You felt your neck was swollen but never bothered about it, till you felt your hands had some spontaneous movements. You have never felt such tremors earlier. You also started feeling very hot despite of the cooling being adequate at home. Now you are anxious and worried if the swelling in the neck is the underlying cause for it. You fear having a cancer. You should learn more to handle this.
About goiter
Goiter is an abnormal diffuse or nodular enlargement of the thyroid gland, a butterfly shaped gland situated in the neck just below the Adam’s apple. This produces hormones thyroxine (T4) and triiodothyronine (T3) that are required to maintain the bodily processes necessary for life. These control the mood, pulse, digestion, and energy levels. Goiter can be seen in the presence of normal, deficient (hypothyroidism), or exaggerated (hyperthyroidism) function of the thyroid gland. Usually a painless enlargement, goiter is not a cancer.
Women above the age of 50 are more prone to goiter. So are the pregnant women. A diet deficient in iodine or rich in hormone inhibiting foods like cabbage, broccoli, and cauliflower, is a major modifiable risk factor for goiter. Having another family member affected by an autoimmune enlargement of the thyroid increases the risk as these conditions can be inherited. Exposure to radiation, either accidental as in nuclear accidents or for therapy as in treatment of other medical condition of neck or chest, also increases the risk for goiter.
Causes
Goiter occurs when the thyroid gland does not produce enough hormones to meet the requirements in the body for driving the chemical process of energy production and utilization. To meet the increased needs, the thyroid enlarges. Simple goiter is of two types, endemic (colloid) and sporadic (nontoxic) goiter. Colloid goiter occurs in people living in areas with iodine-deficient soil. Since iodine is a mineral necessary for thyroid hormone production, these people are not able to make enough of hormones and this causes the thyroid to enlarge. Another factor for iodine deficiency goiter is the consumption of hormone-inhibiting foods like cabbage, broccoli and cauliflower. The exact cause in sporadic goiter is not known. In another type of goiter seen in Grave’s disease, there is an autoimmune cause for goiter. Goiter occurs because the defense system, called the immune system that usually attacks invading germs to destroy them, aberrantly attacks the thyroid and stimulates it to produce more hormones and causes it to enlarge. In another autoimmune condition called Hashimoto’s disease, there is an underproduction of hormones and this causes the thyroid to enlarge as it attempts to produce more hormones in an attempt to compensate the deficiency. In another type of goiter called the nodular goiter, one or more nodules may cause growth and hence enlargement of the thyroid gland. In most cases, these nodules are not a cancer. Hormonal changes in pregnancy can cause the thyroid to enlarge. Cancer of the thyroid and inflammation are other causes of goiter. Some medicines like lithium or aminoglutethimide can cause a nontoxic goiter.
Symptoms
The main symptom of goiter is an enlarged thyroid. This may be a localized swelling in form of a nodule or a generalized enlargement that is evidently visible. As the thyroid gland enlarges in the neck, it can press upon the surrounding structures in the neck and upper chest. Pressure upon the wind pipe can cause cough and hoarseness. Breathing may get difficult with large goiters. Pressure upon food pipe causes difficult swallowing. Upon raising the arm above the head, there may be a swelling of superficial blood vessels in neck and dizziness.
Thyroid enlargement can have complications due to the over or under function of the gland. Excessive production of thyroid hormones called hyperthyroidism can cause an increase in heart beat, diarrhea, tremors, agitation, sleep problems, anxiety, weight loss despite of increased or normal appetite, and excessive sweating and heat intolerance. An under activity of the thyroid, called hypothyroidism, can lead to tiredness, weight gain, constipation, dry rough skin, loss of hair, and menstrual irregularities.
Diagnosis
Goiter is diagnosed by clinical examination and few tests. The patient may be asked to swallow while the doctor palpates the gland. An enlarged gland can be felt as a prominence that moves with the act of swallowing. A blood test may be done to assess the thyroid function. This involves laboratory measurement of the hormones T3 and T4. In addition, thyroid stimulating hormone (TSH) may be measured. This is a hormone produced by the pituitary gland, a small pea shaped gland situated at the base of the brain. TSH regulates the hormone production by the thyroid. The blood may also be tested for antibodies if an autoimmune cause is suspected. An ultrasound may reveal the size, nodules, and any possible compressions. A thyroid scan may be done by injecting a radioactive material into the superficial blood vessel and then taking images to study its uptake by the thyroid gland. This uptake is suggestive to the activity of the gland. The size and extent of goiter can be studied by doing a CT scan or magnetic resonance imaging (MRI).
Treatment
A goiter that is too small and causes no distressing symptoms may be just advised a watchful waiting. If goiter occurs due to iodine deficiency, solution of potassium iodine or Lugol’s iodine may be taken. Radioactive iodine treatment may help to shrink an overactive gland that is producing excess hormones. A part or whole gland may be removed surgically if it is causing disabling symptoms. In hypothyroidism, thyroid hormones may be supplemented as tablets containing medicine called levothyroxine. If the goiter is due to inflammation, medicines like aspirin or corticosteroids can help.
Outlook
Goiter is becoming a public health problem in many regions. Awareness and community participation can help to address this growing concern. Goiter can be prevented by regular consumption of iodized table salt. Foods rich in iodine include seaweeds and seafood like shrimp and shellfish, cow’s milk, yogurt, and some vegetables grown in coastal regions. Paradoxically, too much of iodine can also lead to goiter. If this is the situation then the iodine rich foods and supplements should be discontinued.
