Goiter: Causes

Pathogenesis (development of disease)

In the majority of cases, goiter is caused by iodine deficiency. This involves an attempt to compensate for insufficient (inadequate) hormone production (TSH increases reactively because insufficient T3 and T4 are produced due to iodine deficiency, thus stimulating hyperplasia (excessive cell formation) of the thyroid gland). According to their function (functional), euthyroid goiter (normal metabolic values) is distinguished from hypothyroid goiter (in case of hypothyroidism) and hyperthyroid goiter or toxic goiter (in case of hyperthyroidism). The permanent TSH secretion (TSH release) leads to a growth stimulation of the thyroid gland and thereby probably to local mutations (genetic changes), which develop an autonomous (independent) goiter from a diffuse TSH-dependent goiter. Such cases are referred to as focal autonomy.

Etiology (causes) of iodine-deficient goiter/euthyroid goiter and dyshormogenic goiter

Biographic causes

  • Genetic burden from parents, grandparents.
  • Gender – women are more commonly affected overall; likely due to an increased incidence of autoimmune disease
  • Hormonal factors
    • Adolescents in the growth phase*
    • Pregnant women*
    • Breastfeeding*
    • Women in climacteric climacteric (menopause of women).

* People with increased iodine requirements (→ endemic alimentary iodine deficiency).

Behavioral causes

  • Diet
    • Intake of strumigenic substances such as:
      • Casava roots
      • Crucifeae family vegetables (cauliflower, Brussels sprouts, savoy cabbage) [thiocyanates].
      • Milk (from areas with grass containing strumigens).
    • Micronutrient deficiency (vital substances) – iodine; see prevention with micronutrients.

Disease-related causes

Endocrine, nutritional and metabolic diseases (E00-E90).

  • Acromegaly (IGF-1-dependent) – endocrinologic disorder caused by overproduction of the growth hormone somatotropin (STH), with marked enlargement of the body’s end limbs or protruding parts (acras), such as the hands, feet, lower jaw, chin, nose, and eyebrow ridges.
  • Autoimmune thyroiditis (thyroid function: euthyroid, hypo- and hypertyroid) – in Hashimoto’s thyroiditis, there is destruction (destruction of thyrocytes (hormone-producing cells of the thyroid gland); in Graves’ disease, there is TRAK-mediated thyrocyte stimulation
  • Iodine deficiency-related diffuse goiter (E01.0).
  • Iodine deficiency-related multinodular goiter (E01.1)
  • Iodine deficiency-related goiter, unspecified (E01.2)
  • Non-toxic diffuse goiter (E04.0).
  • Non-toxic solitary thyroid nodule (E04.2)
  • Non-toxic multinodular goiter (E04.2)
  • Other specified nontoxic goiter (E04.8).
  • Nontoxic goiter, unspecified (E04.9)
  • Dyshormogenic goiter (E07.1)
  • Riedel’s goiter
  • Thyroid hormone synthesis disorder – TSH-triggered goiter multinodosa.
  • Thyroid hormone resistance (end-organ dependent function).
  • Thyroiditis de Quervain (thyroid function: euthyroid, hypo- and hypertyhreotic) – usually pressure painful, fever and general condition worsened, increased inflammatory parameters.

Medication

  • Lithium
  • Perchlorate
  • Thyrostatic agents

Etiology (causes) of goiter with hypothyroidism/hypothyroid goiter (hypothyroidism)

Biographic causes

  • Genetic stress from parents, grandparents.

Disease-related causes.

Endocrine, nutritional and metabolic diseases (E00-E90).

  • Autoimmune thyroiditis (thyroid function: euthyroid, hypothyroid, and hypertyroid) – in Hashimoto’s thyroiditis, there is destruction of thyrocytes; in Graves’ disease, there is TRAK-mediated thyrocyte stimulation
  • Acquired hypothyroidism
  • Congenital (congenital) hypothyroidism with diffuse goiter.
  • Thyroid hormone synthesis disorder – TSH-triggered goiter multinodosa.
  • Thyroiditis de Quervain (thyroid function: euthyroid, hypo- and hypertyhreotic) – usually pressure painful, fever and general condition worsened, increased inflammatory parameters.

Medication

  • Lithium
  • Perchlorate
  • Thyrostatic

Etiology (causes) of goiter with hyperthyroidism/hyperthyroid goiter (hyperthyroidism)

Biographic causes

  • Genetic stress from parents, grandparents.

Disease-related causes

  • Autoimmune thyroiditis (thyroid function: euthyroid, hypo- and hypertyroid) – in Hashimoto’s thyroiditis, destruction of thyrocytes is present; in Graves’ disease, TRAK-mediated thyrocyte stimulation is present.
  • Hyperthyroidism with diffuse goiter (E05.0).
  • Hyperthyroidism with toxic solitary thyroid nodule (E05.1)
  • Hyperthyroidism with toxic multinodular goiter (E05.3)
  • Iodine deficiency-related multinodular goiter (E01.1) in combination with autoimmune thyroiditis
  • Thyroiditis de Quervain (thyroid function: euthyroid, hypo- and hypertyhreotic) – usually pressure painful, fever and general condition worsened, increased inflammatory parameters.
  • TSHoma (synonym: gonadotropinoma) – TSH-producing pituitary tumor is typically associated with clinical signs of hyperthyroidism and enlargement of the thyroid gland (rare cause of hyperthyroidism)

For causes of hypothyroidism or hyperthyroidism – see at the respective disease.