Overview
Goiter is a goiter caused by various reasons mostly without obvious symptoms, can also be manifested as hoarseness, difficulty swallowing, fear of heat, fatigue, neck pain, etc. Puberty, pregnancy, lactation may appear physiological enlargement, this disease can also be caused by hyperthyroidism, iodine deficiency, etc. The treatment of the disease is mainly medication, surgery and so on.
Definition
Goiter is a disease in which the thyroid gland increases in size and mass due to benign hyperplasia of the thyroid epithelial cells.
Due to different causes, the thyroid gland may be diffusely or nodularly enlarged, and the secretion of thyroid hormones may be normal, decreased or increased. Clinical manifestations vary with the function of the thyroid gland, as well as with the size and location of the enlarged thyroid gland.
Classification
Classification according to thyroid function
Non-toxic goiter: also known as simple goiter, with normal thyroid function.
Toxic goiter: refers to goiter with thyrotoxicosis.
Classification according to epidemiologic features
Endemic goiter: The prevalence of simple goiter in children in a region exceeding 5% is called endemic goiter.
Sporadic goiter: It occurs during puberty, pregnancy, lactation, and menopause, and is usually due to a temporary increase in thyroxine requirements.
Classification according to the morphology of the goiter
Diffuse goiter: diffuse enlargement of the thyroid gland.
Nodular goiter: enlargement of the thyroid gland with nodule formation.
Morbidity
Goiter is predominantly sporadic, its prevalence increases with age, and sporadic goiter is three to five times more common in women than in men [1].
Etiology
Causes
There are many causes of goiter, the main ones being the following.
Iodine deficiency
Iodine deficiency is the main factor causing endemic goiter. Mountainous and highland areas are far away from the sea and the iodine content in the soil is low, so the drinking water and food in these areas often lack sufficient iodine content.
Iodine is the raw material for the synthesis of thyroid hormones. When iodine is deficient, thyroid tissue undergoes compensatory hyperplasia, resulting in goiter.
Substances that may cause goiter
Common foods such as cabbage and cassava can release thiocyanate which can inhibit the enzyme thyroid peroxidase and cause goiter.
Drugs such as potassium thiocyanate, potassium perchlorate, p-aminosalicylic acid, sulfonamides, pau d’arco, colchicine, lithium, etc., can inhibit the concentration of iodide ions or organicization, and a large amount of iodide can inhibit the synthesis and release of thyroid hormones, thus causing goiter.
High iodine
Less common than low iodine, long-term consumption of water containing high iodine and long-term use of iodine-containing drugs may also cause goiter.
Genetic mutation
These include genetic abnormalities involving proteins involved in thyroid hormone synthesis, such as thyroglobulin, sodium/iodine co-transporter, and mutations in the thyroid peroxidase gene.
Certain thyroid disorders
such as autoimmune thyroiditis, Graves’ disease, and thyroid adenomas, can also lead to goiter.
Increased demand for thyroid hormones by the body
Sporadic goiter is most common during puberty, pregnancy, lactation and menopause, and is mostly due to a temporary increase in the body’s need for thyroid hormones during these specific periods.
Symptoms
Most goiters are slow-growing, so most patients have no obvious symptoms and are often detected during a physical examination.
Compression symptoms
When a goiter severely compresses the surrounding tissues, it may show signs and symptoms.
When the trachea is compressed, symptoms such as coughing, shortness of breath, inspiratory wheezing, etc. may occur, which may lead to tracheal deviation and narrowing.
When the esophagus is compressed, dysphagia may occur.
When the recurrent laryngeal nerve is compressed, hoarseness may be manifested.
Post-thoracic goiter may cause obstruction of venous return in the head, neck and upper limbs, and fainting and other manifestations may occur.
Symptoms of thyroid dysfunction
When accompanied by hyperthyroidism, there may be fear of heat, excessive sweating, irritability, tachycardia, menstrual disorders and other manifestations.
When accompanied by hypothyroidism, there may be chills, fatigue, weight gain and so on.
Other symptoms
When there is bleeding within the thyroid nodule, it can cause pain and enlargement of the thyroid gland.
In areas of severe endemic goiter, children with cretinism may present with significant mental retardation, motor dysfunction and severe goiter.
Medical Treatment
Department of Medicine
Endocrinology
If physical examination reveals goiter, abnormal thyroid function, or fever, excessive sweating, chills, or fatigue, it is recommended to consult a doctor promptly.
General Surgery
If a physical examination reveals an enlarged thyroid gland and coughing, hoarseness, difficulty in swallowing, etc., it is recommended to consult a doctor promptly.
Thyroid Surgery
If you experience any of the above symptoms, you may also seek medical attention at the Thyroid Surgery Department.
Preparation
How to get to the doctor: registration, preparation of documents, FAQs
Tips for the doctor
To make it easier for the doctor to examine you, try not to wear high-collared clothing or necklaces.
Preparation Checklist
Symptom list
Pay particular attention to the time of onset of symptoms, special manifestations, etc.
Is there swelling and pain in the front of the neck?
Is there fear of heat, excessive sweating, irritability?
Are there any chills, fatigue, loss of appetite?
Any cough, difficulty in swallowing, hoarseness, fainting, etc.?
When did the above symptoms appear?
List of medical history
Is there any history of autoimmune thyroiditis, Graves’ disease, thyroid adenoma, etc.?
Have you lived in an iodine-deficient area for a long time?
Any long-term use of iodine-containing medications, such as amiodarone?
Any history of food or drug allergy?
Checklist
Test results in the past 6 months, which can be brought to the doctor’s office
Laboratory tests: thyroid function, thyroid autoantibodies, etc.
Imaging tests: thyroid ultrasound, CT, etc.
Diagnosis
Diagnosis is based on
Medical history
Patients with goiter may have a history of the following conditions.
History of autoimmune thyroiditis, Graves’ disease, thyroid adenoma, etc.
Have lived in an iodine-deficient area for a long time.
History of long-term use of iodine-containing drugs such as amiodarone.
Clinical manifestations
Most patients have no obvious symptoms.
If the goiter compresses the trachea, cough, shortness of breath, inspiratory wheezing, tracheal deviation, narrowing, etc.; compression of the esophagus may cause dysphagia; compression of the recurrent laryngeal nerve may show hoarseness.
When accompanied by hyperthyroidism, there may be fear of heat, excessive sweating, irritability, tachycardia and other manifestations.
When accompanied by hypothyroidism, there may be chills, fatigue, weight gain.
Laboratory Tests
Thyroid function tests
Thyroid function is determined based on the levels of thyrotropin (TSH), free thyroxine (FT₄), free triiodothyronine (FT₃), and serum free thyroid hormone.
In combined hyperthyroidism, there may be a decrease in TSH and an increase in FT₄ and FT₃.
In combination with hypothyroidism, there may be an increase in TSH and a decrease in FT₄ and FT₃.
Thyroid Antibody Tests
Thyroid peroxidase antibody measurement helps to clarify the presence of autoimmune thyroiditis.
TR-Ab measurement helps to clarify the presence of Graves’ disease.
Imaging
Ultrasound of the thyroid gland
Thyroid ultrasonography can observe the size of the thyroid gland and the presence or absence of thyroid nodules, as well as the specific features of the nodules, including: size, number, borders, shape, echogenicity, presence or absence of calcification, and blood flow.
Iodine 131 Nuclear Scan
It can be used to assess the functional status of the thyroid gland, and can also clarify whether the upper mediastinal mass is thyroid tissue.
CT, MRI
It is mainly used to clarify the relationship between goiter and adjacent tissues, and the continuation of retrosternal goiter.
Precautions: Metal objects such as necklaces and earrings should be removed during the MRI examination.
Barium esophagography
It can clarify the degree of esophageal compression.
Differential diagnosis
Anterior cervical fat
Anterior cervical fat is located in front of the thyroid gland in the neck, which is soft and does not move up and down with swallowing; ultrasonography can clarify the diagnosis.
Parathyroid adenoma
Parathyroid adenoma is located after the thyroid gland. Parathyroid adenoma is usually small and not easy to detect, but sometimes it can be large and make the thyroid gland protruding, and it can also move with swallowing during the examination, and it can be differentiated according to the clinical manifestations and the parathyroid nuclear scan.
Treatment
The aim of treatment is to reduce the size of the thyroid gland, relieve the symptoms of compression and ensure normal thyroid function.
Mild asymptomatic goiter can be left untreated for the time being, with close observation of clinical symptoms and regular follow-up.
For those with obvious goiter with compression symptoms, drug and surgical treatment can be adopted according to the specific situation.
General treatment
Patients with simple iodine deficiency can be treated with iodine supplementation, and the thyroid gland can be retracted to different degrees after supplementation.
Drug treatment
Thyroid hormone
Thyroid hormone can be applied to patients with obvious goiter and higher than normal thyrotropin.
The commonly used drug is levothyroxine sodium.
The dosage should be adjusted under medical supervision and thyroid function should be monitored during treatment.
If the individual’s tolerated dose is exceeded or an overdose is taken, adverse effects such as arrhythmia, headache, muscle weakness, insomnia and excessive sweating may occur.
Antithyroid drugs
For patients with combined hyperthyroidism, antithyroid medications, such as imidazoles and thiouracils, including methimazole and propylthiouracil, may be applied.
The application of antithyroid drugs can reduce the synthesis of thyroid hormones and relieve the symptoms of hyperthyroidism.
Surgical treatment
It is necessary to choose the appropriate surgical methods under the guidance of the doctor, including sub-total thyroidectomy, total thyroidectomy, and so on.
Iodine 131 Treatment
Iodine 131 treatment utilizes beta rays released when iodine 131 is ingested by the thyroid gland to destroy thyroid tissue cells, but may cause hypothyroidism.
Prognosis
Cure
Most cases of simple goiter have a favorable prognosis, while a few cases may develop into nodular goiter and abnormal thyroid function.
Dangers
If goiter is obvious, it may cause symptoms such as neck enlargement, difficulty in swallowing and breathlessness, which may affect the appearance and life.
Daily
Daily management
People with iodine deficiency can supplement iodine-rich foods such as kelp, seaweed and nori, and use iodized salt in cooking.
Avoid excessive consumption of foods that inhibit thyroid hormone synthesis such as cabbage and cassava for a short period of time.
Eat a reasonable diet and limit the use of foods high in cholesterol, such as cream, animal brains and offal.
Adopt good living habits, regular work and rest, and avoid exertion.
Exercise moderately to maintain good health.
Dress in loose-fitting clothes and avoid clothes with too tight a collar.
Keep a good mindset and avoid bad emotions such as fear and anxiety.
Prevention
For goiter caused by iodine deficiency, iodine supplementation is the main measure to prevent and treat the disease.
Since increased urinary iodine excretion and increased iodine demand by the fetal thyroid gland in pregnant and lactating women may lead to a relative deficiency of maternal thyroid hormones, it is recommended that pregnant and lactating women have an iodine intake of 250 μg per day, i.e., eat iodine-rich seafood frequently on top of iodized salt.
For patients with abnormal thyroid function, the specific iodine intake needs to be clarified under the guidance of a doctor.
Try to avoid foods and drugs that can cause goiter, such as cassava and potassium perchlorate.