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Goitre
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A goitre (BrE), or goiter (AmE) (Latin struma), also called a bronchocele, is a swelling in the neck (just below the Adam's apple or larynx) due to an enlarged thyroid gland.
are classified in different ways:
Other type of classification:
dwide, the most common cause for goiter is iodine deficiency. In countries that use iodized salt, Hashimoto's thyroiditis becomes the most common cause.
Other causes are:
ne is necessary for the synthesis of the thyroid hormones thyroxine (T4) and triiodothyronine (T3).
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Encyclopedia
A goitre (BrE), or goiter (AmE) (Latin struma), also called a bronchocele, is a swelling in the neck (just below the Adam's apple or larynx) due to an enlarged thyroid gland.
Classification
They are classified in different ways:
- A "diffuse goiter" is a goiter that has spread through all of the thyroid (and can be a "simple goitre", or a "multinodular goitre").
- "Toxic goiter" refers to goiter with hyperthyroidism. These most commonly due to Graves' disease, but can be caused by inflammation or a multinodular goiter.
- "Nontoxic goiter" (associated with normal or low thyroid levels) refers to all other types (such as that caused by lithium or certain other autoimmune diseases).
Other type of classification:
- I - palpation struma - in normal posture of head it cannot be seen. Only found when palpating.
- II - struma is palpative and can be easily seen.
- III - struma is very big and is retrosternal. Pressure and compression marks.
Causes
Worldwide, the most common cause for goiter is iodine deficiency. In countries that use iodized salt, Hashimoto's thyroiditis becomes the most common cause.
Other causes are:
Occurrence
Iodine is necessary for the synthesis of the thyroid hormones thyroxine (T4) and triiodothyronine (T3). In endemic goitre, iodine deficiency leaves the thyroid gland unable to produce its hormones because the hormones are made out of iodine. When levels of thyroid hormones fall, thyrotropin-releasing hormone (TRH) is produced by the hypothalamus. TRH then prompts the pituitary gland to make thyrotropin or thyroid stimulating hormone (TSH), which stimulates the thyroid gland’s production of T4 and T3. It also causes the thyroid gland to grow in size by increasing cell division.
Goiter 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.
Treatment
Treatment may not be necessary if the goitre is small. Goiter may be related to hyper- and hypothyroidism (especially Graves' disease) and may be reversed by treatment of hyper- and hypothyroidism. Graves' disease can be corrected with antithyroid drugs (such as propylthiouracil and methimazole), thyroidectomy (surgical removal of the thyroid gland), and iodine-131 (131I - a radioactive isotope of iodine that is absorbed by the thyroid gland and destroys it). Hypothyroidism may raise the risk of goitre because it usually increases the production of TRH and TSH. Levothyroxine, used to treat hypothyroidism, can also be used in euthyroid patients for the treatment of goitre. Levothyroxine suppressive therapy decreases the production of TRH and TSH and may reduce goitre, thyroid nodules, and thyroid cancer. Blood tests are needed to ensure that TSH is still in range and the patient has not become subclinically hyperthyroid. If TSH levels are not carefully monitored, it is alleged that levothyroxine may increase the risk of osteoporosis but no peer reviewed studies on levothyroxine replacement of Hypothyroid patients causing this effect have actually been produced.
Thyroidectomy with 131I may be necessary in euthyroid goitrous patients who do not respond to levothyroxine treatment, especially if the patients have difficulty breathing or swallowing. 131I, with or without the pre-injection of synthetic TSH, can relieve obstruction and reduce the size of the goitre by thirty to sixty-five percent. Depending on how large the goiter is and how much of the thyroid gland must be removed or destroyed, thyroidectomy or 131 may produce hypothyroidism requiring life-long treatment.
Symptoms
The symptoms of goiter are mainly the swelling of the front part of the neck and protruding eyes.
History and future
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-mixture-in-wine form. This was outlined in Zhen Quan's (died 643 AD) book, as well as several others. One Chinese book (i.e. 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 Persian physician, provided the first description of Graves' disease after noting the association of goitre and exophthalmos in his Thesaurus of the Shah of Khwarazm, the major medical dictionary of its time. Al-Jurjani also established an association between goitre and palpitation. The disease was later named after Irish doctor Robert James Graves, who described a case of goiter with exophthalmos in 1835. The German Karl Adolph von Basedow also independently reported the same constellation of symptoms in 1840, while earlier reports of the disease were also published by the Italians Giuseppe Flajani and Antonio Giuseppe Testa, in 1802 and 1810 respectively, and by the English physician Caleb Hillier Parry (a friend of Edward Jenner) in the late 18th century.
Paracelsus (1493–1541) was the first person to propose a relationship between goitre and minerals (particularly lead) in drinking water. 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 Great Lakes, Midwest, and Intermountain regions. The condition now is practically absent in affluent nations, where table salt is supplemented with iodine. However, it is still prevalent in India, Central Asia and Central Africa.
Some health workers fear that a resurgence of goitre might occur because of the trend to use rock salt and/or sea salt, which has not been fortified with iodine.
Famous goitre sufferers
- Edward Gibbon
- Former President George H. W. Bush and his wife Barbara Bush both were diagnosed with Graves' disease and goitres, within two years of each other. In the president's case, the disease caused hyperthyroidism and cardiac dysrhythmia. Scientists said that the odds of both George and Barbara Bush having Graves’ disease might be 1 in 100,000 or as low as 1 in 3,000,000
- Andrea True (according to an interview on VH-1)
- Jose Fadul
See also
External links
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