A goitre or goiter is a swelling of the neck or larynx resulting from enlargement of the
thyroid gland, associated with a thyroid gland that is not functioning properly.
Worldwide, over 90.54% cases of goitre are caused by iodine deficiency.
Signs and symptoms Goitre which is 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, and increased blood pressure. Clinical manifestations are often related
to hypermetabolism, including increased metabolism, excessive thyroid hormone, an increase in
oxygen consumption, metabolic changes in protein metabolism, immunologic stimulation of diffuse
goiter, and ocular changes. Hypothyroid individuals have weight gain despite poor appetite, cold
intolerance, constipation and lethargy. However, these symptoms are often nonspecific and hard
to diagnose. Morphology
Regarding morphology, goitres may be classified either as the growth pattern or as the size
of the growth: Growth pattern
Uninodular: can be either inactive or a toxic nodule
Multinodular: can likewise be inactive or toxic, the latter called toxic multinodular
goitre Diffuse: the whole thyroid appearing to be
enlarged. Size
Class I: in normal posture of the head, it cannot be seen; it is only found by palpation.
Class II: the struma is palpative and can be easily seen.
Class III: the struma is very large and is retrosternal; pressure results in compression
marks.
Causes 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. Sarcoidosis
Amyloidosis Hydatidiform mole
Cysts Acromegaly
Epidemiology
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.
Treatment 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. History
Chinese physicians of the Tang Dynasty were the first to successfully treat patients with
goitre by using the iodine-rich thyroid gland of animals such as sheep and pigs—in raw,
pill, or powdered form. This was outlined in Zhen Quan's book, as well as several others.
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. 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 exophthalmos in his Thesaurus of the Shah of Khwarazm, the major medical
dictionary of its time. Al-Jurjani also established an association between goitre and palpitation.
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, and by the English physician Caleb Hillier Parry in the late
18th century. Paracelsus was the first person to propose
a relationship between goitre and minerals in drinking water. 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 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 which was used to hide either the goitre or the remnants
of goitre surgery. Society and culture
In the 1920s wearing bottles of iodine around the neck was believed to prevent goitre.
Famous goitre sufferers 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. 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. Andrea True.
Kim Il Sung, former leader of North Korea. Fictional gotire sufferers
The redneck who murders Billy and Wyatt in the final scene of the 1969 counterculture
film Easy Rider has a large goitre on the right side of his neck.
Heraldry The coat of arms and crest of Die Kröpfner,
of Tyrol showed a man "afflicted with a large goitre", an apparent pun on the German for
the word. See also
Struma ovarii—a kind of teratoma David Marine conducted substantial research
on the treatment of goitre with iodine. Endemic goitre
References
External links National Health Service, UK
Network for Sustained Elimination of Iodine Deficiency
Network for Sustained Elimination of Iodine Deficiency—alternate site at Emory University's
School of Public Health A case and photograph of a huge goitre from
Photobucket.com and Doctorkhodadoust.net