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Goiter

Judith and her maidservant. Artemisia Gentileschi.
Goiter is latin term that refers to a structural problem with the thyroid gland, specifically a globally enlarged thyroid gland. The enlarged thyroid may or may not have another type of structural thyroid problem called thyroid nodules.  Patients with goiters can also have functional thyroid problems, so there are two types of goiters: Non-Toxic Goiter and Toxic Multinodular Goiter.  Your endocrinologist at Houston Thyroid and Endocrine can go into much more detail.  Many people never have any symptoms from a goiter.  The symptoms that may suggest goiter depend on the rate at which the thyroid is growing and if there is a functional thyroid problem as well.  The symptoms of a goiter include compressive symptoms (choking, swallowing, breathing difficulties), enlargement of the neck, hypothyroidism, and hyperthyroidismThe picture is a representation of goiter in Artemisia Gentileschi's painting Judith and her Maidservant. Judisth is depicted with a goiter, which despite being a manifestation of possible hypothyroidism, in no way detracts from her beauty. .
  

1. Simple non-toxic goiter is defined as any thyroid enlargement associated with hyperthyroidism or hypothyroidism. 

2. Simple goiter refers to a thyroid enlargement in the setting or hyper or hypothyroidism.

3. Toxic multinodular goiter refers to enlarged thyroid glands which are associated with hyperthyroidism. Graves disease is a subset. 
 

Causes of Goiter

Goiter has traditionally been thought to be an adaptive response of the thyroid to any factor that impairs thyroid hormone synthesis. This classic concept of goiter does not explain all the other aspects of goiters.  Years ago it was thought that iodine deficiency was the main cause of goiter since iodine is the main building-block of thyroid hormone.  There is a role of genetic factors in the formation of goiters. This is suggested by the clustering of goiters within families, the higher concordance rate of goiters in monozygotic twins than in dizygotic twins, The female to male ratio of 1:1 in iodine deficient areasversus 9:1 in sporadic goiters, and the presence of goiters in areas where iodine is no longer deficient. The endocrinologists at Houston Thyroid and Endocrine believe goiter should be regarded as a complex genetic trait that is affected by environmental factors.  Although iodine defiency is the most common environmental cause, other factors such as cigarette smoking, infections, drugs, and goitrogens.

Treatment

In many cases, treatment is not needed. Goiters associated with functional disease (hypothyroidism and hyperthyroidism) need to be treated. Thyroid nodules may need evaluation by fine needle aspiration. Let an endocrinologist help in the management. 


References:Helen Christopoulou-Aletra, Niki Papavramidou, and Prof. Paolo Pozzilli. Thyroid. January 2007, 17(1): 37-38. doi:10.1089/thy.2006.0223.
 

 
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