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Goiter

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DIABETES AND ENDOCRINE SYSTEM

Endocrine System

In 1656, Thomas Wharton described the distinct nature of what he termed the thyroid gland, distinguishing it from the larynx, as this structure had been considered a laryngeal gland from the time of Andreas Vesalius in the 16th century. It was nearly 200 more years before the function of the thyroid was elucidated. The normal adult thyroid gland weighs 10-25 g and has 2 lobes connected by an isthmus. Goiter is an enlargement of your thyroid gland. Although generally not uncomfortable, goiter may interfere with swallowing or breathing. The possible causes are numerous.

Causes

Normally, your thyroid gland produces two main hormones — thyroxine and triiodothyronine (T-3). These hormones circulate in your bloodstream and help regulate your metabolism. They maintain the rate at which your body uses fats and carbohydrates, help control your body temperature, influence your heart rate and help regulate the production of proteins. Your thyroid gland also produces calcitonin — a hormone that regulates the amount of calcium in your blood.

Your pituitary gland and hypothalamus control the rate at which these hormones are produced and released. The process begins when the hypothalamus — an area at the base of your brain that acts as a thermostat for your whole system — signals your pituitary gland to make a hormone known as thyroid-stimulating hormone (TSH). Your pituitary gland — also located at the base of your brain — releases a certain amount of TSH, depending on how much thyroxine and T-3 are in your blood. Your thyroid gland, in turn, regulates its production of hormones based on the amount of TSH it receives from the pituitary gland.

In goiter caused by iodine deficiency, your thyroid can't make and release enough thyroxine and T-3, both of which contain iodine. Many causes of thyroid enlargement exist other than iodine deficiency. Some of the causes are serious, others not. Causes of goiter include:

  • Graves' disease. This disease, an autoimmune disorder, is the most common cause of an overactive thyroid (hyperthyroidism). In Graves' disease, antibodies produced by your immune system stimulate the thyroid to produce too much thyroxine. Normally, your immune system uses antibodies to help protect against viruses, bacteria and other foreign substances that invade the body. In Graves' disease, antibodies mistakenly attack your thyroid gland and occasionally the tissue behind your eyes and the skin of your lower legs. Scientists aren't sure why Graves' disease occurs. The overstimulation of your thyroid in Graves' disease results in uniform and nonpainful swelling of the gland.

  • Hashimoto's disease. This disease, also called lymphocytic thyroiditis, is the most common cause of an underactive thyroid (hypothyroidism). Hashimoto's disease also is an autoimmune disorder and causes inflammation, which impairs your thyroid's ability to produce hormones. Then, your pituitary gland attempts to stimulate your thyroid gland to produce more thyroid hormones, causing your thyroid gland to enlarge.

  • Multinodular goiter. In this condition, several nodules develop in both sides of your thyroid, resulting in overall enlargement of the gland. Multinodular goiter may occur with either low or excessive thyroid hormone production.

  • Solitary thyroid nodules. Thyroid nodules are common, particularly in women. They occur usually on just one side of the thyroid. The cause of thyroid nodules is unknown, but people who've been exposed to certain types of radiation seem more likely to develop nodules. More than 95 percent of nodules are noncancerous (benign) and don't lead to cancer.

  • Thyroid cancer. Thyroid cancer is much less common than benign thyroid nodules. Cancer of the thyroid appears as an enlargement on one side of the thyroid.

  • Pregnancy. A hormone produced during pregnancy, human chorionic gonadotropin (HCG), may cause slight uniform enlargement of your thyroid gland.

  • Inflammation. Thyroiditis is an inflammatory condition of the thyroid. Various types of thyroiditis can result in an enlargement of your thyroid gland. Some may cause thyroid pain, often aggravated by swallowing or pressure. Some types of thyroiditis are associated with hyperthyroidism.

Goiter > 1 > 2 > 3 > 4

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