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Goiter Causes and Risks: A simple goiter occurs when the thyroid gland is unable to meet the metabolic demands of the body through sufficient hormone production. The thyroid gland compensates by enlarging, which usually overcomes mild deficiencies of thyroid hormone. A simple goiter may be classified as an endemic (present continuously in a community) or sporadic goiter. Endemic (also known as colloid) goiters are usually caused by inadequate dietary intake of iodine in certain geographical areas with iodine depleted soil, usually areas away from the sea coast. In the US, the Great Lakes, Midwest, and Intermountain regions are known as the "goiter belt.". The use of iodized table salt prevents this deficiency. The incidence of iodine deficiency is now rare in the U.S. because of widespread distribution of foods from iodine sufficient areas and salt to which potassium iodide has been added. Sporadic goiters are caused by swallowing of large amounts of certain foods or drugs and does not affect any particular segment of the population. Goitrogenic foods contain substances that decrease thyroid hormone production. Examples of these foods are rutabagas, cabbage, soybeans, peanuts, peaches, strawberries, spinach, and radishes. Drugs include lithium, cobalt , iodides, phenylbutazone, and others. Hereditary factors may cause goiters. Excessive iodine intake is also a cause of goiter. Risk factors: female gender, over 40 years old, inadequate dietary intake of iodine, residence in an endemic area, ingestion of large amounts of goitrogenic foods or drugs, and a family history of goiters. Prevention: The use of iodized table salt prevents endemic goiter . Limiting goitrogenic foods and drugs prevents sporadic goiter. Symptoms: Signs and Tests: Treatment: Hormone replacement inhibits thyroid stimulating hormone and allows for recovery of the thyroid gland. Small doses of iodine (Lugol's or potassium iodine solution) will treat iodine deficiency. Eliminating or reducing goiter producing foods or drugs is indicated for sporadic goiter. A large goiter that is unresponsive to medical management, or restricts swallowing and breathing, may require partial removal of the gland (subtotal thyroidectomy ). Prognosis: The outcome is expected to be good with treatment. Simple goiters may disappear spontaneously, or may become large. Occasionally a person may develop hyperthyroidism with a nodular goiter after receiving excess iodine therapy. More frequently, hypothyroidism develops. Complications: Call Your Healthcare Provider: Call your health care provider if you experience any swelling or enlargement in the front of your neck, increased resting pulse rate, palpitations , diarrhea , nausea , vomiting , sweating without exercise of increased room temperature, tremors , agitation , shortness of breath , or signs of hypothyroidism . This picture shows an enlargement of the thyroid (goiter), which can be caused by lack of iodine in the diet, thyroid infection, or excessive thyroid function (hyperthyroidism). Since iodine has been added to table salt, the incidence of goiter has decreased. This special scan (scintiscan) shows enlargement of the thyroid gland and extension behind the breastbone (retrosternal space). The false color image was generated by a computer during a radioisotope (I-131) thyroid scan.
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