Goitre is characterized by enlargement of the thyroid gland, which causes swelling of the neck. Known as gladanda in Ayurveda, it usually occurs due to a deficiency of iodine in the body. However, it can also be caused due to various reasons such as an overactive or underactive thyroid gland, deficiency of iodine and thyroid cancer. In some cases, the swelling of the gland is quite noticeable and becomes quite large after a certain period of time. Although it can be diagnosed with thyroid function tests, people affected by goitre face difficulty in breathing, swallowing food or even drinking a glass of water.
Types
Goitre can be classified into the following types, namely:
- Diffused goitre: In this case, the entire thyroid gland swells and feels smooth when touched.
- Nodular goitre: It results in small lumps or nodules in the thyroid gland due to fluid build-up. These can be present in the form of single or multiple nodules.
- Congenital goitre: This type of goitre occurs in children while they are born or later in life. Congenital goitre is caused by genetic disease which does not lead to the formation of thyroid hormone, thyroid problems in the mother during pregnancy, medications consumed by the mother that affect the baby’s thyroid, or when a baby is born without half of the thyroid gland.
Symptoms
The patient suffering from goitre should look out for symptoms like swelling of the thyroid gland, which leads to the formation of a lump on the neck. The lump on the front of the neck will move even as you swallow food or water. Goitre develops very slowly; hence it may take months or years to start showing symptoms. Apart from this, other symptoms associated with this disease are:
- Coughing
- A tightness in the throat, causing difficulty in swallowing (dysphagia)
- Feeling that the food is stuck in the throat, especially when the patient is lying down.
- Hoarseness in the voice, which could also cause irritation
- Swelling of the neck vein
- Dizziness, especially when an individual raises arms above the head
Some of the less common symptoms of goitre include:
- A high-pitched noise may form while breathing
- Difficulty in inhaling and exhaling
- Coughing
- Difficulty in swallowing food
- Wheezing
Patients with goitre as well as hyperthyroidism or hypothyroidism can show additional symptoms like:
- Increased pulse rate
- Rapid heartbeat
- Sweating without any physical activity.
- Shaking
- Agitation
- Diarrhoea
- Nausea
- Vomiting
- Dry skin
- Weight gain
- Irregular menstrual cycle
- Tiredness
Causes And Risk Factors
Causes
Although various factors can cause, the exact cause of the condition cannot be identified in some cases. Here are some of the common causes of goitre:
- Iodine deficiency: It is a critical factor in enhancing the risk of goitre. Since iodine is essential for producing thyroid hormones by the gland, lack of this mineral in the body leads to underproduction of these hormones leading to goitre.
- Hyperthyroidism: An overactive thyroid gland causes excessive thyroid hormones, which leads to swelling of the gland.
- Hypothyroidism: Goitre can develop due to under activity of the thyroid gland, which causes swelling of the gland due to decreased production of hormones by the gland.
- Smoking: The presence of thiocyanate, a chemical present in tobacco smoke, interferes with the utilization of iodine in the body, thereby causing goitre.
- Hormonal imbalance: Hormonal changes that occur during pregnancy, menopause and puberty, affect the functioning of the thyroid gland leading to goitre.
- Inflammation of thyroid gland: In some cases, inflammation of the thyroid gland caused due to certain medications and bacterial or viral infections cause goitre.
- Thyroid cancer: Thyroid cancer, in rare cases, causes swelling of the gland, which results in goitre.
- Certain drugs like lithium and amiodarone used to treat medical conditions can cause sporadic goitre.
Risk Factors
Factors that increase a person's risk for goitre are:
- Family history of goitre.
- Women
- Individuals born and raised with an iodine-deficient diet.
- Individuals above 40 years.
- Eating very high amounts of soy, peanuts, or broccoli.
Several diseases that may develop goitre later in patients are:
- Hashimoto’s thyroiditis: A condition where the body’s immune system damages the thyroid gland leading to less thyroid hormone production.
- Grave’s disease: In this condition, the immune system attacks the thyroid gland, causing it to increase thyroid production.
- Colloid goitre: Abnormal growth of thyroid during puberty.
- Viral or bacterial infections: These cause inflammation and increase the thyroid gland’s size, leading to a painful goitre.
Diagnosis
If you feel a lump on your neck, you need to consult a doctor to know its exact cause immediately. To confirm the condition, your doctor will conduct a physical exam and ask you to swallow to feel swelling or lump in the thyroid area. The doctor may identify any swelling in the thyroid gland by probing the neck area for signs of tenderness. If you have a slightly larger goitre than normal, you may experience swelling in a particular vein of the neck. This may cause a certain degree of dizziness, especially when the doctor asks you to lift your arm above your head.
The doctor may also ask you to take a few blood tests to understand the functioning of the thyroid gland. These include:
- Free thyroxine test
- Thyroid-stimulating hormone (TSH) test
- A blood test to identify antibodies which are produced in the goitre.
- You may also be asked to undergo other tests such as a thyroid scan or thyroid ultrasound to rule out the possibility of any abnormalities or cancerous areas in the thyroid gland. If a lump is found in the ultrasound, you will be asked to undergo a biopsy to check if you have thyroid cancer.
- Ultrasound test to determine the size of thyroid gland and nodules.
- If the goitre increases in size and spreads to the chest, the doctor may perform a CT scan or MRI.
Treatment
Treatment for goitre depends on the size and the spread of goitre. If the goitre size is small and is not affecting the patient’s life, the doctor may not prescribe any treatment. But the goitre will be closely monitored for any changes. There are several options for treating goitre. Here are the common ones that are safe as well as effective.
- Radioactive iodine: The main goal of this treatment option is to reduce the size of the enlarged thyroid gland to its actual size. In this, radioactive iodine is administered orally. This approach is particularly effective if the goitre is caused due to excessive production of the thyroid hormone due to enlargement of the gland. Patients, after this treatment, need to take synthetic thyroid hormone for their whole life.
- Medications: Drugs such as levothyroxine act as a replacement of the thyroid hormone and thus, aid in the treatment. Levothyroxine is prescribed to the patient when hypothyroidism is the cause of goitre. This treatment would restore thyroid levels in the body and decrease the goitre size but does not completely treat this condition. If the cause of goitre is hyperthyroidism, then the patients are prescribed methimazole and propylthiouracil. However, anti-inflammatory medications such as aspirin and corticosteroids are recommended to treat inflammation of the thyroid gland. These drugs help in reducing the discomfort caused by the lump in the neck. Medications may not make the lump disappear, but they lessen the pain and swelling, thereby providing relief.
- Surgery: If a large-sized goitre is caused, then it can be removed through surgery. Large-sized goitre causes breathing and swallowing problems in patients. Surgery is also done to remove the nodules or if the patient has cancer. However, if the thyroid gland is removed completely, the patients will have to take synthetic thyroid hormones for the rest of their lives.
Prognosis And Complications
Prognosis
A goitre might disappear on its own or even get bigger. In a few cases, the goitre can become toxic and start producing thyroid hormones of its own. This increases the total level of thyroid hormone in the body leading to hyperthyroidism.
Complications
Radioactive iodine is one of the treatment options for goitre. Taking too much iodine can lead to toxic effects. Surgery performed to remove the goitre can lead to bacterial or viral infections, parathyroid gland damage, or nerve damage. The parathyroid gland regulates calcium levels. Damage to this organ leads to calcium supplementation for the rest of the patient’s lives. The thyroid gland is close to the nerves which control an individual’s vocal cords. Any temporary or permanent damage to this nerve can lead to problems with voice or breathing.
References
- Goiters and Thyroid Nodules. Nemours. Available at: https://kidshealth.org/en/parents/goiter.html.
- Goiter. Cleveland Clinic. Available at: https://my.clevelandclinic.org/health/diseases/12625-goiter.
- Simple goiter. MedlinePlus. Available at: https://medlineplus.gov/ency/article/001178.htm.
- Azizi F, et al. Primordial and primary preventions of thyroid disease. Int J Endocrinol Metab. 2017 Oct 7;15(4):e57871.
- Goiter. American Thyroid Association. Available at: https://www.thyroid.org/goiter/.
- Goitre. NHS. Available at: https://www.nhs.uk/conditions/goitre/treatment/.
More From Goitre
Every year 25 May is observed as World Thyroid Day globally to raise awareness and understanding about thyroid health. As we celebrate this day, we have made a small effort to make you understand the cause and risk factors of some thyroid related disorders. Take a look -
The most common symptoms of goitre are difficulty in swallowing, coughing, hoarseness, and breathing, and a visible swelling at the base of your neck. It can develop at any age.
An abnormal enlargement of your thyroid gland can be termed as goitre. If you wish to get rid of that unpleasant thyroid swelling then you should try these natural hacks.
World Thyroid Day 2018: Keep these points in mind if you suffer from hypothyroidism.
It has been estimated that about 42 million in the country today suffer from various forms of thyroid diseases.
Part of the endocrine system, the thyroid is critical to maintain everyday health.
Thyroid hormone is majorly responsible for regulating the metabolic rate in the body.
Women are 3-10 times more susceptible to thyroid disorders than men.
Thyroid gland secrets hormones such as T3 and T4, which are responsible for various metabolic activities in the body.
Goitre, cretinism, hypothyroidism and pregnancy complications. Click to know how lack of iodine can affect you!
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2.91 kg goitre removed from a 60-year-old woman at AIIMS
Difficulty in swallowing is not a disorder/disease as such, but consulting a doctor may help diagnose the underlying condition.
Every year 25 May is observed as World Thyroid Day globally to raise awareness and understanding about thyroid health. As we celebrate this day, we have made a small effort to make you understand the cause and risk factors of some thyroid related disorders. Take a look -
An abnormal enlargement of your thyroid gland can be termed as goitre. If you wish to get rid of that unpleasant thyroid swelling then you should try these natural hacks.
World Thyroid Day 2018: Keep these points in mind if you suffer from hypothyroidism.
It has been estimated that about 42 million in the country today suffer from various forms of thyroid diseases.
Part of the endocrine system, the thyroid is critical to maintain everyday health.
Thyroid hormone is majorly responsible for regulating the metabolic rate in the body.
Women are 3-10 times more susceptible to thyroid disorders than men.
Thyroid gland secrets hormones such as T3 and T4, which are responsible for various metabolic activities in the body.
Have you been checking the iodine content of your salt? If not, you should read this!
2.91 kg goitre removed from a 60-year-old woman at AIIMS
Difficulty in swallowing is not a disorder/disease as such, but consulting a doctor may help diagnose the underlying condition.
The most common symptoms of goitre are difficulty in swallowing, coughing, hoarseness, and breathing, and a visible swelling at the base of your neck. It can develop at any age.
Goitre, cretinism, hypothyroidism and pregnancy complications. Click to know how lack of iodine can affect you!
