Almost every second German suffers from an enlargement of the thyroid gland, the relatively inconspicuous butterfly-shaped organ above the trachea. Yet the reasons for goiter or goiter are many and sometimes even preventable.
What is goiter (goiter)?
Schematic diagram showing the anatomy of thyroid enlargement or goiter. Click to enlarge. Goiter – or struma in Latin – is the term used to describe enlargement of the thyroid gland. Depending on the degree of enlargement, goiter is divided into three categories:
Grade 0 means the enlargement of the thyroid gland can only be detected by ultrasound. Grade I means the thyroid gland is palpably enlarged. Grade II classification indicates that the thyroid enlargement is not only palpable, but the goiter is also clearly visible. Often, a goiter can also develop without there being a disturbance in thyroid hormone production. This is the most common case, then one speaks of a euthyroid goiter. In rarer cases, the thyroid gland either produces more hormones, which is called a hyperthyroid goiter, or produces too few hormones, so it is called a hypothyroid goiter. The goiter may enlarge uniformly (diffuse goiter) or form nodules in places (nodular goiter), resulting in an irregular deformation of the thyroid gland. Depending on whether one or more nodules have formed, a distinction is made between the terms struma uninodosa and struma multinodosa.
Causes
The causes of thyroid enlargement (goiter) can vary widely. However, in 90 percent of cases, it is a nutritional iodine deficiency. Other causes of goiter may be autoimmune diseases such as Graves’ disease, Hashimoto’s thyroiditis, or strumigenic – i.e. promoting goiter – substances such as lithium, nitrates or thyrostatic drugs. Cysts or tumors can also cause goiter. In a few cases, other organs and tissues are also affected by metastases. Far rarer causes of goiter are benign tumors of the pituitary gland, but also disorders of thyroid hormone synthesis and diseases such as sarcoidosis or amyloidosis. Smoking and selenium deficiency are also suspected of promoting goiter.
Symptoms, complaints, and signs
A goiter can remain asymptomatic for a long period of time. Some patients notice mild problems swallowing or have a feeling of having a lump in their throat. As the disease progresses, it manifests itself with symptoms such as hoarseness, difficulty swallowing, and shortness of breath. This may be accompanied by a feeling of tightness in the chest. If there is an accompanying thyroid dysfunction, further symptoms may develop. These include gastrointestinal complaints and hormonal disorders. Externally, a goiter can often be recognized by the visible thickening of the neck. In some patients, hot nodules form in the area of the thyroid gland. Then hormonal complaints, pain and an increase in the original feeling of pressure can occur. In the long term, these growths lead to hyperthyroidism, which is associated with further complications. The symptoms of goiter develop insidiously. It often takes years before the goiter is noticed. By then, however, permanent damage to the thyroid gland has usually already developed. If goiter is detected early, surgery can relieve the symptoms. However, there is a risk that a goiter will form again. A full-blown goiter considerably restricts the quality of life of those affected and, in individual cases, can also cause psychological discomfort.
Diagnosis and course of the disease
Infographic showing the anatomy and location of the thyroid gland, as well as the symptoms of hyperthyroidism and hypothyroidism. Click image to enlarge. The course of thyroid disease is often quite unremarkable. Initially, a nutritional goiter does not cause any symptoms. Only the visible goiter with shortness of breath at increased exertion or the bending of the head as well as a feeling of pressure when swallowing give a hint of a disease. Larger goiter can form so-called “goiters”, i.e. the goiter develops in the direction of the sternum and thus causes a noticeable narrowing of the trachea. The consequences are whistling breathing noises, shortness of breath and hoarseness. Other clinical pictures are caused by nodule formation. Most thyroid nodules are benign in nature.However, a distinction is made between cold and hot nodules: While hot nodules are virtually never malignant, isolated cold nodules often turn out to be thyroid carcinomas if the iodine supply is good.
Complications
Goiter triggered by iodine deficiency does not cause noticeable complications. In larger goiters, the pressure on the trachea and esophagus can cause difficulty swallowing, shortness of breath, and an uncomfortable feeling of pressure and lumpiness, among other symptoms. If the goiter expands further, the trachea narrows and shortness of breath increases. Due to the shortness of breath and the pressure on the blood vessels, the right heart is also strained – a goiter heart forms. In the thyroid gland, a goiter can cause nodules that, in the worst case, become inflamed and lead to sepsis. Complications can also arise during the surgical removal of a goiter. For example, secondary bleeding, wound healing problems and infections of the surgical area may occur. In addition, visible scars may result. If important nerves are damaged, hoarseness and shortness of breath may occur, and the patient may have to be artificially ventilated. Thyroid surgery can also impair the function of the parathyroid glands. This throws the calcium level out of balance and leads to various complications. Last, prescribed painkillers and narcotics can cause side effects and interactions or trigger allergic reactions in the patient.
When should you see a doctor?
If the affected person notices mild swelling or changes in the neck, continue to monitor it. If the irregularity is temporary, in many cases a doctor is not needed. Here, spontaneous healing often occurs, due to an overuse situation. If the growths or changes in the appearance of the skin continue unabated, if they occur repeatedly or if they increase in size, a doctor should be consulted. In case of hormonal irregularities, abnormalities in sexual desire or menstrual disorders, further examinations are necessary. If the affected person suffers from complaints of the swallowing act, changes in the vocal environment or shortness of breath, a doctor must be consulted. Hoarseness, a change in the color of the voice, or side noises when speaking must be investigated. Discoloration, redness, peculiarities of behavior or irritability are also signs of health impairment. The complaints must be presented to a physician so that further examinations can be initiated. Only in this way is it possible to make a diagnosis, on the basis of which a treatment plan is drawn up. Changes in hair growth as well as deformation of the nails or soft nails are also indications that may point to irregularities in thyroid function. If there is a feeling of pressure in the neck, a decrease in well-being, as well as increased fatigue, a doctor should also be consulted. Mood swings, depressive states, or an untraceable euphoric demeanor should be investigated
Treatment and therapy
There are three options for the treatment of goiter. For example, if thyroid enlargement is to be inhibited or decreased, drug therapy is an option. Reduction of thyroid volume can be achieved by administering either levothyroxine or iodine, or a combination therapy in which the benefits of both agents are utilized. In cases of thyroid autonomy or diseases such as cancer or Graves’ disease, radioiodine therapy is used. To treat goiter, this nuclear medicine procedure uses radioactive iodine, which is enriched in the thyroid gland and destroys excess hormone-producing tissue there. Often, a combination of both treatment options is used in the 1 to 3 years of therapy. If there are gross limitations in the quality of life due to goiter or suspected thyroid carcinoma, surgical intervention is the most effective treatment method. The entire thyroid gland or that part of the goiter that produces too many hormones is removed through an incision. Thus, surgery is also a rapid therapy for the treatment of hyperthyroidism, as the remaining hormones in the blood are rapidly broken down by the organism.
Prevention
Prevention of strumen can be ensured mainly by a basic iodine supply.In many countries, table salt in particular has been enriched with iodine for this purpose, which has already resulted in a significant decrease in struma, especially in children and adolescents.
What you can do yourself
Goiter must be treated with medication or surgery. The most important self-help measure is to take the prescribed iodine supplements regularly. Depending on the size of the goiter, intravenous iodine treatment may be necessary. Chronically ill goiter patients must take special iodine with L-thyroxine. Accompanying this, the patient must take thyroid hormones. This helps the thyroid gland to regain its original size. A healthy diet is a basic requirement for the prevention of goiter. Patients who suffer from recurrent goiter should regulate the iodine in their diet so that medical iodine dosage can be fine-tuned. After thyroid surgery, the patient must rest. The surgical wound should heal quickly, as long as the patient does not stress it with strenuous physical movements. If after the removal of the goiter discomfort reappears, the doctor must be informed. Occasionally, after the removal of a goiter, there is a calcium deficiency in the body. This can be counteracted by eating foods that contain a lot of calcium. In addition to dairy products, red meats as well as beans, nuts, herbs, and green vegetables are good sources of calcium.
