Goiter is not a cancerous growth but rather an enlargement of the thyroid gland. There are different types of goiters. The most common is simple goiter. This is caused for no apparent reason, or, when the thyroid glands do not function properly to manufacture sufficient quantities of the thyroid hormone for the body’s requirements.
Simple goiter can be divided into endemic or colloid goiter and sporadic or non-toxic goiter. The first occurs in people who suffer from iodine deficiency – especially those who live in places where there is lack of iodine in the soil. The specific causes of the second type are not known, although certain medications can cause them – lithium or aminoglutethimide.
Toxic nodular goiter is a type where small nodules growth inside the enlarged thyroid gland. These nodules produce excess of the thyroid hormone. Toxic nodular goiter occurs in those who already have simple goiter. Older people – especially women over 60 are prone to this disease.
Who are at high risk ?
There are certain people who are at risk of contracting goiter, like those with a family history of this disease, those over the age of 40, women and people who have iodine deficiency.
Symptoms of Goiter
Know goiter symptoms and get timely treatment to avoid complications.
Swollen thyroid gland is the first and most prominent goiter symptom. The size of the swelling could be a large lump in the neck or a small nodule. A nodule is a raised bump that is solid. It usually appears under the skin or in the skin and has a width of at least 10cm or more. The exact position of the goiter is at the bottom of the neck. A swollen thyroid gland puts pressure on the esophagus and windpipe, therefore causing other symptoms.
Breathing difficulties: This can be caused when the goiters are large. This produces a sensation of a feeling of discomfort when breathing or not getting sufficient air.
Cough: This is another goiter symptom and is caused due to the goiter pressing on nearby tissues.
Hoarseness: An enlarged goiter can press against the nerves that lead to the voice box. This causes change in a person’s normal voice. It affects those who speak for long hours like teachers.
Discomfort when swallowing: This occurs because the goiter is pressing on the esophagus. Swallowing solid foods and pills becomes difficult. Patients often report that they feel a lump-like sensation in the throat that does not go way.
Pemberton’s sign: Due to an enlarged goiter, other symptoms that you experience include a swelling of the neck vein where the goiter is located and dizziness experienced when arms are raised above head level. Dizziness is a lightheaded feeling that makes you feel you will faint or vertigo when you feel the world is spinning or you are moving or spinning when you are not. When patients with goiter raise their hands above their heads, they will notice that their veins in the neck look enlarged, their face turns red and they find it difficult to breathe. This is called the Pemberton’s sign.
Pain in the goiter: Sometimes the goiter can contain fluid-filled cysts. These cysts can bleed at times, causing a painful thyroid, difficult breathing or enlarged goiter.
Symptoms of hypothyroidism: This can be a complication due to goiter and results in an under-active thyroid. Some of the symptoms are:
- Slowed down physical and mental abilities
- Intolerance to cold
- Lowered heart rate
- Weight gain
- Numb and tingling feeling in the hands
Symptoms of hyperthyroidism: This is also a complication due to goiter and results in an overactive thyroid. Some of the symptoms are:
- Increased appetite that still results in weight loss
- Increased heart rated
- Elevated blood pressure
- Muscle weakness
- Tremors of the hands
What to do?
Patients who have a large or small growth and accompanying symptoms such as dizziness, difficulty swallowing or hoarseness must consult a doctor. The growth may need surgery to alleviate goiter symptoms.
Treatment of Goiter
The doctor will conduct a physical exam and then request some diagnostic tests. He will feel your neck and make you swallow. He will run tests like thyroid scan and uptake, free thyroxine (T4), thyroid stimulating hormone test or ultrasound of the thyroid.
Some doctors try to find abnormal thyroid antibodies present in the blood, which indicates an inflammation of the thyroid gland.
Treatment is based on the cause and size of the goiter. In places where iodine deficiency is the cause, iodine supplements will be given. People will be advised to use iodine-enriched salt. Iodine could be added to water, crops, salt and animal feed to eliminate the root causes of iodine deficiency. People will be recommended a diet that enhances thyroid production.
If diet is not the cause of goiter symptoms, thyroid hormone replacement will be given combined with thyroxine. This drug can shrink the size of the goiter by blocking production of TSH.
Those with large sized goiters may require surgery to partially remove the thyroid. They could also be given radioactive iodine that can shrink the thyroid gland sufficiently to prevent interference with swallowing or breathing. Surgery can also be performed so that cosmetic problems are corrected.
Goiter : Prevention and Precaution
The prognosis for goiter is varied. Sometimes it can disappear completely or it can become larger. Some people can develop hypothyroidism since the thyroid gland has been destroyed by goiter and stops manufacturing sufficient quantities of the thyroid hormone.
Others can develop hyperthyroidism when the goiter turns toxic and produces excessive levels of thyroid hormone (toxic nodular goiter).
People who suffer from goiter have to follow certain precautions for if left unattended, goiter can result in complications like thyroid cancer, toxic nodular goiter, hypothyroidism, hyperthyroidism and difficulty in breathing or swallowing.
Avoid eating large quantities of goiter causing foods like broccoli, cabbage, cassava and cauliflower. Endemic colloid goiter can be easily prevented by using iodized table salt.