GOITRE (ENLARGED THYROID GLAND): CLASSES, CAUSES, SIGNS AND SYMPTOMS AND TREATMENT

OVERVIEW

Goitre is a swelling in the neck resulting from an enlarged thyroid gland. Causes of goitre include: Hyperthyroidism, hypothyroidism, lack of/insufficient iodine in the diet, autoimmune disorders such as Grave's disease, goitrogenic foods, inflammation of the thyroid gland, thyroid cancer, radiation, etc. Goitres can be so large that they press on the windpipe, hindering breathing and even swallowing of food. Treatment of goitre include: treating underlying medical conditions, administering radioactive iodine and iodine supplements, and surgery

Goitre

The thyroid gland is a butterfly shaped gland located at the base of the front of the neck and lies in front of the windpipe (trachea). It secrets 2 major hormones, namely: Thyroxine (T4) and Triiodothyronine (T3) which helps in the normal functioning of the body.

It is this gland that becomes enlarged to form a diseased state called Goiter. This enlargement can be so much that it presses on the windpipe, hindering breathing and swallowing of food, thereby causing choking and sometimes cough

Thyroid gland

Morphologically (i.e. as seen normally), goiters can be classified based on the size of the growth. The classification is as follows: 

• Class I: This kind of goiter can not be seen, but it is there! It can only be found when the neck is felt. 

• Class II: Here, the goiter is small but can be seen easily

• Class III: In this type, the goiter is very large, and when pressed with the fingers, compression marks can be seen

Goitre formation

CAUSES

The various causes of goiter include:

• Hyperthyroidism: An over-active thyroid gland 

• Hypothyroidism: An under-active thyroid gland 

• Lack of/Insufficient iodine in the diet: This is the most common cause of goiter worldwide 

• Autoimmune diseases: In autoimmune disorders, the body produces an antibody that damages a different     part of the body-in this case, the thyroid gland. An autoimmune disease which can cause goiter is Grave’s disease 

• Medication: Certain medications can predispose one to goiter. Examples are anti-retrovirals, immunosuppressants, lithium, amiodarone, etc. 

• Goitrogenic foods: These are foods that, if consumed in excess, can suppress the function of the thyroid gland. They include spinach, peanuts, soybeans, tofu, etc.

• Thyroiditis: Inflammation of the thyroid gland can also make it enlarge 

• Hereditary: Some people may inherit a tendency for the thyroid gland to swell 

• Thyroid cancer: When there are cancerous growth in the thyroid gland, goiter may result

• Pregnancy and menopause

• Radiation to the chest and neck region 

SIGNS AND SYMPTOMS

Although goitre primarily manifests as swelling of the neck, other signs are symptoms it may present include:

• Hoarseness of voice
• Coughing more frequently than usual
• A feeling of tightness in the throat
• Swallowing difficulties (less common)
• Breathing difficulties (less common)

TREATMENT

Treatment of goiter depends on various factors such as: the size and working condition of the thyroid gland, severity of the signs and symptoms and the presence of underlying conditions. Treatment procedures are as follows:

1. Observation: If the goiter is small, doesn’t cause problems, and your thyroid gland is functioning properly, a wait-and-see approach may be suggested by your doctor. If your thyroid gland is inflamed, aspirin or a corticosteroid medication may be administered to treat the inflammation 

2. Treating underlying medical conditions:

• Hypothyroidism: If the underlying condition is an underactive thyroid gland,  the synthetic hormone Levothyroxine (Levothroid, synthroid) will be administered to make up for the shortfall. The hormone is administered orally in the form of pills which is swallowed once a day. Possible side-effects of this hormone therapy are muscle cramps, irregular heartbeat, pain in the chest.

• Hyperthyroidism: If the underlying condition is an overactive thyroid gland, Thionamides will be administered. This will help reduce the amount of thyroid hormones being produced by the gland. This medication is also taken orally. Side effects (though may be noticed after several weeks) may include: mild skin rash, itchy skin, nausea, joint pain, and agranulocytosis (this is usually very rare). Treatments with thionamides usually lasts from 2 to 4months

3. Use of radioactive iodine: In some cases, radioactive iodine is used to treat an overactive thyroid gland. The radioactive iodine is taken orally and reaches the thyroid gland through the bloodstream. It then destroys thyroid cells, resulting in a smaller thyroid gland. An underactive thyroid gland is usually the outcome and the person will then need to be given hormone therapy (Levothyroxine)

4. Iodine supplements: If iodine deficiency is the cause of the goiter, the person will have to be administered with iodine supplements. The person will also need to be fed with iodine-containing foods such as seafoods.

5. Surgery: This is usually the last resort if the goiter is so large that the person has difficulty with breathing or swallowing and other treatments have not worked. A large chunk of the gland (sometimes even half of it) will be removed so as to relieve symptoms and at the same time, retain its functional integrity. Most times, hormone therapy will be needed after the surgical process 

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