A goitre (British English), or goiter (American English), is a swelling in the neck resulting from an enlarged thyroid.
Worldwide, over 90% of goitre cases are caused by iodine deficiency.
Signs and symptoms
A goitre can present as a palpable or visible enlargement of the
Thyroid at the base of the neck. A goitre, if 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 (increased heart rate),
palpitations, ,
tremor,
Hypertension and
heat intolerance. Clinical manifestations are often related to
hypermetabolism (increased metabolism), excessive
Thyroid hormones, an increase in oxygen consumption, metabolic changes in protein metabolism, immunologic stimulation of diffuse goitre, and ocular changes (
exophthalmos).
Hypothyroid people commonly have poor appetite,
cold intolerance,
constipation,
lethargy and may undergo weight gain. However, these symptoms are often
non-specific and make diagnosis difficult.
According to the WHO classification of goitre by palpation, the severity of goitre is currently graded as grade 0, grade 1, grade 2.
File:Struma 001.jpg|Goitre Class II, WHO grade 2
File:Kone med stor struma.jpg|Goitre Class III, WHO grade 2
Causes
Worldwide, the most common cause for goitre is iodine deficiency, commonly seen in countries that scarcely 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.
Goitre can also result from cyanide poisoning, which is particularly common in tropical countries where people eat the cyanide-rich
cassava root as the staple food.
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| Increased size of thyroid may be permanent if untreated for around five years |
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| Remission with treatment |
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Remission with treatment, but still lower quality of life for 14 to 21 years after treatment, with lower mood and lower vitality, regardless of the choice of treatment |
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Overall relative 5-year survival rate of 85% for females and 74% for males[Numbers from EUROCARE, from Page 10 in: ] |
Mostly harmless |
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Diagnosis
Goitre may be diagnosed via a thyroid function test in an individual suspected of having it.
Types
A goitre may be classified either as nodular or diffuse. Nodular goitres are either of one nodule (uninodular) or of multiple nodules (multinodular).
Multinodular goiter (MNG) is the most common disorder of the thyroid gland.
- Growth pattern
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Uninodular goitre: one thyroid nodule; can be either inactive, or active (toxic) – autonomously producing thyroid hormone.
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Multinodular goitre: multiple nodules;
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Diffuse goitre: the whole thyroid appearing to be enlarged due to hyperplasia.
- Size
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Class I: the goitre in normal posture of the head cannot be seen; it is only found by palpation.
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Class II: the goitre is palpable and can be easily seen.
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Class III: the goitre is very large and is retrosternal (partially or totally lying below the sternum), pressure results in compression marks.
Treatment
Goitre is treated according to the cause. If the
thyroid gland is producing an excess of
thyroid hormones (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
potassium iodine are given. If the goitre is associated with an underactive
thyroid, thyroid supplements are used as treatment. Sometimes a partial or complete
thyroidectomy is required.
Medical and scientific developments
The discovery of iodine's importance in thyroid function and its role in preventing goiter marked a significant medical breakthrough. The introduction of iodized salt in the early 20th century became a key public health initiative, effectively reducing the prevalence of goiter in previously affected regions. This measure was one of the earliest and most successful examples of mass preventive health campaigns.
Epidemiology
for iodine deficiency per 100,000 inhabitants in 2002:
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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.[1]
Iodine mainly accumulates in the sea and in the topsoil. Before iodine enrichment programs, goiters were common in areas with repeated flooding or glacial activities, which erodes the topsoil. It is endemic in populations where the intake of iodine is less than 10 μg per day.[
]
target="_blank" rel="nofollow"> Goitre as a determinant of the prevalence and severity of iodine deficiency disorders in populations, World Health Organization - 2014
Examples of such regions include the alpine regions of Southern Europe (such as Switzerland), the Himalayans, the Great Lakes basin, etc. As reported in 1923, all the domestic animals have goiter in some of the glacial valleys of Southern Alaska. It was so severe in Pemberton Meadows that it was difficult to raise young animals there.
History
Chinese physicians of the
Tang dynasty (618–907) 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 (d. 643 AD) 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 Islamic medicine, provided the first description of Graves' disease after noting the association of goitre and a displacement of the eye known as exophthalmos in his Thesaurus of the Shah of Khwarazm, the major medical dictionary of its time.[ – the history and naming of the disease]
Paracelsus (1493–1541) was the first person to propose a relationship between goitre and minerals (particularly lead) in drinking water.[ "Paracelsus" Britannica] 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 ,[ "In Raising the World's I.Q., the Secret's in the Salt", article by Donald G. McNeil, Jr., 16 December 2006, The New York Times] Central Asia, and Central Africa.
Goitre had been prevalent in the alpine countries for a long time. Switzerland reduced the condition by introducing iodized salt in 1922. The Bavarian tracht in the Miesbach and Salzburg regions, which appeared in the 19th century, includes a choker, dubbed Kropfband (struma band) which was used to hide either the goitre or the remnants of goitre surgery.
In various regions around the world, particularly in mountainous areas, the prevalence of goiter was linked to iodine deficiency in the diet. For example, the Alps, the Himalayas, and the Andes had high rates of goiter due to the iodine-poor soil. In these regions, iodine deficiency led to widespread hormonal imbalances, particularly affecting thyroid function.
Society and culture
In the 1920s wearing bottles of iodine around the neck was believed to prevent goitre.
Notable cases
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Former U.S. 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.
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 language for the word ("Kropf").
Social Impacts
In some historical contexts, goiters were so prevalent that they became normalized within the culture. For instance, in certain Alpine regions, large goiters were sometimes considered a sign of beauty. Conversely, in other areas, individuals with goiters faced social stigma, which could lead to marginalization and discrimination.
See also
External links
