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| {{SK}} Goitre; goiter; bronchocele | | {{SK}} Goitre; goiter; bronchocele |
| ==Overview==
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| A '''goitre''' (BrE), or '''goiter''' (AmE) ([[Latin]] ''struma''), also called a '''bronchocele''', is a swelling in the neck (just below [[Adam's apple]] or [[larynx]]) due to an enlarged [[thyroid|thyroid gland]].
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| ==Classification== | | ==[[Goitre overview|Overview]]== |
| They are classified in different ways:
| | ==[[Goitre historical perspective|Historical Perspective]]== |
| | | ==[[Goitre classification|Classification]]== |
| * A "diffuse goitre" is a goitre that has spread through all of the thyroid (and can be a "simple goitre", or a "multinodular goitre").
| | ==[[Goitre pathophysiology |Pathophysiology]]== |
| * "Toxic goitre" refers to goitre with [[hyperthyroidism]]. These most commonly due to [[Graves disease]], but can be caused by [[inflammation]] or a multinodular goitre.
| | ==[[Goitre causes|Causes]]== |
| * "Nontoxic goitre" (associated with normal or low thyroid levels) refers to all other types (such as that caused by [[lithium]] or certain other [[autoimmune]] diseases).
| | ==[[Goitre differential diagnosis|Differentiating Goitre from other Diseases]]== |
| | | ==[[Goitre epidemiology and demographics|Epidemiology and Demographics]]== |
| == Causes == | | ==[[Goitre risk factors|Risk Factors]]== |
| | | ==[[Goitre natural history, complications and prognosis|Natural history, Complications and Prognosis]]== |
| Other causes are:
| | ==Diagnosis== |
| * [[Hashimoto's thyroiditis]] (E06.3)
| | [[Goitre history and symptoms|History and Symptoms]] | [[Goitre physical examination|Physical Examination]] | [[Goitre laboratory findings|Laboratory Findings]] | [[Goitre ultrasound|Ultrasound]] | [[Goitre other diagnostic studies|Other Diagnostic Studies]] |
| * [[Graves-Basedow disease]] (E05.0)
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| * inborn errors of thyroid hormone synthesis, causing [[congenital hypothyroidism]] (E03.0)
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| * [[Thyroiditis]] (acute, chronic) (E06)
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| * [[Adverse drug reaction|Side-effects]] of pharmacological therapy (E03.2)
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| * [[Thyroid cancer]]
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| * [[Iodine]] deficiency
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| == Occurrence == | |
| Iodine is necessary for the synthesis of the thyroid [[hormone]]s [[triiodothyronine]] and [[thyroxine]] (T3 and T4). In conditions producing endemic goitre, when iodine is not available, these hormones cannot be made. In response to low thyroid hormones, the [[pituitary gland]] releases [[thyroid stimulating hormone]] (TSH). Thyroid stimulating hormone acts to increase synthesis of T3 and T4, but it also causes the thyroid gland to grow in size by increasing cell division.
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| Goitre is more common among women, but this includes the many types of goitre caused by autoimmune problems, and not only those caused by simple lack of iodine.
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| ==Treatment== | | ==Treatment== |
| Treatment for goitre may not be necessary if the goitre is small. [[Hypothyroidism]] should be treated, and this treatment often leads to a substantial reduction in the size of the goitre. Removal of the goitre may be necessary if it causes difficulty with breathing or swallowing. There is now an alternative to surgery in large goitres. Radioiodine therapy with or without the pre-injection of a synthetic [[thyroid stimulating hormone]], TSH, can relieve obstruction and reduce the size of the goitre by 30-65%. But removal of a goitre requires removing the thyroid. The complete removal of the thyroid gland removes the body's ability to produce thyroid hormone. In this case, oral [[thyroxine]] supplements are necessary to avoid harm from [[hypothyroidism]].
| | [[Goitre medical therapy|Medical Therapy]] | [[Goitre surgery|Surgery]] | [[Goitre radioactive iodine|Rdioactive Iodine]] | [[Goitre primary prevention|Primary Prevention]] | [[Goitre cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] |
| | | ==Case Studies== |
| == History and future == | | :[[Goitre case study one|Case #1]] |
| Paracelsus (born Philippus Aureolus Theophrastus Bombastus von Hohenheim) (1493–1541) was the first to describe the connection between goitre and the consumption of minerals, specifically lead in drinking water.<ref>[http://dictionary.reference.com/browse/Paracelsus "Paracelsus"] entry in Dictionary.com, retrieved October 9, 2007</ref>
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| Goitre was previously common in many areas that were deficient in iodine in the soil. For example, in the English Midlands, the condition was known as '''Derbyshire Neck'''. In the United States, goitre was found in the Great Lakes, Midwest, and Intermountain regions. The condition now is practically absent in affluent nations, where [[Sodium chloride|table salt]] is supplemented with iodine. However, it is still prevalent in India,<ref>[http://www.nytimes.com/2006/12/16/health/16iodine.html "In Raising the World’s I.Q., the Secret’s in the Salt"], article by Donald G. McNeil, Jr., December 16, 2006, ''New York Times''</ref> Central Asia and Central Africa.
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| Some health workers fear that a resurgence of goitre might occur because of the trend to use rock salt and/or sea salt, which has not been fortified with [[iodine]].
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| New research indicates that there may in fact be a tendency to inherit an increased vulnerability to goitre.
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| ==See also== | | ==See also== |
| *[[Struma ovarii]] (a kind of [[teratoma]]) | | *[[Struma ovarii]] (a kind of [[teratoma]]) |
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| ==References==
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| {{reflist|2}}
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| == External links ==
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| * [http://www.nhsdirect.nhs.uk/articles/article.aspx?articleId=179 National Health Services, UK]
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| * [http://www.iodinenetwork.net Network for Sustained Elimination of Iodine Deficiency]
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| * [http://www.sph.emory.edu/PAMM/sang/partnership/ Network for Sustained Elimination of Iodine Deficiency] - alternate site at Emory University's School of [[Public Health]]
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| {{Endocrine pathology}} | | {{Endocrine pathology}} |
