| The thyroid gland is located in the front of the neck and secretes hormones (thyroxine and triiodothyronine) that play an important role in controlling the body's metabolism. An enlarged thyroid gland is called a goiter. There are many different causes of goiters.
When a goiter is present, production of thyroid hormones may be normal, excessive, or inadequate. An enlarged thyroid gland with normal function may occur at the onset of puberty, during pregnancy, as a result of taking birth control pills, or at menopause.
The thyroid gland requires iodine in order to produce thyroxine. Insufficient iodine in the diet causes the gland to swell. Goiters have historically been a local (endemic) problem in developing countries, parts of Europe, and in the Great Lakes region (before iodine was added to the US salt supply). Although iodine deficiency is the most common cause of endemic goiter, certain foods and water pollutants can themselves cause goiter or aggravate a tendency toward goiter.
A toxic goiter produces excessive thyroid hormones leading to thyrotoxicosis. Some symptoms of thyrotoxicosis include a rapid heart rate, tremors, weight loss, and nervousness.
A goiter may be associated with conditions in which the immune system reacts against the body's own tissues (autoimmune disorders), including Hashimoto's thyroiditis and Graves' disease. Decreased thyroid hormone production (hypothyroidism) or overproduction of thyroid hormone (hyperthyroidism) can result in goiters. Goiters can also be caused by infections; inflammation and infiltration; non-cancerous (benign) or cancerous (malignant) tumors; thyroid enzyme deficiency present at birth; or some medications.Risk: Women are 5 to 8 times more likely than men to have a thyroid disorder, with 1 in 8 women developing some form of thyroid disorder in their lifetimes. The risk of thyroid disorder increases with age. A small percentage of women (5% to 8%) develop thyroid abnormalities after delivering a baby (postpartum). In the US, autoimmune disease (Hashimoto's thyroiditis) causes most goiters. Incidence and Prevalence: Worldwide, 800 million people have a diet deficient in iodine; an estimated 200 million of these individuals have goiter (Mulinda). |
Source: Medical Disability Advisor
| History: Goiters can range in size from a barely noticeable lump to a visible swelling on the neck. An individual may notice swelling in the Adam's apple area of the neck where the thyroid gland is located. A large goiter may press on the food pipe (esophagus) or windpipe (trachea), making swallowing or breathing difficult. Pregnant women may notice discomfort in swallowing. In thyrotoxicosis, a condition caused by a toxic goiter (one that produces excessive hormones), symptoms may include increased appetite, warm dry skin, weight loss, trembling (tremor), difficulty sleeping (insomnia), a rapid heartbeat, muscle weakness and restlessness (agitation). Physical exam: A goiter can be easily felt when the doctor gently presses on the area of the thyroid and asks the individual to swallow water. Tests: A goiter is an enlarged thyroid gland; thyroid function tests on a blood sample are necessary to determine the cause of the enlargement. Ultrasound can distinguish fluid-filled sacs (cysts) from solid nodules and is useful for following changes in the size of a goiter over time. A CT scan shows the size of the goiter and the effect on adjacent tissues. Radionuclide uptake and scan are useful in determining thyroid gland function, anatomy and especially, thyroid nodule function. A small sample of tissue may be removed from the thyroid gland for microscopic examination (fine needle aspiration biopsy) to determine if solid nodules are cancerous (malignant). A barium swallow study can show esophageal compression and spirometry can demonstrate tracheal compression. |
Source: Medical Disability Advisor
| Treatment depends on the underlying cause. Very small goiters may not require treatment. Iodine deficiency is corrected by dietary changes and the intake of salt supplemented with iodine. When a goiter is the result of a disease process, treatment is aimed at the underlying disorder and may include medication to supplement or suppress thyroid function. Large goiters or those that cause difficulty with swallowing or breathing may require partial or total removal of the thyroid gland (thyroidectomy). Medication may be prescribed to shrink thyroid nodules or they may be removed surgically. |
Source: Medical Disability Advisor
| Results vary depending on the underlying condition. The early stages of goiter often respond well to medication (hormone therapy); a marked reduction in size or complete resolution can occur within 3 to 6 months. When nodules are present, only about one-third of individuals see a reduction in gland size after hormone therapy. Surgery (thyroidectomy) is generally effective. Even in cases in which the goiter regresses with treatment, it may recur in months or years. Undiagnosed progressive thyroid cancer can be fatal. |
Source: Medical Disability Advisor
| An unusually large goiter can displace the food pipe (esophagus) or the windpipe (trachea), causing difficulties in breathing and/or swallowing. Thyrotoxicosis, caused by a toxic goiter, can lead to serious cardiac complications. |
Source: Medical Disability Advisor
| Generally, a goiter does not require work restrictions or accommodations. If surgery is indicated for treatment, sick leave may be necessary while the individual recovers. |
Source: Medical Disability Advisor
| If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case. Regarding diagnosis:
- Has the diagnosis of goiter been confirmed by blood tests, x-rays, ultrasound, and/or iodine uptake test? Has malignancy been eliminated as a possibility?
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Has the neck been thoroughly examined to rule out tumors, cysts, or nodules of other structures?
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Is the goiter unusually large?
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Does individual have increased appetite, warm dry skin, weight loss, trembling (tremor), difficulty sleeping (insomnia), occasional muscle weakness, and restlessness (agitation)?
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Does individual have thyrotoxicosis? Is there swelling in the Adam's apple area of the neck?
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Is individual having trouble breathing?
Regarding treatment:
- If dietary changes have not been effective in resolving the goiter, are medications being considered?
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Is surgery being considered? Partial or total thyroidectomy?
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Is underlying condition being effectively controlled?
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Are there other treatment options that may be more effective?
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Would individual benefit from consultation with a specialist (endocrinologist, surgeon)?
Regarding prognosis:
- Has medication been effective in diminishing or resolving goiter?
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Has individual been compliant with dietary changes and addition of iodized salt?
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Does individual have an underlying condition such as malnutrition or anorexia nervosa that may affect recovery? If so, is this condition being effectively treated?
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Has underlying condition responded favorably to treatment?
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If medication was not effective or if goiter recurs, is individual now a candidate for surgery?
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Source: Medical Disability Advisor
| Mulinda, James R. "Goiter." eMedicine. Eds. Steven R. Gambert, et al. 10 Dec. 2004. Medscape. 10 Feb. 2005 <http://emedicine.com/med/topic916.htm>. |
Source: Medical Disability Advisor