An enlarged swelling, in the front of the neck is called goiter. This swelling occurs due to the thyroid gland which may be benign or due to irregular cell growth or formation of more nodules in the gland. According to experts like the Best Internal medicine Doctor in Karachi, this swelling can occur with or without changes in the thyroid hormones—T3 and T4. Read on to know more about goiter, its types, symptoms, causes, diagnosis and treatment options:
What are the types of goiter?
As mentioned before, goiter is a swelling of the thyroid gland in the front of the neck. Based on the etiology of goiter, they are subdivided into the following types:
- Simple goiters: if the thyroid gland is unable to produce more thyroid hormones, it enlarges in size due to stimulation from the prompting hormone from the pituitary gland called thyroid stimulating hormone (TSH). The thyroid gland thus swells to make more thyroid hormone.
- Non-toxic/sporadic goiter: this type of goiter occurs secondary to medication and drugs and has no other cause.
- Endemic goiter: lack of iodine in the diet triggers thyroid gland to enlarge as well. Thyroid gland uses iodine to make thyroid hormones and a lack thereof can cause enlargement of the gland. This is called endemic goiter and is common in regions where iodine is not added to table salts.
- Multinodular goiter: when multiple small nodules or lumps grow in the thyroid, it’s called multinodular goiter.
- Toxic goiter: this is when the thyroid gland is enlarged and also produces a lot of thyroid hormone.
What are the symptoms of goiter?
Goiter in the neck can cause local symptoms such as:
- Throat tightness
- Difficulty in breathing
- Hoarseness of voice
- Pain or difficulty in swallowing as the large swelling presses on the esophagus
What are the causes of goiter formation?
The causes of goiter include:
- Iodine deficiency: as mentioned before, iodine is essential for the production of hormones in the thyroid. Deficiency of iodine results not only in decreased hormone production but also enlargement of the thyroid. Iodine deficiency is commonly seen in mountainous regions of developing countries, where table salt is not fortified with iodine.
- Inflammation: autoimmune disorder (whereby body’s own immune system attacks the thyroid gland), medication, certain viral and bacterial infections can cause inflammatory changes in the thyroid, causing goiter to form.
- Graves’ disease: in this disorder, there are antibodies formed by the immune system that stimulate the thyroid to produce more thyroid hormones, and cause the thyroid to enlarge. Graves’ also causes hyperthyroidism.
- Hashimoto’s thyroiditis: in this autoimmune disorder, an infection triggers the attack on the thyroid gland, causing hypothyroidism and goiter.
- Thyroid cancer: uncontrolled growth of the thyroid as seen in cancer causing goiter formation.
- Pregnancy: hormonal changes in pregnancy, particularly the production of human chorionic gonadotropin (hCG) cause the thyroid to enlarge and be overactive.
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How is goiter diagnosed?
Diagnosis of goiter and its cause require a thorough physical examination and history taking following by investigations like:
- Blood test: to check whether the thyroid gland is under or over producing the thyroid hormones. Blood tests are also performed to check the levels of autoantibodies against thyroid gland.
- Thyroid ultrasound: to check the size of the goiter and the presence of nodules.
- Thyroid scan: in this investigation a radioactive dye is injected in the body, followed by its imaging on a computer. The dye is taken up by the thyroid gland, even if its present at multiple sites. This gives an idea to the healthcare provider about the size of the goiter and the presence of thyroid-hormone producing tissue.
- CT/MRI: if the goiter has spread to the chest, this imaging modality is used.
- Biopsy: is used to rule out cancer.
What are the treatment options?
Goiter is treated with medication, radioactive iodine given under the supervision of Best Internal medicine Doctor in rawalpindi, followed by surgery if the goiter is not responding to medication.