Definition – Goitre is derived from the Latin word ‘guttur’ meaning throat. Goitre denotes enlargement of the thyroid gland irrespective of its cause.
1. Simple Goitre
- Diffuse hyperplastic goitre.
- Nodular goitre.
- Colloid goitre.
2. Toxic Goitre
- Diffuse toxic goitre (Grave’s disease).
- Toxic nodular goitre.
- Toxic nodule.
3. Neoplastic Goitre
- Benign tumours.
- Malignant tumours.
- Autoimmune thyroiditis.
- Subacute or granulomatous or de-Quervain’s thyroiditis.
- Riedel’s thyroiditis.
This goitre is mainly formed due to stimulation with increased TSH.
- Familial Goitre – This goitre may be seen in families. There is an enzyme deficiency within the thyroid gland. This may impair iodine accumulation, oxidation or coupling of iodotyrosine.
- Endemic Goitre – In certain places, there is very low iodide content in the water and food, so the inhabitants do not even get the minimum requirements of iodine. These areas are the regions of the Alps, the Andes and the Himalayas.
- Goitrogens – Vegetables of the Brassica family i.e., cabbage, turnips, kale, brussel, cauliflower, sprout, etc. have low iodine content and those who consume such foods may present with this type of goitre.
- Physiological – Conditions like puberty, pregnancy, etc. where there is more demand of thyroid hormones than normal.
- Sporadic Goitre – Enlargement of the thyroid gland for which no definite cause can be established.
The thyroid gland is diffusely enlarged and smooth. It may be nodular.
- In the first stage, due to TSH stimulation, the lobules are composed of active follicles. This is called the ‘stage of diffuse hyperplasia’.
- When TSH stimulation ceases by ingestion of iodine, the second stage appears. This is the stage of involution, forming large follicles filled with colloid.
- If this condition continues i.e., in the third stage, the gland enlarges to an enormous extent which is known as colloid goitre.
Sex – Usually seen in females.
Age – Usually in the late thirties or forties.
As of Diffuse hyperplastic goitre.
On examination, the nodules may be palpable which are usually multiple. The nodules are usually colloid, cystic, degenerative, hemorrhagic or may form calcification.
Diffuse Hyperplastic Goitre
Sex – Females are more often affected in the ratio of about 9: 1.
Age – Usually starts in teenagers. If the history of goitre and hypothyroidism starts from early childhood some inherited defect may be present.
Most patients with this type of goitre are asymptomatic. The most common symptom is the swelling of the neck.
If the goitre is too big there may be pressure effects on the trachea or on the oesophagus (dysphagia). There may be distension of jugular veins due to pressure effect.
On inspection, there is diffuse swelling of the thyroid gland which moves on swallowing.
On palpation, the thyroid is uniformly enlarged. Its consistency is softer than the gland of a patient with Grave’s disease.
Age – Usually above 25 years of age.
As of Diffuse hyperplastic goitre.
On palpation, there is diffuse swelling of the thyroid gland which is quite soft.
The patient is euthyroid, the gland is soft and smooth on palpation. The gland moves on swallowing.
This is particularly in the case of nodular goitre and colloid goitre:
- Secondary thyrotoxicosis
- Tracheal obstruction
- Assessment of thyroid function is essential to exclude mild hyperthyroidism.
- Straight X-ray of the neck and chest may show tracheal deviation or compression or sometimes calcification of the goitre.
- Barium swallow X-ray indicates if the patient complains of dysphagia.
Treatment of Non-nodular Goitre
All table salts should contain iodine. If the goitre is drug-induced, discontinuance of the offending drug is advised.
–Operation – Partial thyroidectomy.
Treatment of Multinodular Goitre
Medicinal treatment but the majority of the patients require surgery in the form of partial thyroidectomy.
Treatment of Colloid Goitre
For cosmetic reasons, treatment is always partial thyroidectomy.
Reference: A Handbook of Surgery by Dr Mansi Sharma