Goiter | Thyroid gland

Goiter

The enlargement of the thyroid gland during regular hormone production is called “goiter” (synonym: goiter). The thyroid gland is considered to be enlarged when its volume exceeds 18ml in women and 25ml in men. A goitre can be caused by a hereditary defect, iodine deficiency, so-called “struma” substances (for example nitrates, lithium or thiocyanate) in food or certain drugs.

The most common cause is iodine deficiency. Since Germany is considered an iodine deficiency area, it is understandable that more than 30% of the population suffer from an enlarged thyroid gland. Women are affected about twice as often as men.

The iodine deficiency induces the release of growth factors in the thyroid gland, which then causes an increase in the size of the thyroid cells (=hyperplasia) and growth of the surrounding connective tissue. The more the iodine content falls below the optimal value of 200μg the more the thyroid gland is stimulated to grow. In addition to iodine deficiency, there are other factors that can cause struma; these include autoimmune diseases (M. Basedow and Hashimoto), thyroid autonomy, thyroid inflammation (thyroiditis), hyperthyroidism and, finally, thyroid cancer.

In principle, a goiter is conservative and can be treated well with medication. To compensate for the iodine deficiency, patients receive iodine substitution (100- 200μg/day). If necessary, a combination therapy with thyroxine (50 μg/day) is additionally given after a lack of improvement, as both reduce the growth stimulus.

Surgical therapy is only indicated in cases of suspected cancer or strictures with autonomy. Depending on how severe the suspicion is, partial or total resection (removal) is performed. A complication in patients with goiter is the formation of nodular substances, so-called “hot or cold nodules”.This results in the transformation of the diffuse struma tissue with simultaneous loss of its ability to be regulated by the hormone TSH, which triggers thyroid hormone production. To prevent goiter, it is advisable to treat risk groups (pregnant women, pubescent children and genetically pre-stressed patients) prophylactically (as a precaution) with iodine tablets.