Types of Goitre | Causes | Diagnosis | Treatment of Goiter

Posted on March 20, 2009 by mkr in Endocrine System

What is Goiter

Goiter is defined as non-inflammatory, non-neoplastic enlargement of thyroid glands. More cases of goiter are found in women as compare to men. Goiter may become toxic and lead to hyperthyroidism.

Enlargement of thyroid glands ( Goitre) is related to several factors causing:

  • Primary hyperplasia.
  • Compensatory hyperplasia to meet the increased demand to thyroxin by the body.
  • Increased storage of colloid

Types or classification of Goitre

I. Simple goiter

  • Physiological (puberty goiter).
  • Parenchymatous goiter.
  • Colloid goiter.
  • Nodular or adenomatous goiter.

II. Secondary goitre

  • Primary thyrotoxicosis.
  • Secondary thyrotoxicosis arising from nodular or colloid goiter.

Causes of Goiter

  1. Iodine deficiency.
  2. Idiopathic.
  3. Physiological- puberty and pregnancy.
  4. Grave’s disease.
  5. Goitrogens- anti-thyroid drugs, iodine containing medicine, aminoglutethimide, lithium.
    Foods- soybean and cassava.
  6. Thyroiditis – Hashimoto’s, acute or sub acute (de Quervain’s) and reidel’s septic.
  7. Dyshormonogenesis- iodine trapping defect, organification defect and resistance of thyroid hormones.
  8. Tumors- adenoma, carcinoma and lymphoma.
  9. Others- sarcoidosis and syphilis.

Diagnosis of Goitre

  • Diagnosis of the common condition of simple goiter is arrived at by the exclusion of other causes, such as Hashimoto’s thyroiditis, sub-acute thyroiditis, dyshormonogenesis or carcinoma of the thyroid gland.

Investigation of Goiter

  • Thyroid function test- the level of the thyroid activity should be determined by the test.
  • Serum cholesterol- elevated in primary thyroid failure.
  • Tendon reflex duration- tendon reflexes are prolonged.
  • Thyroid antibodies- antibodies to thyroglobulin or thyroid peroxidase are typically strongly positive in Hashimoto’s thyroiditis.
  • Thyroid scan- it can be done to differentiate between a diffuse and nodular goiter. Metastatic goiter can also be detected.

Treatment for Goiter

  • An adequate intake of iodine, particularly in the early life, is the only really satisfactory way of preventing sporadic simple goiter.
  • Sub-total thyroidectomy- Indications- recurrent hyperthyroidism, sensitive reaction to anti-thyroid drugs, severe thyrotoxicosis, frankly large goiter with respiratory obstruction and poor drug compliance.
    Advantages- cure a higher percentage of person and cures in shorter time.
  • Replacement therapy- thyroxin (T4) is the treatment of choice in conditions of thyroiditis like Hashimoto’s disease and acute and sub-acute de Quervain’s thyroiditis. Duration of therapy is usually life long.

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