A Family Doctor's Tale - GOITER

DOC I HAVE GOITER

Goiter is the abnormal diffuse enlargement of the thyroid gland.

People who are at risk of Goiter are:
1.Goiter are more common in females than in male.

2.Goiter occurs in all edge groups but is more common in the 30- 60 age group.

3.Goiter may be endemic in areas of deficient iodine intake.

The causes of Goiter are:
1.Toxic goiter caused by hyperthyroidism usually diffuse with signs of hyperthyroidism

2.Autoimmune bacterial or viral thyroiditis(Hashimoto's disease) also presents with smooth diffuse goiter.

3.Benign tumors of the thyroid such as adenoma, cyst may presents more of nodular form of goiter.

4.Malignant tumors of the thyroid may be nodular or diffuse

5.Inherited disorders of thyroid gland metabolism may also manifest as goiter

6.Nontoxic or simple goiter is common in those people deficient in iodine intake.

7.Some goiters are caused by ingestion of goiter stimulating agents or medicines such as thyroxine

The symptoms and signs of Goiter are:
Symptoms:
1.Obvious swelling in the thyroid gland present for some time

2.Painful swelling are suggestive of bacterial or viral infection-

3.Hoarseness of voice may occur if there is pressure on the vocal cord or recurrent nerve to vocal cord

4.Dyspnea or breathlessness if there is pressure on the trachea

5.Dysphagia or difficuly in swallowing due to pressure on the oesophagus

Signs:
1.Goiter or swelling of thyroid may be smooth, diffuse or nodular.
The swelling moves on swallowing.

2.Cystic nodules may feel hard while solid nodules may be soft to firm.

3.Thyroid hormones may be normal, increased or decreased

4.Neck lymph nodes are enlarged

The diagnosis of Goiter is made using:

1.blood test for thyroid hormones(T$ and T3), TSH levels and thyroid stimulating immunoglobulins

2.fine needle aspiration biopsy is a simple way to determine if a nodule is benign or malignant.

3.ultrasound scans are done to differentiate between solid, diffuse and cystic nodules,

4.thyroid scans which help to show if a nodule is producing excessive thyroid hormone(hot) or not.

5.CT Scan or MRI are not routine to Goiter investigation except where there is suspected compression of teachea.

The Treatment of Goiter is:
Benign lumps can be monitored by doctors at regular intervals.

If there are symptoms of compressing a neighbouring organ or the nodule is cancerous, surgery is required.

Patients who has symptoms of hyperthyroidism are advised to go for medical treatment with carbimazole, radioactive iodine treatment or surgery.

Beta blockers are given in hyperthyroid cases where the heart beat is very fast.

Iodine deficient goiter patients may require iodine supplements.

Goiter due to Hashimoto disease or simple nontoxic goiter may become smaller with thyroxine treatment.

Prognosis of Goiter is good in all benign cases.

Malignant Goiter are slow growing and have good prognosis.

The prognosis of the more serious carcinoma will depend on any spread to other organs.

Hyperthyroid patients recovers after 2 years of anti-thyroid medications and 30 per cent remains in remission after withdrawal of anti-thyroid medications