Goitre (patient information)

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 * Associate Editor(s)-In-Chief: Jinhui Wu, M.D.

Overview
Goitre is a condition that the thyroid gland grows larger than normal. The most common cause is a lack of iodine in the diet. It also can be caused by many other diseases such as Graves' disease, Hashimoto's disease and thyroid cancer. Usual signs and symptoms include a visible swelling at the base of your neck, a tight feeling in your throat, cough, hoarseness and shortness of breath. Blood tests of thyroid gland hormone level, ultrasonography and thyroid gland scans may be helpful for the diagnosis. Treatment of goitre depends on the cause and the size of the lump. The cause of goitre determines the outcome.

What are the symptoms of goitre?
Not all goiters cause signs and symptoms. When symptoms do occur they may include:
 * A visible swelling at the base of your neck, the size may range from a single small nodule to large neck lump.
 * A tight feeling in your throat
 * Cough
 * Hoarseness
 * Difficulty swallowing
 * Shortness of breath
 * Fatigue
 * Increased appetite
 * Nervousness
 * Restlessness
 * Weight loss
 * Muscle cramps

Who is at highest risk?
Goiters can affect anyone. Some common risk factors for goiter include:
 * A lack of dietary iodine: Epidemical data show that people living in areas lack of iodine and not getting enough iodine in the diet are at high risk of goiter.
 * Female gender: Studies demonstrate that women are more likely to thyroid disorders than men.
 * Age over 50 years
 * Personnal or family history: A personal or family history of autoimmune disease increases your risk.
 * Certain medications: Some drugs, such as immunosuppressants, antiretrovirals, amiodarone for arrhythmia and lithium for psychiatric disorders, may increase the risk of developing goitre.
 * Radiation: Clinical surveys demonstrate the risk increases when patients have been treated with radiation to the neck or chest area, even when they have been exposed to radiation in a nuclear facility, test or accident.

Diagnosis

 * Blood hormone level tests: Blood tests of thyroid hormone can determine the function of thyroid and pituitary glands. Usually, serum thyroid hormone levels (T3, T4) and serum thyroid-stimulating hormone (TSH) are detected. Goiter associated with an overactive thyroid usually involves a high level of thyroid hormone and a lower than normal TSH level in the blood.
 * An antibody test: For some causes of goiter such as Hashimoto's thyroiditis and Graves-Basedow disease, a blood test about antibodies may be helpful to the diagnosis.
 * Ultrasonography: This is an painless test which uses sound waves to create a picture of the internal organs. During the test, a transducer is put over your neck to form images on a computer screen. The images can tell the size of thyroid gland and whether the gland contains nodules inside.
 * Thyroid gland scans: This is a nuclear medicine test. During the test, a radioactive isotope is injected into the patient's vein. Then, a special camera produces an image of the thyroid gland on a computer screen. Thyroid gland scans can provide information about the nature and size of your thyroid gland.

When to seek urgent medical care?
Call your health care provider if you have symptoms of this disorder. Follow the health care provider's recommendations for follow-up visits.

Treatment options
Goiter treatment depends on the cause, the size of the goiter, patient's signs and symptoms. Usual treatments include medications, surgery and radioactive iodine.
 * Observation: An observation approach is recommended for patient whose goiter is small, and doesn't cause problems, and blood hormone tests are normal.
 * Medications:
 * Iodine deficiency: For those that the goiter is due to iodine deficiency, Lugol's iodine or potassium iodine solution may be recommended.
 * Hypothyroidism: If the goiter is due to underactive thyroid, treatment is thyroid hormone supplements.
 * Thyroid gland inflammation: For patients with thyroid gland inflammation, aspirin or corticosteroid are needed.
 * Hyperthyroidism: For goiters associated with hyperthyroidism, antithyroid drugs such as propylthiouracil and methimazole may need to control hormone levels.
 * Surgery: Surgery can be used for patients with
 * A large goiter that is uncomfortable or causes difficulty breathing or swallowing
 * Nodular goiter causing hyperthyroidism
 * Thyroid cancer
 * Radioactive iodine: This treatment is used to treat an overactive thyroid gland by destroying thyroid cells. It may result in hyperthyroidism in some cases. Hormone replacement with the synthetic thyroid hormone levothyroxine becomes necessary to deal with the side efects.

Where to find medical care for goitre?
Directions to Hospitals Treating goitre

Prevention of goitre

 * Using iodized table salt to prevent from goitre caused by iodine deficiency.
 * Making regular check of thyroid gland function and under the doctor's direction when taking medications such as immunosuppressants, antiretrovirals, amiodarone and lithium.
 * Avoiding or decreasing radiation exposure of thyroid gland.

What to expect (Outook/Prognosis)?
Prognosis of goitre depends on the causes of the disease. The outcome of goitre caused by the thyroid cancer is worse than prognosis caused by other diseases, such as Graves' disease, Hashimoto's disease and iodine deficiency.

Copyleft Sources
http://www.mayoclinic.com/print/goiter/DS00217/DSECTION=all&METHOD=print http://www.nlm.nih.gov/medlineplus/ency/article/001178.htm http://www.nlm.nih.gov/medlineplus/ency/article/000317.htm