Goitre: Wikis

  
  

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Goiter
Classification and external resources
File:Goiter.jpg
Nodular goiter of a young woman.
ICD-10 E01.-E05.
ICD-9 240.9
DiseasesDB 5332
MedlinePlus 001178
MeSH D006042

A goiter (Latin gutteria, struma), also called a bronchocele, is a swelling in the thyroid gland,[1] which can lead to a swelling of the neck or larynx (voice box). Goitre usually occurs when the thyroid gland is not functioning properly.

Contents

Classification

They are classified in different ways:

  • A "diffuse goiter" is a goiter that has spread through all of the thyroid (and can be a "simple goiter", or a "multinodular goiter").
  • "Toxic goiter" refers to goiter with hyperthyroidism. These most commonly due to Graves' disease, but can be caused by inflammation or a multinodular goiter.
  • "Nontoxic goiter" (associated with normal or low thyroid levels) refers to all other types (such as that caused by lithium or certain other autoimmune diseases).

Other type of classification:

  • I - palpation struma - in normal posture of head it cannot be seen. Only found when palpating.
  • II - struma is palpative and can be easily seen.
  • III - struma is very big and is retrosternal. Pressure and compression marks.

Symptoms

In general, goiter unassociated with any hormonal abnormalities will not cause any symptoms aside from the presence of anterior neck mass. However, for particularly large masses, compression of the local structures may result in difficulty in breathing or swallowing. In those presenting with these symptoms, malignancy must be considered.

Meanwhile, toxic goiters will present with symptoms of thyrotoxicosis such as palpitations, hyperactivity, weight loss despite increased appetite, and heat intolerance.

Causes

Worldwide, the most common cause for goiter is iodine deficiency. In countries that use iodized salt, Hashimoto's thyroiditis becomes the most common cause.

Other causes are:

Hypothyroid

Hyperthyroid

Treatment

Treatment may not be necessary if the goiter is small. Goiter may be related to hyper- and hypothyroidism (especially Graves' disease) and may be reversed by treatment. Graves' disease can be corrected with antithyroid drugs (such as propylthiouracil and methimazole), thyroidectomy (surgical removal of the thyroid gland), and iodine-131 (131I - a radioactive isotope of iodine that is absorbed by the thyroid gland and destroys it). Hypothyroidism may raise the risk of goitre because it usually increases the production of TRH and TSH. Levothyroxine, used to treat hypothyroidism, can also be used in euthyroid patients for the treatment of goitre. Levothyroxine suppressive therapy decreases the production of TRH and TSH and may reduce goitre, thyroid nodules, and thyroid cancer. Blood tests are needed to ensure that TSH is still in range and the patient has not become subclinically hyperthyroid. If TSH levels are not carefully monitored, it is alleged that levothyroxine may increase the risk of osteoporosis but no peer reviewed studies on levothyroxine replacement of Hypothyroid patients causing this effect have actually been produced.

Thyroidectomy with 131I may be necessary in euthyroid goitrous patients who do not respond to levothyroxine treatment, especially if the patients have difficulty breathing or swallowing. 131I, with or without the pre-injection of synthetic TSH, can relieve obstruction and reduce the size of the goitre by thirty to sixty-five percent. Depending on how large the goiter is and how much of the thyroid gland must be removed or destroyed, thyroidectomy or 131I may produce hypothyroidism requiring life-long treatment and may eventually lead to death.

Epidemiology

Disability-adjusted life year for iodine deficiency per 100,000 inhabitants in 2002.[2]
     no data      less than 50      50-100      100-150      150-200      200-250      250-300      300-350      350-400      400-450      450-500      500-800      more than 800

Iodine is necessary for the synthesis of the thyroid hormones thyroxine (T4) and triiodothyronine (T3). In endemic goitre, iodine deficiency leaves the thyroid gland unable to produce its hormones because the mature hormone molecules require iodine atoms to be attached. When levels of thyroid hormones fall, thyrotropin-releasing hormone (TRH) is produced by the hypothalamus. TRH then prompts the pituitary gland to make thyrotropin or thyroid stimulating hormone (TSH), which stimulates the thyroid gland’s production of T4 and T3. It also causes the thyroid gland to grow in size by increasing cell division. Goiter 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.

History

Chinese physicians of the Tang Dynasty (618–907) were the first to successfully treat patients with goitre by using the iodine-rich thyroid gland of animals such as sheep and pigs—in raw, pill, or powdered-mixture-in-wine form.[3] This was outlined in Zhen Quan's (d. 643 AD) book, as well as several others.[4] One Chinese book (i.e. The Pharmacopoeia of the Heavenly Husbandman) asserted that iodine-rich sargassum was used to treat goitre patients by the 1st century BC, but this book was written much later.[5]

In the 12th century, Zayn al-Din al-Jurjani, a Persian physician, provided the first description of Graves' disease after noting the association of goitre and exophthalmos in his Thesaurus of the Shah of Khwarazm, the major medical dictionary of its time.[6][7] Al-Jurjani also established an association between goitre and palpitation.[8] The disease was later named after Irish doctor Robert James Graves,[9] who described a case of goiter with exophthalmos in 1835. The German Karl Adolph von Basedow also independently reported the same constellation of symptoms in 1840, while earlier reports of the disease were also published by the Italians Giuseppe Flajani and Antonio Giuseppe Testa, in 1802 and 1810 respectively,[10] and by the English physician Caleb Hillier Parry (a friend of Edward Jenner) in the late 18th century.[11]

Paracelsus (1493–1541) was the first person to propose a relationship between goitre and minerals (particularly lead) in drinking water.[12] Iodine was later discovered by Bernard Courtois in 1811 from seaweed ash.

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 table salt is supplemented with iodine. However, it is still prevalent in India, China[13] Central Asia and Central Africa.

Society and culture

Famous goitre sufferers

See also

References

  1. ^ goiter at Dorland's Medical Dictionary
  2. ^ "Mortality and Burden of Disease Estimates for WHO Member States in 2002" (xls). World Health Organization. 2002. http://www.who.int/entity/healthinfo/statistics/bodgbddeathdalyestimates.xls. 
  3. ^ Temple, Robert. (1986). The Genius of China: 3,000 Years of Science, Discovery, and Invention. With a forward by Joseph Needham. New York: Simon and Schuster, Inc. ISBN 0671620282. Pages 133–134.
  4. ^ Temple, Robert. (1986). The Genius of China: 3,000 Years of Science, Discovery, and Invention. With a forward by Joseph Needham. New York: Simon and Schuster, Inc. ISBN 0671620282. Page 134.
  5. ^ Temple, Robert. (1986). The Genius of China: 3,000 Years of Science, Discovery, and Invention. With a forward by Joseph Needham. New York: Simon and Schuster, Inc. ISBN 0671620282. Pages 134–135
  6. ^ Basedow's syndrome or disease at Who Named It? - the history and naming of the disease
  7. ^ Ljunggren JG (August 1983). "[Who was the man behind the syndrome: Ismail al-Jurjani, Testa, Flagani, Parry, Graves or Basedow? Use the term hyperthyreosis instead]". Lakartidningen 80 (32-33): 2902. PMID 6355710. 
  8. ^ Nabipour, I. (2003), "Clinical Endocrinology in the Islamic Civilization in Iran", International Journal of Endocrinology and Metabolism 1: 43–45 [45] 
  9. ^ Robert James Graves at Who Named It?
  10. ^ Giuseppe Flajani at Who Named It?
  11. ^ Hull G (1998). "Caleb Hillier Parry 1755-1822: a notable provincial physician". Journal of the Royal Society of Medicine 91 (6): 335–8. PMID 9771526. 
  12. ^ "Paracelsus" Britannica
  13. ^ "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
  14. ^ The Health and Medical History of President George Bush DoctorZebra.com. 8 August 2004. Retrieved 8 October 2006.
  15. ^ "George H.W. Bush." NNDB.
  16. ^ Robert G. Lahita and Ina Yalof. Women and Autoimmune Disease: The Mysterious Ways Your Body Betrays Itself. Page 158.
  17. ^ Lawrence K. Altman, M.D. “Doctors Say Bush Is in Good Health.” The New York Times. September 14, 1991.
  18. ^ Lawrence K. Altman, M.D. “The Doctor’s World; A White House Puzzle: Immunity Ailments.”, The New York Times. May 28, 1991]
  19. ^ “Andrea True.” Elle.

External links


1911 encyclopedia

Up to date as of January 14, 2010

From LoveToKnow 1911

GOITRE (from Lat. guttur, the throat; synonyms, Bronchocele, Derbyshire Neck), a term applied to a swelling in the front of the neck caused by enlargement of the thyroid gland. This structure, which lies between the skin and the anterior surface of the windpipe, and in health is not large enough to give rise to any external prominence (except in the pictures of certain artists), is liable to variations in size, more especially in females, a temporary enlargement of the gland being not uncommon at the catamenial periods, as well as during pregnancy. In goitre the swelling is conspicuous and is not only unsightly but may occasion much discomfort from its pressure upon the windpipe and other important parts of the neck. J. L. Alibert recorded cases of goitre where the tumour hung down over the breast, or reached as low as the middle of the thigh.

Goitre usually appears in early life, often from the eighth to the twelfth year; its growth is at first slow, but after several years of comparative quiescence a sudden increase is apt to occur. In the earlier stages the condition of the gland is simply an enlargement of its constituent parts, which retain their normal soft consistence; but in the course of time other changes supervene, and it may become cystic, or acquire hardness from increase of fibrous tissue or from calcareous deposits. Occasionally the enlargement is uniform, but more commonly one of the lobes, generally the right, is the larger. In rare instances the disease is limited to the isthmus which connects the two lobes of the gland. The growth is unattended with pain, and is not inconsistent with good health.

Goitre is a marked example of an endemic disease. There are few parts of the world where it is not found prevailing in certain localities, these being for the most part valleys and elevated plains in mountainous districts(see Cretinism). The malady is generally ascribed to the use of drinking water impregnated with the salts of lime and magnesia, in which ingredients the water of goitrous districts abounds. But in localities not far removed from those in which goitre prevails, and where the water is of the same chemical composition, the disease may be entirely unknown. The disease may be the result of a combination of causes, among which local telluric or malarial influences concur with those of the drinking water. Goitre is sometimes cured by removal of the individual from the district where it prevails, and it is apt to be acquired by previously healthy persons who settle in goitrous localities; and it is only in such places that the disease exhibits hereditary tendencies.

In the early stages, change of air, especially to the seaside, is desirable, and small doses of iron and of iodine should be given; if this fails small doses of thyroid extract should be tried. If palliative measures prove unsuccessful, operation must be undertaken for the removal of one lateral lobe and the isthmus of the tumour. This may be done under chloroform or after the subcutaneous injection of cocaine. If chloroform is used, it must be given very sparingly, as the breathing is apt to become seriously embarrassed during the operation. After the successful performance of the operation great improvement takes place, the remaining part of the gland slowly decreasing in size. The whole of the gland must not be removed during the operation, lest the strange disease known as Myxoedema should be produced (see Metabolic Diseases).

In exophthalmic goitre the bronchocele is but one of three phenomena, which together constitute the disease, viz. palpitation of the heart, elargement of the thyroid gland, and protrusion of the eyeballs. This group of symptoms is known by the name of "Graves's disease" or "Von Basedow's disease" - the physicians by whom the malady was originally described. Although occasionally observed in men, this affection occurs chiefly in females, and in comparatively early life. It is generally preceded by impoverishment of blood, and by nervous or hysterical disorders, and it is occasionally seen in cases of organic heart disease. It has been suddenly developed as the effect of fright or of violent emotion. The first symptom is usually the palpitation of the heart, which is aggravated by slight exertion, and may be so severe as not only to shake the whole frame but even to be audible at some distance. A throbbing is felt throughout the body, and many of the larger blood-vessels are, like the heart, seen to pulsate strongly. The enlargement of the thyroid is gradual, and rarely increases to any great size, thus differing from the commoner form of goitre. The enlarged gland is of soft consistence, and communicates a thrill to the touch from its dilated and pulsating blood-vessels. Accompanying the goitre a remarkable change is observed in the eyes, which attract attention by their prominence, and by the startled expression thus given to the countenance. In extreme cases the eyes protrude from their sockets to such a degree that the eyelids cannot be closed, and injury may thus arise to the constantly exposed eyeballs. Apart from such risk, however, the vision is rarely affected. It occasionally happens that in undoubted cases of the disease one or other of the three above-named phenomena is absent, generally either the goitre or the exophthalmos. The palpitation of the heart is the most constant symptom. Sleeplessness, irritability, disorders of digestion, diarrhoea and uterine derangements, are frequent accompaniments. It is a serious disease and, if unchecked, may end fatally. Some cases are improved by general hygienic measures, others by electric treatment, or by the administration of animal extracts or of sera. Some cases, on the other hand, may be considered suitable for operative treatment. (E. O.*)


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Simple English

[[File:|thumb|a woman with a goitre]]

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 gland.

[[File:|thumb|Thyroid gland]]

Contents

Classification

They are classified in different ways:

  • A "diffuse goitre" is a goitre that has spread through all of the thyroid (and can be a "simple goitre", or a "multinodular goitre").
  • "Toxic goitre" refers to goitre with hyperthyroidism. These most commonly due to Graves disease, but can be caused by inflammation or a multinodular goitre.
  • "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).

Causes

Other causes are:

  • Thyroid cancer
  • Iodine deficiency
  • Hashimoto's thyroiditis (E06.3)
  • Graves-Basedow disease (E05.0)
  • inborn errors of thyroid hormone synthesis, causing congenital hypothyroidism (E03.0)
  • Thyroiditis (acute, chronic) (E06)
  • Side-effects of pharmacological therapy (E03.2)

New research indicates that there may be a tendency to inherit an increased vulnerability to goitre.

Famous goitre sufferers

References

Other websites

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