Goiter

Goiter

Almost every second German suffers from an enlargement of the thyroid, the relatively inconspicuous butterfly-shaped organ above the trachea. The reasons for goiter or goiter are varied and sometimes even avoidable.

What is goiter (goiter)?

The enlargement of the thyroid gland is referred to as goiter – or struma in Latin. Depending on the degree of enlargement, goiter is divided into three categories:

At grade 0, the enlargement of the thyroid gland can only be detected by ultrasound. For what is the definition of lupus nephritis, please visit healthknowing.com.

Grade I means the thyroid is palpably enlarged.

The grade II classification indicates that the thyroid gland enlargement can not only be felt, but that the goiter can also be clearly seen.

Goiter can often develop without there being a disturbance in thyroid hormone production. This is the most common case, then one speaks of a euthyroid goiter. In rarer cases, the thyroid gland either produces more hormones, known as hyperthyroid goiter, or produces too few hormones, resulting in hypothyroid goiter.

The goiter can enlarge uniformly (goiter diffusa) or form knots in places (goiter nodosa), which results in an irregular deformation of the thyroid gland. Depending on whether one or more nodes have formed, a distinction is made between the terms goiter uninodosa and goiter multinodosa.

Causes

The causes of an enlarged thyroid (goiter) can be very different. However, in 90 percent of cases it is a diet-related iodine deficiency.

Other reasons for goiter formation can be autoimmune diseases such as Graves ‘ disease, Hashimoto’s thyroiditis or goitre-promoting substances such as lithium, nitrates or antithyroid drugs.

Cysts or tumors can also cause goiter. In a few cases, other organs and tissues are also affected by metastases. Far rarer causes of goiter are benign tumors of the pituitary gland, but also disorders of thyroid hormone synthesis and diseases such as sarcoid or amyloidosis. Smoking and a lack of selenium are also suspected of promoting goiter.

Symptoms, Ailments & Signs

A goiter can remain symptom-free for a long period of time. Some patients experience mild difficulty swallowing or a lump in their throat. As the disease progresses, symptoms such as hoarseness, difficulty swallowing and shortness of breath. This can be accompanied by a feeling of tightness in the chest.

If there is an accompanying thyroid dysfunction, further symptoms can arise. These include, for example, gastrointestinal complaints and hormonal disorders. Externally, a goiter can often be recognized by the visible thickening of the neck. Some patients develop hot nodules in the thyroid area.

This can lead to hormonal problems, pain and an increase in the original feeling of pressure. In the long term, these growths lead to an overactive thyroid gland, which is associated with further complications. Goiter symptoms develop gradually. It often takes years before the goiter is noticed.

By then, however, permanent damage to the thyroid gland has usually developed. If goiter is detected early, surgery can relieve the symptoms. However, there is a risk that a goiter will form again. A full-blown goiter significantly reduces the quality of life of those affected and can also cause mental problems in individual cases.

Diagnosis & course of disease

The course of thyroid diseases is often quite unremarkable. For the time being, a diet-related goiter does not cause any symptoms. Only the visible goiter with shortness of breath with increased exertion or the bending of the head and a feeling of pressure when swallowing give an idea of ​​an illness.

Larger goiters can form so-called “goiter hearts”, which means that the goiter develops in the direction of the breastbone and thus causes a noticeable narrowing of the trachea. The consequences are wheezing, shortness of breath and hoarseness.

Other clinical pictures arise from the formation of knots. Most thyroid nodules are benign in nature. However, a distinction is made between cold and hot nodules: while hot nodules are practically never malignant, isolated cold nodules with a good iodine supply often turn out to be thyroid carcinomas.

Complications

Goiter caused by iodine deficiency does not cause noticeable complications. In the case of larger goiters, the pressure on the trachea and esophagus can cause, among other things, difficulty swallowing, shortness of breath and an unpleasant feeling of pressure and lumps. If the goiter continues to expand, the trachea narrows and the shortness of breath increases.

Due to the shortness of breath and the pressure on the blood vessels, the right heart is also strained – a goitrous heart forms. Goiter can cause nodules in the thyroid gland, which in the worst case can become inflamed and lead to sepsis. Complications can also occur during the surgical removal of a goiter. This can lead to secondary bleeding, wound healing disorders and infections in the surgical area.

Visible scars can also appear. If important nerves are damaged, it can lead to hoarseness and shortness of breath, and the patient may have to be artificially ventilated. Thyroid surgery can also impair the function of the parathyroid glands. This throws the calcium level out of balance and leads to various complications. Finally, prescribed painkillers and anesthetics can cause side effects and interactions or trigger allergic reactions in the patient.

When should you go to the doctor?

If the person affected notices slight swelling or changes in the neck, these should be observed further. In many cases, a temporary irregularity does not require a doctor. Spontaneous healing often occurs here due to an overload situation. If the growths or changes in the appearance of the skin persist, recur or increase in size, consult a doctor. In the case of hormonal irregularities, abnormalities in sexual desire or menstrual disorders, further examinations are necessary.

If the person concerned suffers from swallowing problems, changes in the vocal environment or shortness of breath, a doctor must be consulted. Hoarseness, a change in voice color, or extraneous noise when speaking need to be investigated. Discolouration, redness, behavioral peculiarities or irritation are also signs of a health impairment. The complaints must be presented to a doctor so that further investigations can be initiated. This is the only way to make a diagnosis, on the basis of which a treatment plan can be drawn up.

Changes in hair growth and deformation of the nails or soft nails are also indications that may indicate irregularities in thyroid function. A doctor should also be consulted if there is a feeling of pressure in the neck, a decrease in well-being and increased tiredness. Mood swings, depressive states or an incomprehensible euphoric occurrence should be examined

Treatment & Therapy

There are three options for treating goiter. If, for example, an enlargement of the thyroid gland is to be inhibited or reduced, drug therapy is possible. Thyroid volume reduction can be achieved by administration of either levothyroxine or iodine, or a combination therapy that utilizes the benefits of both agents.

Radioiodine therapy is used in the case of thyroid autonomy or diseases such as cancer or Graves’ disease. To treat goiter, this nuclear medical procedure uses radioactive iodine, which accumulates in the thyroid gland and destroys excess hormone-producing tissue there. A combination of both treatment options is often used in the 1 to 3-year therapy period.

Surgical intervention is the most effective treatment method in the case of severe limitations in quality of life due to goiter or suspected thyroid carcinoma. The entire thyroid gland or the part of the goiter that produces too many hormones is removed through an incision. The operation is therefore also a rapid therapy for the treatment of hyperfunction, since the remaining hormones in the blood are quickly broken down by the organism.

Prevention

Prevention of goiters can be guaranteed above all by a basic supply of iodine. In many countries, table salt in particular has been enriched with iodine for this purpose, which has already led to a significant reduction in goiter formation, especially in children and adolescents.

You can do that yourself

A goiter must be treated with medication or surgery. The most important self-help measure is to take the prescribed iodine preparations regularly. Depending on the size of the goiter, intravenous iodine treatment is necessary. Chronically ill goiter patients must take special iodine with L-thyroxine. In addition, the patient must take thyroid hormones. As a result, the thyroid returns to its original size.

A healthy diet is a prerequisite for avoiding goiter. Patients who repeatedly suffer from goiter should regulate the iodine in their diet so that medicinal iodine administration can be precisely coordinated.

After an operation on the thyroid gland, the patient must rest. The surgical wound should heal quickly as long as the patient does not strain it with strenuous physical movements. If symptoms recur after the goiter has been removed, the doctor must be informed. Occasionally, after a goiter has been removed, there is a lack of calcium in the body. This can be counteracted by eating foods that contain a lot of calcium. In addition to dairy products, red meats, beans, nuts, herbs and green vegetables are also good sources of calcium.

Goiter