THE GOITER DILEMMA…

The term GOITER is simply an enlargement of your thyroid gland. The thyroid gland is at the base of your neck right below the Adam’s Apple. It is butterfly-shaped and surrounds the trachea/esophagus. Goiters are mostly unnoticed by people and sometimes caught accidentally during other routine visits to your primary care or ENT.  Sometimes they are caught by an MRI or CT of other areas of the body. Goiters if enlarged, however, can cause some coughing, and make it difficult for you to swallow or breathe.

I am pretty sure you have heard of the most common cause of a goiter in the entire world? It is a lack of iodine in our diet. Here in the United States, our government made sure our table salt contains iodine… ionized NA+CL-. So here goiters are commonly caused by an over or underproduction of thyroid hormones  (thyroxin). Nodules form and swelling occurs. There are a few reasons outside of the iodine issue that causes the over or underproduction of thyroxin.  We can look at a few of these later in the blog.

Treatment options range from doing nothing, taking prescription medications and even a surgical intervention… So what are the symptoms?

Again many times you do not show signs of goiter however if you do they may be:

• Overt swelling is visibly seen in the mirror as you brush your teeth
• Tightness feeling around your throat
• Coughing- excessive or constant
• Difficulty breathing-shortness of Breath
• Difficulty swallowing-gagging
• Hoarseness

Causes

Calcium (CA++) is also regulated by hormone calcitonin… also produced by the thyroid.

What controls the thyroid? The pituitary and hypothalamus regulate the thyroid release of thyroxine (T-4/T-3)

The hypothalamus is the beginning of the regulation and is called the “thermostat” of the body. The hypothalamus by the use of biochemical signaling sends a signal to the pituitary gland to produce TSH or stimulating hormone. The pituitary… a different organ works in a concerted effort with the hypothalamus-ALSO can release TSH, which is dependent upon T-3 amounts in your blood. Basically the thyroid gland, in turn, regulates the production of TSH by a biofeedback mechanism between the hypothalamus and pituitary gland. Yes, these are very intricate systems that can get out of balance by different pathologies...  

Goiters do not necessarily mean the thyroid is not working properly and can be enlarged with normal hormone levels. However if  T-3 production increases or decreases this can cause certain problems AND there may or may not be a goiter present.

Common factors can cause your thyroid gland to enlarge.

• Iodine deficiency. Iodine, which we covered already above is an essential element for the production of thyroid hormones. It is sometimes missing from the diet and mainly in 3rd and 4th world countries. It is found primarily in seawater and in the soil of coastal regions around the globe. In many 3rd and 4th world countries, people who live away from coastal regions or live in high elevations are often iodine deficient. This can cause the development of goiters.  The thyroid enlarges as it attempts to gather iodine. Unfortunately, an unseen concomitant diet rich in foods that inhibit iodine uptakes such as cabbage or broccoli… exacerbates the iodine deficiency. Here in the USA, we enrich foods so that the majority of our citizens have iodine readily for our thyroids.
• Graves’ disease. An overproduction of thyroid hormone (hyperthyroidism). This is caused by antibodies produced by your immune system by mistake… and they attack your thyroid gland. This causes it to produce excessive amounts of thyroxine. This increased stimulation causes swelling. There are a plethora of symptoms besides the goiter associated with Graves, such as high metabolism, weight loss, and protruding eyes.
• Hashimoto’s disease. This is a goiter that is because of an underactive thyroid (hypothyroidism). Hashimotos is also an autoimmune disease instead of causing your thyroid to produce too much hormone, antibodies attack and damage the thyroid and less production of TSH occurs. The paradoxical effect is that the pituitary gland senses this issue and tries to stimulate the thyroid. This is the cause of the swelling.
• Multinodular goiter. This is a common occurrence,  where several solid or fluid-filled lumps called nodules to develop in both sides of your thyroid, resulting in overall enlargement of the gland. This is usually benign.
• Solitary thyroid nodules. This is a single nodule that develops in one part of your thyroid gland. Again these are mostly noncancerous (benign) and do not lead to cancer.
• Thyroid cancer. Exceedingly rare but can happen but thyroid nodules. A biopsy of a thyroid nodule is very accurate in determining if it’s cancerous.
• Pregnancy.  Human chorionic gonadotropin (HCG), a hormone produced during pregnancy, may cause your thyroid gland to enlarge slightly.
• Inflammation. Thyroiditis is a general term for an inflammatory condition that can cause pain and swell in the thyroid. Unfortunately, it may also cause the overproduction or underproduction of thyroxine.

Risk factors

Everyone is susceptible to Goiters. They may be present from birth to a geriatric death. We have mentioned many of the risks but here are common ones:

• A lack of dietary iodine. Above we went over the areas in 3rd and 4th world countries where these are commonly found.
• Pregnancy. HCG
• Female in General: More prone to thyroid issues
• Age. The older the more common.
• Medical history.  An autoimmune dx
• Menopause. An unknown reason but an increase in chance.
• Pharmacology:  Specific cardiac medications: amiodarone and psychiatric drug lithium, has increased risk.
• Radiation exposure. It makes sense that all radiation exposure can increase a goiter chance.

Complications

Again most of the time you do not notice a goiter however the ones that enlarge enough to cause breathing problems are at risk.

Other complications are weight loss and gain, emotional changes, and skin changes. 

SEE YOUR ENT!