial or complete thyroidectomy is required.[13]

Epidemiology[edit]
Disability-adjusted life year for iodine deficiency per 100,000 inhabitants in 2002.[14]
no data
fewer than 50
50100
100150
150200
200250
250300
300350
350400
400450
450500
500800
more than 800

Goitre is more common among women, but this includes the many types of goitre caused by autoimmune
problems, and not only those caused by simple lack of iodine.

History[edit]

Goitre and cretinism in Styria, copper engraving, 1815

Women in Miesbacher Tracht, including a goitre choker

Chinese physicians of the Tang Dynasty (618907) were the first to successfully treat patients with goitre by
using the iodine-rich thyroid gland of animals such as sheep and pigsin raw, pill, or powdered form.[15] This
was outlined in Zhen Quan's (d. 643 AD) book, as well as several others.[16] One Chinese book, The
Pharmacopoeia of the Heavenly Husbandman, asserted that iodine-rich sargassum was used to treat goitre
patients by the 1st century BC, but this book was written much later.[17]

In the 12th century, Zayn al-Din al-Jurjani, a Persian physician, provided the first description of Graves' disease
after noting the association of goitre and a displacement of the eye known as exophthalmos in his Thesaurus of
the Shah of Khwarazm, the major medical dictionary of its time.[18][19] Al-Jurjani also established an association
between goitre and palpitation.[20] The disease was later named after Irish doctor Robert James Graves, who
described a case of goitre with exophthalmos in 1835. The German Karl Adolph von Basedow also
independently reported the same constellation of symptoms in 1840, while earlier reports of the disease were
also published by the Italians Giuseppe Flajani and Antonio Giuseppe Testa, in 1802 and 1810 respectively,[21]
and by the English physician Caleb Hillier Parry (a friend of Edward Jenner) in the late 18th century.[22]

Paracelsus (14931541) was the first person to propose a relationship between goitre and minerals (particularly
lead) in drinking water.[23] Iodine was later discovered by Bernard Courtois in 1811 from seaweed ash.

Goitre was previously common in many areas that were deficient in iodine in the soil. For example, in the
English Midlands, the condition was known as Derbyshire Neck. In the United States, goitre was found in the
Great Lakes, Midwest, and Intermountain regions. The condition now is practically absent in affluent nations,
where table salt is supplemented with iodine. However, it is still prevalent in India, China,[24] Central Asia, and
Central Africa.

Goitre had been prevalent in the alpine countries for a long time. Switzerland reduced the condition by
introducing iodised salt in 1922. The Bavarian tracht in the Miesbach and Salzburg regions, which appeared in
the 19th century, includes a choker, dubbed Kropfband (struma band) which was used to hide either the goitre
or the remnants of goitre surgery.[25]

Society and culture[edit]


In the 1920s wearing bottles of iodine around the neck was believed to prevent goitre.[26]

Notable cases[edit]

Former US President George H. W. Bush and his wife Barbara Bush were both diagnosed with Graves'
disease and goitres, within two years of each other. The disease caused hyperthyroidism and cardiac
dysrhythmia.[27][28] Scientists said that the odds of both George and Barbara Bush having Graves' disease
might be 1 in 100,000 or as low as 1 in 3,000,000.[29]
Andrea True (according to an interview on VH1).[30]

Heraldry[edit]
The coat of arms and crest of Die Krpfner, of Tyrol showed a man "afflicted with a large goitre", an apparent
pun on the German for the word ("Kropf").[31]