Synonyms in a broader sense
- Goiter
- Thyroid enlargement
- Enlargement of the thyroid gland
- Parathyroid gland
- Nodular goiter
- Multinodular goiter
Definition goiter
The term “struma” (from the lat. struma “glandular swelling”, pl. strumae) or goiter denotes an enlargement of the thyroid gland. The struma has an essential cause in an iodine deficiency, therefore the struma is found especially in iodine deficiency areas like the Alps. Iodine deficiency, swelling of the thyroid gland
- Shield nozzle flaps
- Connecting piece (isthmus)
Occurrence in the population
Iodine is found in the earth. Germany is an iodine deficiency area, probably because the iodine was lost at the end of the ice age with the melting glacier water. For this reason there is an iodine deficiency in about 30% of the Central European population.
Women are affected about four times as often as men. Although drinking water in Germany is not enriched in iodine, a decreasing tendency of iodine deficiency symptoms has been observed in recent years. The reason for this is certainly the increased consumption of iodine-containing common salt, which plays an important role. A goiter usually develops between the ages of 20 and 40.
Classification
According to its external appearance, the goiter (thyroid enlargement) is divided into the following degrees: Grade 0The thyroid gland is not visible or palpable but is nevertheless enlarged. Grade IaThe thyroid gland is palpably enlarged, but not visible even with an overstretched head. Grade IbThe thyroid gland is palpably enlarged and is only enlarged when the head is hyperextended.
Grade IIDThe thyroid gland is visibly enlarged even without hyperextension of the head Grade IIIDThe thyroid gland is considerably enlarged. Neighboring organs are also affected, e.g. displacement or narrowing of the windpipe (see also: Tracheal Narrowing), cervical vessels or esophagus. In this stage, the growth of the thyroid gland can extend beyond the breastbone.
According to the changes within the thyroid gland is divided into a number of different types: The anatomically normal lying thyroid gland is called eutop. The thyroid gland whose position deviates from this – e.g. in the chest or under the tongue – is called dystop.
- Struma diffusa (uniformly enlarged) and
- Struma nodosa (already existing nodes).
- Euthyroid (normal hormone production),
- Hyperthyroid (increased hormone production),
- Hypothyroid (reduced hormone production).
If nodes form in the thyroid gland, this is called struma nodosa.
These can be various nodular changes. A nodose goiter can be caused by a benign glandular growth, a so-called adenoma. It can also be benign fluid-filled cavities (cysts) or benign scarring or calcification.
Two different types of benign nodes can form in the thyroid gland. Whether a cold or hot nodule is present can be investigated by means of a thyroid function examination, the scintigraphy. For this purpose, the patient is administered an iodine substance that has been radioactively marked.
The iodine accumulates particularly strongly in a hot node and thus makes it “visible”. The name “hot” node is due to the color representation in the scintigraphy. It is represented in the so-called warm colors red and yellow.
A cold node does not absorb the iodine. It is represented with the cold colors blue and violet and can therefore be distinguished. In most cases the nodes are benign, even in iodine deficiency areas.
Criteria for which a malignant nodule should be considered are for example thyroid carcinomas in the family history, local irradiation of the thyroid gland in the past, palpable single nodules and also laboratory findings (elevated CEA, calcitonin, thyroglobolin). In most cases, an ultrasound examination can also provide an estimate of the benign or malignant nature of the thyroid gland. If a single cold nodule is detected in a goiter nodosa, it is considered a thyroid carcinoma (malignant goiter) in Germany until proven otherwise.
Fortunately, thyroid carcinomas are very rare; the probability that a nodular goiter is a carcinoma is less than one percent.In contrast, strum formations are very frequent, so for safety reasons, a step-by-step diagnostic procedure is performed to assess the risk in order to exclude a carcinoma as far as possible. First of all, an ultrasound (sonography), a thyroid function examination (scintigraphy) and a laboratory check are performed. If a thyroid carcinoma is suspected, a fine needle puncture is performed to obtain thyroid cells.
In case of doubt, surgical removal of the struma (strum resection) may also be necessary.
- A so-called “cold” node does not produce hormones and the thyroid gland is not impaired in its function by the cold node (euthyroid goiter nodosa). A benign cyst, a cavity filled with fluid, is also counted as a cold node, as it has no function whatsoever.
Smaller cysts can be removed by a puncture (similar to taking a blood sample), larger ones may also require surgery.
- A “hot” lump produces thyroid hormones, which can cause too many of the hormones to enter the bloodstream and thus cause the symptoms of hyperthyroidism (hyperthyroid goiter nodosa).
The Struma nodosa is very widespread in Germany. Every third adult has an enlargement or one or more nodes in the thyroid gland, and women are even more frequently affected than men. With increasing age, however, the probability that several nodules will form in the thyroid gland also increases; this is called goiter multinodosa.
This occurs mainly when the thyroid gland has been enlarged for years. If there is an iodine deficiency, the thyroid gland initially enlarges and, as it progresses, a nodular remodelling of the tissue, known as multinodal goiter. Examination of the goiterThe direct, personal, clinical examination by the physician is the first and very important measure that serves to find a diagnosis.
The doctor looks at the neck and palpates the thyroid gland. Depending on the symptoms, other parts of the body can and must also be examined. Sonographic (ultrasound examination) in the case of goiter Ultrasound is used to assess the situation in the thyroid gland.
Cysts can be seen and even punctured, nodules can be detected, and the volume of the thyroid gland can be measured precisely. Laboratory chemical (blood testLaboratory values) for goiter The blood test with determination of the hormone levels (in particular the thyroid hormones) provides information about the function of the thyroid gland. The blood may also contain antibodies which may play a role in thyroid diseases.
Scintigraphy (scintigraphy) for goiter The thyroid scintigraphy is used to gain further information about nodules or functional disorders. It distinguishes between “hot” and “cold” nodes. The nodes that absorb more radioactively marked iodine are called “hot”.
The “cold” nodes are those that do not absorb iodine. Puncture of the thyroid gland can be used to obtain samples for a histological examination under the microscope. X-rays – examinations of goiterIn the case of impairment of neighboring organs, X-rays, CT or MRI images help to gain a better understanding of the extent of thyroid enlargement and may allow better planning of surgery.
