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| {{Infobox_Disease | | | {| class="infobox bordered" style="width: 15em; text-align: left; font-size: 90%; background:AliceBlue" |
| Name = {{PAGENAME}} |
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| Image = Kone_med_stor_struma.jpg |
| | | colspan="1" style="text-align:center; background:DarkGray" | |
| Caption = A woman with a goiter. |
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| DiseasesDB = 5332 |
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| ICD10 = {{ICD10|E|01|0|e|00}}-{{ICD10|E|01|2|e|00}} |
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| ICD9 = {{ICD9|240.9}} |
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| ICDO = |
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| OMIM = |
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| MedlinePlus = 001178 |
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| eMedicineSubj = |
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| eMedicineTopic = |
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| MeshID = Goiter |
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| }}
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| {{SI}}
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| {{CMG}}
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| | '''Goiter Microchapters''' |
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| ==Overview==
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| '''Goiter''' is defined as an enlargement of the [[thyroid gland]].
| | [[Cushing’s disease|Home]] |
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| ==Etymology== | | |- bgcolor="Pink" |
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| | [[Goiter (patient information)|Patient Information]] |
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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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| | [[Goiter overview|Overview]] |
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| ==Classification== | | |- bgcolor="Pink" |
| They are classified in different ways:
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| | [[Goiter historical perspective|Historical Perspective]] |
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| * A "diffuse goitre" is a goitre that has spread through all of the thyroid (and can be a "simple goitre", or a "multinodular goitre").
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| * "Toxic goitre" refers to goitre with [[hyperthyroidism]]. These most commonly due to [[Graves disease]], but can be caused by [[inflammation]] or a multinodular goitre.
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| * "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).
| | [[Goiter classification|Classification]] |
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| == Epidemiology and Demographics == | | |- bgcolor="Pink" |
| * Sporadic form more common in women: 8:1 (female:male)
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| | [[Goiter pathophysiology|Pathophysiology]] |
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| == Causes == | | |- bgcolor="Pink" |
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| | [[Goiter causes|Causes]] |
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| Other causes are:
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| * [[Hashimoto's thyroiditis]] (E06.3)
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| * [[Graves-Basedow disease]] (E05.0)
| | [[Goiter differential diagnosis|Differentiating Goiter from other Diseases]] |
| * [[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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| == Occurrence == | | |- bgcolor="Pink" |
| 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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| | [[Goiter epidemiology and demographics|Epidemiology and Demographics]] |
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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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| | [[Goiter risk factors|Risk Factors]] |
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| ==Diagnosis== | | |- bgcolor="Pink" |
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| | [[Goiter screening|Screening]] |
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| ===Physical examination=== | | |- bgcolor="Pink" |
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| | [[Goiter natural history, complications and prognosis|Natural History, Complications and Prognosis]] |
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| * Inspection
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| * Palpation
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| | Diagnosis |
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| (Images courtesy of Charlie Goldberg, M.D., UCSD School of Medicine and VA Medical Center, San Diego, CA)
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| | [[Goiter history and symptoms|History and Symptoms]] |
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| <div align="left">
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| <gallery heights="175" widths="175">
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| Image:thyromegaly.jpg|Thyromegaly
| | [[Goiter physical examination|Physical Examination]] |
| Image:head_goiter2.jpg|Thyromegaly
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| Image:head_goiter1.jpg|Thyromegaly
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| </gallery>
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| </div>
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| ===Laboratory tests=== | | |- bgcolor="LightSkyBlue" |
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| | [[Goiter laboratory findings|Laboratory Findings]] |
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| * [[T3]]
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| * [[T4]]
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| * [[TSH]]
| | [[Goiter electrocardiogram|Electrocardiogram]] |
| * [[FT3]]
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| * [[FT4]]
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| === Thyroid ultrasound=== | | |- bgcolor="LightSkyBlue" |
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| | [[Goiter chest x ray|Chest X Ray]] |
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| == Differential Diagnosis == | | |- bgcolor="LightSkyBlue" |
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| | [[Goiter CT|CT]] |
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| In alphabetical order. <ref>Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016</ref> <ref>Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X</ref>
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| | [[Goiter MRI|MRI]] |
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| === Diffuse Goiter === | | |- bgcolor="LightSkyBlue" |
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| | [[Goiter echocardiography or ultrasound|Echocardiography or Ultrasound]] |
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| * [[Acromegaly]]
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| * [[Acute thyroiditis]]
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| * [[Adenoma of the thyroid]]
| | [[Goiter other imaging findings|Other Imaging Findings]] |
| * [[Amyloidosis]]
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| * [[Anaplastic carcinoma of the thyroid]]
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| * Benign and malignant thyroid gland tumors
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| * Calcium and fluorides in water
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| * [[Carcinosarcoma of the thyroid]]
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| * Chemicals
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| * [[Colloid nodule of the thyroid]]
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| * Compensatory hyperplasia after hemithyroidectomy
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| * [[Cyst]]
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| * Defects in thyroid hormone synthesis
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| * [[DeQuervain's Thyroiditis]]
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| * [[Drugs]]
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| * Excess [[thyroid stimulating hormone]] ([[TSH]])
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| * Focal [[thyroiditis]]
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| * [[Follicular carcinoma of the Thyroid]]
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| * Goitrogenic vegetables (bamboo shoots, broccoli, cabbage, cassava, cauliflower, brussels sprouts, turnips)
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| * [[Grave's Disease]]
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| * [[Hashimoto's Thyroiditis]]
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| * [[Hematoma]]
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| * [[Hyperthyroidism]]
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| * [[Hypothyroidism]]
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| * Impairment of the thyroid hormone synthesis/enzyme defect
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| * [[Insulin-like growth factor]]
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| * [[Iodine deficiency]]
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| * [[Lymphoma]]
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| * Maternal antithyroid drug therapy
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| * Maternal iodine therapy
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| * [[Medullary carcinoma of the thyroid]]
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| * [[Menopause]]
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| * [[Metastases of extrathyroidal tumors]]
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| * [[Mixed papillary-follicular carcinoma of the thyroid]]
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| * [[Multiple adenomas]]
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| * [[Nontoxic nodular goiter]]
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| * [[Papillary carcinoma of the thyroid]]
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| * [[Paraneoplastic production of thyroid stimulating hormone]] ([[TSH]])
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| * [[Parasite]]
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| * Parathyroid tumoral tissue
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| * [[Pregnancy]]
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| * [[Puberty]]
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| * [[Reidel's Thyroiditis]]
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| * Resistance to thyroid hormone
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| * [[Sarcoidosis]]
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| * [[Sarcoma]]
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| * [[Selenium deficiency]]
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| * [[Silent thyroiditis]]
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| * [[Squamous Cell Carcinoma of the thyroid]]
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| * [[Toxic multinodular goiter]]
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| * Thymic tumoral tissue
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| * Thyroid gland autonomy
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| * Thyroid growth immunoglobulins
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| * [[Thyroiditis]]
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| === Hyperthyroid === | | |- bgcolor="LightSkyBlue" |
| * [[Chloriocarcinoma of the thyroid]]
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| * [[Embrional cell carcinoma of the testis]]
| | [[Goiter other diagnostic studies|Other Diagnostic Studies]] |
| * Gestational stimulation by human chorionic gonadotropin
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| * [[Grave's Disease]]
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| * [[Hydatiform mole]]
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| * Pituitary resistence to thyroid hormone
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| * [[Thyroid stimulating hormone (TSH)-secreting pituitary gland tumor]]
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| * [[Thyroiditis]]
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| === Other === | | |- bgcolor="CadetBlue" |
| * [[Carotid]] [[aneurysm]]
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| * [[Cystic hygroma]]
| | Treatment |
| * [[Dermoid]]
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| * [[Hemangioma]]
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| * [[Lipoma]]
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| * [[Lymph node]]
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| * [[Parathyroid]] [[adenoma]]
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| * [[Teratoma]]
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| * [[Thyroglossal duct cyst]]
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| ==Treatment== | | |- bgcolor="PaleTurquoise" |
| 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, supplements of oral [[thyroxine]] are necessary to avoid harm from [[hypothyroidism]].
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| | [[Goiter surgery|Surgery]] |
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| == History and future == | | |- bgcolor="PaleTurquoise" |
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| | [[Goiter medical therapy|Medical Therapy]] |
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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 Midwest, and Intermountain regions. The condition now is practically absent in affluent nations, where [[Sodium chloride|table salt]] is [[Iodized salt|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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| | [[Goiter Radiation therapy|Radiation therapy]] |
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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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| | [[Goiter primary prevention|Primary Prevention]] |
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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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| | [[Goiter secondary prevention|Secondary Prevention]] |
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| ==See also== | | |- bgcolor="PaleTurquoise" |
| *[[Struma ovarii]] (a kind of [[teratoma]])
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| | [[Goiter cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] |
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| ==References== | | |- bgcolor="PaleTurquoise" |
| {{reflist|2}}
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| | [[Goiter future or investigational therapies|Future or Investigational Therapies]] |
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| == External links == | | |- bgcolor="CadetBlue" |
| * [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]
| | Case Studies |
| * [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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| == References == | | |- bgcolor="PaleTurquoise" |
| {{reflist|2}}
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| | [[Goiter case study one|Case #1]] |
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| == Suggested Reading and Key General References == | | |- bgcolor="PaleGoldenrod " |
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| | {{PAGENAME}} On the Web |
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| == Suggested Links and Web Resources == | | |- bgcolor="LightYellow" |
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| | [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?CMD=search&db=pubmed&term={{urlencode:{{#if:{{{1|}}}|{{{1}}}|{{PAGENAME}}}}}} Most recent articles] |
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| == For Patients == | | |- bgcolor="LightYellow" |
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| | [http://scholar.google.com/scholar?ie=UTF-8&oe=utf-8&q={{urlencode:{{#if:{{{1|}}}|{{{1}}}|{{PAGENAME}}}}}}&qt_s=Search&sa=N&tab=ps Most cited articles] |
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| {{endocrine_system}} | | |- bgcolor="LightYellow" |
| {{Endocrinology}} | | ! |
| {{Endocrine pathology}} | | [http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=search&db=pubmed&term={{urlencode:{{#if:{{{1|}}}|{{{1}}}|{{PAGENAME}}}}}}%20AND%20systematic%5Bsb%5D Review articles] |
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| | [http://www.google.com/search?q={{urlencode:{{#if:{{{1|}}}|{{{1}}}|{{PAGENAME}}}}}}+ppt&ie=utf-8&oe=utf-8&aq=t&rls=org.mozilla:en-US:official&client=firefox-a Powerpoint slides] |
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