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Goitre: What you need to know

Goitre: What you need to knowIf you find yourself having throat tightness, cough and trouble swallowing, you may probably be suffering from symptoms of goitre. Goitre is a swelling (hypertrophy) of a gland in the neck called the thyroid gland. The thyroid gland is situated in front of the windpipe and is responsible for producing and secreting hormones that regulate growth and metabolism.

In rare cases, enlargement of the thyroid gland is caused by cancer, leading to a diagnosis of thyroid cancer rather than goitre. The degree of swelling and the severity of symptoms produced by the goitre depend on the individual. Some cases involve a small amount of swelling, and others can involve considerable swelling that actually constricts the trachea and causes breathing problems.

Most cases are categorised as ‘simple’ goitres that do not involve inflammation or any detriment to thyroid function, produce no symptoms, and often have no obvious cause.

What causes goitre?

Iodine deficiency is the major cause of goitre worldwide, but this is rarely a cause in more economically developed countries that add iodine to salt as iodine is inconsistently present in plant foods and vegan diets. Rates of goitre are higher in areas where there is a deficiency of the trace mineral, which is found in seafood, plant food grown in iodine-rich soil, and cow’s milk.

In some parts of the world, the prevalence of the condition can be as high as 80 per cent – such populations tend to be in remotely mountainous areas of SouthEast Asia, Latin America and central Africa, where daily intake of iodine can fall below 25 micrograms a day, and children are often born with hypothyroidism.

The thyroid gland needs iodine in order to manufacture thyroid hormones, which regulate the body’s rate of metabolism. The main cause of goitre in developed countries is autoimmune disease. Women over the age of 40 are at greater risk of goitre, as are people with a family history of the condition.

Signs and symptoms of goitre
  • Throat symptoms of tightness, cough, and hoarseness
  • Trouble swallowing (dysphagia)
  • In severe cases, difficulty breathing (possibly with a high-pitch sound).

Other symptoms may be present because of the underlying cause of the goitre, but they are not symptomatic of the goitre itself.

In cases where goitre is as a result of hypothyroidism, the underactive thyroid can cause symptoms such as cold intolerance, constipation, forgetfulness, personality changes, hair loss and weight gain. Aside from the swelling itself, many cases of goitre present no symptoms or signs at all. Most cases are classified as simple diffuse and therefore smooth to the touch; others, classified as nodular, feel lumpy because of solid or fluid-filled lumps.

Treatments for goitre

Goitre treatment depends on the size of the goitre, your signs and symptoms, and the underlying cause. Your doctor may recommend:

  • Observation. If your goitre is small and doesn’t cause problems, and your thyroid is functioning normally, your doctor may suggest a wait-and-see approach.
  • Medications. If you have hypothyroidism, thyroid hormone replacement with levothyroxine (Levothroid, Synthroid) will resolve the symptoms of hypothyroidism as well as slow the release of thyroid-stimulating hormone from your pituitary gland, often decreasing the size of the goitre. For inflammation of your thyroid gland, your doctor may suggest aspirin or a corticosteroid medication to treat the inflammation. For goitres associated with hyperthyroidism, you may need medications to normalise hormone levels.
  • Surgery. Removing all or part of your thyroid gland (total or partial thyroidectomy) is an option if you have a large goitre that is uncomfortable or causes difficulty breathing or swallowing, or in some cases, if you have nodular goitre causing hyperthyroidism. Surgery is also the treatment for thyroid cancer. You may need to take levothyroxine after surgery, depending on the amount of thyroid removed.
  • Radioactive iodine. In some cases, radioactive iodine is used to treat an overactive thyroid gland. The radioactive iodine is taken orally and reaches your thyroid gland through your bloodstream, destroying thyroid cells. The treatment results in diminished size of the goitre, but eventually may also cause an underactive thyroid gland.

By Gabriel Ifinnwa

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