The term goiter (goiter) means an increase in the volume of the thyroid gland. It can be found in the general population with a frequency of up to 25%, with the fact that it is up to 4 times more frequent in women compared to men. In 50% of people, a nodular form of the throat can be found. The occurrence of goiter is most often associated with a lack of iodine intake in the body. With the introduction of iodization of table salt (in Croatia since 1953), the incidence of goiter was significantly reduced, but not completely eradicated. Today, it is known that in addition to iodine deficiency, there are other factors that potentiate goiter (so-called goitrogenes or strumogenic factors).
Factors that potentiate goiter
- congenital genetic disorder of iodine accumulation within thyroid cells
- use of drugs (sulfonylurea preparations, phenobarbitone, amiodarone, rifampicin, lithium salts)
- all conditions in which TSH receptors on thyroid cells are stimulated (autoimmune thyroid disorders, conditions that cause an increase in TSH levels (pituitary and hypothalamic tumors)
- inflammation of the thyroid gland
- granulomatous diseases (sarcoidosis, tuberculosis)
- food compounds such as cyanoglucosides and thioglucosides (especially found in cabbage)
- reduced intake of selenium
Forms of goiter
In case of nodular goiter, it should think about the existence of cysts and adenomas, as well as malignant thyroid tumors and metastases of tumors in the thyroid gland (especially if it is a single-nodular thyroid gland). We distinguish the diffuse form of goiter (no nodes) and the already mentioned, nodular form. According to the hormonal expression, goiter can be euthyroid (we find normal thyroid hormone values), hypothyroid and hyperthyroid (we find increased or decreased thyroid hormone values). The special anatomical form is the so-called retrosternal goiter that tends to grow behind the sternum.
Symptoms of goiter
Goiter is usually presented without any symptoms, although complaints often depend on its size and the presence of pressure on local anatomical structures. Patients may present with thickening or deformation of the front of the neck, discomfort in the neck, feeling of suffocation, cough, difficulty breathing or hoarseness.
Diagnosis and treatment
The most important diagnostic elements are a specialist and ultrasound examination, while other diagnostic methods include thyroid scintigraphy and rarely CT or MR imaging (the same is necessary when planning an operation in patients with large goiters or suspected goiter spread into the chest cavity). If indicated, it is necessary to carry out a cytological puncture. Laboratory evaluation of TSH is also required to assess thyroid function and sometimes antibodies.
When treating, should always strive to discover the cause of goiter and eliminate it. Goiters that do not cause discomfort and do not represent a cosmetic defect do not require treatment. If indicated, goiters are treated with thyroid hormones, surgery or the use of radioactive iodine and thyrostatics and radioactive iodine if "warm/hot" nodes are found.