What is goiter disease?
In goiter disease, the thyroid gland enlarges abnormally. Most patients with goiter are painless, but symptoms may develop depending on the size of the goiter. The most common symptom of goiter is a lump in the neck. When you touch it, you can tell that it’s not greasy, it’s firm. Other symptoms of large goiter may include a lump in the throat, difficulty swallowing, difficulty breathing, and even in severe cases, voice changes and even paralysis of the vocal cords.
The most common cause of goiter is iodine deficiency, which is more common in areas where dietary iodine intake is low or absent. This problem is common all over the world. In the United States, this problem was very common before the use of iodine. But after taking iodine, the incidence of goiter in the United States has decreased dramatically.
Today, in the United States, goiters are caused by factors such as overproduction of thyroid hormone (hyperthyroidism), underproduction of thyroid hormone (hypothyroidism), or multiple masses in the thyroid gland itself (multiple goiters).
What are the symptoms of goiter?
Most goiters do not cause symptoms, but if the goiter becomes large enough, symptoms may appear. In fact, goiters that appear small are diagnosed by doctors by routine examination of the patient’s neck or by using various types of X-rays or scans. Symptoms develop when the goiter becomes large enough to put pressure on other structures in the neck.
Patients with a larger thyroid goiter usually experience the following symptoms:
- Lump or tumor in the neck
- Sensation of unpleasant pressure in the respiratory tube or trachea
- Feeling that something should be swallowed or difficulty in swallowing
- Excess production of thyroid hormone, thyroxine, which causes the following causes:
– Severe weight loss
– Sensation of sensitivity to heat
– Trembling
– anger
– Irregular or rapid heartbeat
What can cause goiter?
The following factors are the cause of goiter disease:
- Iodine deficiency:
Diets that have little iodine in them can cause goiter in people. In some regions of the world, there is still a lack of iodine in the diet, but in many countries, the addition of iodine in the diet has reduced this disease.
- Enlargement of normal thyroid tissue:
– The cause of thyroid goiter is not well known. These conditions are known as follicular hyperplasia (follicular cells of normal thyroid cells). Both follicular hyperplasia and follicular adenomas are not clearly cancerous and do not require surgery unless they cause symptoms due to their size.
- Thyroid cysts:
Thyroid cysts are fluid-filled cavities caused by degenerating thyroid adenomas, congenital cysts, or an overproduction of thyroid-produced fluid called keloid.
- Inflammatory thyroid diseases (thyroiditis)
Hashimoto’s thyroiditis is a chronic inflammatory condition of the thyroid gland caused by an autoimmune process of auto-antibodies that damage thyroglobulin (a natural protein produced by the thyroid gland). Hashimotothyroidism is usually associated with decreased production of thyroid hormone called hypothyroidism. It may also be accompanied by the formation of masses similar to thyroid masses. These masses are not the same as worrisome thyroid masses.
- Multiple thyroid disease (also called multiple goiter or just “goiter”)
Multiple goiter is a thyroid gland that contains several thyroid masses. The cause of multiple goiters is unknown, but in some cases there may be a strong genetic background in goiter patients. In patients with multiple goiters, the goiters can be very large and extend from the neck to the inside of the chest cavity.
- Thyroid cancer:
Although the likelihood of a thyroid mass being cancerous is very low, the following are associated with an increased risk of malignancy:
– Age less than 30 years
– Age more than 50 years
– It is seen more in men than women
– Strong hereditary background of thyroid cancer
– Strong hereditary background from other endocrine cancers
– Very large thyroid masses
– Dry voice
What are the treatments for thyroid goiter?
If the ultrasound with or without biopsy shows that the patient has a small and benign thyroid goiter and has little or no symptoms, the doctor may suggest that the patient be monitored for the goiter. The follow-up period with this condition is somewhat arbitrary and usually includes repeat thyroid blood tests, ultrasounds, and physical examinations every approximately one year. If the size of the thyroid goiter increases or other symptoms develop, other methods may be used. Small thyroid goiters that do not change over the years may never need any treatment.
Thyroid hormone therapy
If you have hypothyroidism, your doctor will prescribe thyroid hormone in pill or capsule form. There are different types of thyroid hormone pills that doctors may prescribe to treat low hormone levels. In fact, the administration of thyroid hormone can reduce the production of thyroid stimulating hormone (TSH) of the pituitary gland and thus reduce the growth of thyroid tissue. In many cases, when patients have hypothyroidism, their goiters are smaller than normal.
If you have hyperthyroidism, your doctor will likely prescribe medication to control the hyperthyroidism. There are two medications that are commonly prescribed to control hyperthyroidism. The first is methimizole and the second is prothiouracil (PTU). These drugs should be prescribed by endocrinologists who explain how these drugs work and the possible side effects and complications of their use. These drugs can be used to prepare patients for:
o Treatment with radioactive iodine
If you have an inflammatory goiter, your doctor may prescribe medications that treat the inflammation. Both aspirin, corticosteroids (steroids), and nonsteroidal anti-inflammatory drugs may be prescribed for thyroid goiter associated with autoimmune or other inflammatory causes.
It is used in conditions where thyroid goiter is associated with excessive production of thyroid hormone
It is consumed orally
RAI treatment often results in a decrease in goiter size
In the long term, it usually results in a lifelong need for thyroid hormone replacement
surgery:
If the following symptoms are present, surgery is a better option:
A large thyroid goiter (produces a visible mass in the neck)
Thyroid goiter causes symptoms on the breathing tube or swallowing tube
Thyroid goiter produces too much thyroid hormone
The presence of thyroid nodules that have indeterminate or suspicious FNAs for cancer.
Multi-nodular goiter causes symptoms
Thyroid goiter that has progressed or is still symptomatic after RAI treatment
How is goiter diagnosed?
Diagnosis of thyroid goiter is done with a complete ultrasound examination of the entire thyroid gland and neck lymph nodes. Ultrasound does not expose you to any radiation. Sound waves are used to look under the skin at important structures in your neck.
A needle biopsy is another ultrasound procedure that is used only if there is a mass in the thyroid goiter that is suspected to be malignant. The process of obtaining a small sample of cells is called fine-needle aspiration (FNA) cytology.
Ultrasound is used to see the thyroid gland and lymph nodes in the neck. During a biopsy, ultrasound helps them make sure they are getting FNA samples from the right areas.
FNA is generally performed on all thyroid nodules that are large enough. This means they are larger than about 1 cm (about 0.5 inches).
FNA biopsy of swollen or abnormal lymph nodes in the neck may be more accurate than the thyroid nodule itself.
Cells from the suspicious area are removed painlessly and examined under a microscope.
- This type of biopsy is usually performed in a doctor’s office or clinic.
- A local anesthetic (numbing medicine) may be injected into the skin over the thyroid nodule before the biopsy.
- Your doctor will insert a thin, hollow needle directly into any suspicious nodule in the thyroid goiter to remove some cells and possibly a few drops of fluid into the syringe.
- The doctor usually repeats this 2 or 3 more times and takes samples from several areas of the nodule.
- The contents of the needle and syringe are then placed on a glass slide, and the FNA samples are then sent to a laboratory, where they are examined under a microscope by a specialized cytologist to see if the cells look malignant, benign, or cancerous.
o Cytology means looking only at cells under a microscope.
o Thyroid cytology requires a specialist doctor (called a cytologist) who is specifically trained in the diagnosis of thyroid nodules and thyroid cancers!
o Unfortunately, the diagnosis of thyroid nodules is often misinterpreted by unskilled or inexperienced cytologists.
o Bleeding at the biopsy site is very rare except in people with bleeding disorders. Even when this happens, bleeding is almost always very limited. Be sure to tell your doctor if you have bleeding problems or are taking medications that can affect bleeding, such as aspirin or blood thinners.
o Sometimes the FNA biopsy needs to be repeated; Because the samples did not contain enough cells.
o Most FNA biopsies show that thyroid goiters are benign.
o Rarely, an FNA biopsy may be benign, even if a diagnosis of thyroid cancer is indeed present.
References
Goiter: What It Is, Causes, Symptoms, Diagnosis & Treatment (clevelandclinic.org)
Goiter: Causes, Types, and Treatment (healthline.com)
Goiter – Diagnosis & treatment – Mayo Clinic
https://www.thyroidcancer.com/thyroid-goiter
