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Iodine is necessary for the synthesis of the thyroid [[hormone]]s [[thyroxine]] (T<sub>4</sub>) and [[triiodothyronine]] (T<sub>3</sub>). In endemic goitre, [[iodine deficiency]] leaves the thyroid gland unable to produce its hormones because the mature hormone molecules require iodine atoms to be attached. When levels of thyroid hormones fall, thyrotropin-releasing hormone ([[TRH]]) is produced by the hypothalamus. TRH then prompts the pituitary gland to make thyrotropin or thyroid stimulating hormone ([[TSH]]), which stimulates the thyroid gland’s production of T<sub>4</sub> and T<sub>3</sub>. It also causes the thyroid gland to grow in size by increasing cell division.

Goitre is more common among women, but this includes the many types of goitre caused by autoimmune problems, and not only those caused by simple lack of iodine.
Goitre is more common among women, but this includes the many types of goitre caused by autoimmune problems, and not only those caused by simple lack of iodine.


Revision as of 12:56, 23 April 2011

Goitre
SpecialtyEndocrinology, nuclear medicine Edit this on Wikidata

A goitre or goiter (Latin gutteria, struma), is a swelling in the thyroid gland,[1] which can lead to a swelling of the neck or larynx (voice box). Goitre rarely occurs when the thyroid gland is functioning properly.

Worldwide, over 90% cases of goitre are caused by iodine deficiency. [2]

Signs and symptoms

Goitre associated with hypothyroidism or hyperthyroidism may present with symptoms of the underlying disorder although the symptoms are often unspecific and hard to diagnose.

Goitre not associated with hormonal abnormalities will not cause any symptoms aside from the presence of anterior neck mass. However, for particularly large masses, compression of the local structures may result in difficulty in breathing or swallowing. In those presenting with these symptoms, malignancy must be considered.

Toxic goitres will present with symptoms of thyrotoxicosis such as palpitations, hyperactivity, weight loss despite increased appetite, and heat intolerance.

Morphology

Struma nodosa (Grad II)
Struma with autonomous adenoma
Struma Grad III

Regarding morphology, goiters may be classified either as the number of enlargements or as the size of the growth:

Number of enlargements
  • Uninodular (struma uninodosa) - can be either inactive or a toxic nodule
  • Multinodular (struma nodosa) - can likewise be inactive or toxic, the latter called toxic multinodular goiter
  • Diffuse (struma diffuse), with the whole thyroid appearing to be enlarged.
Size
  • Class I - palpation struma - in normal posture of the head, it cannot be seen; it is only found by palpation.
  • Class II - the struma is palpative and can be easily seen.
  • Class III - the struma is very large and is retrosternal; pressure results in compression marks.

Causes

Worldwide, the most common cause for goitre is iodine deficiency. Selenium deficiency is also considered a contributing factor. In countries that use iodized salt, Hashimoto's thyroiditis is the most common cause.[3]

Cause Pathophysiology Resultant thyroid activity Nodularity Treatment Incidence and prevalence Prognosis
Iodine deficiency Hyperplasia of thyroid to compensate for decreased efficacy Can cause hypothyroidism Diffuse Iodine Constitutes over 90% cases of goitre worldwide[2]
Congenital hypothyroidism Inborn errors of thyroid hormone synthesis Hypothyroidism
Goitrogen ingestion
Adverse drug reactions
Hashimoto thyroiditis Autoimmune disease in which the thyroid gland is gradually destroyed Hypothyroidism Diffuse and lobular[4] Thyroid hormone replacement Prevalence: 1 to 1.5 in a 1000 Remission with treatment
Pituitary disease Hypersecretion of thyroid stimulating hormone, almost always by a pituitary adenoma[5] Diffuse Pituitary surgery Very rare[5]
Graves' disease - also called Basedow syndrome Autoantibodies (TSHR-Ab) that activate the TSH-receptor (TSHR) Hyperthyroidism Diffuse Antithyroid agents, radioiodine, surgery 1 to 2 cases per 1,000 population per year Remission with treatment, but still lower quality of life for 14 to 21 years after treatment, with lower mood and lower vitality, regardless of the choice of treatment[6]
Thyroiditis Acute or chronic inflammation Can be hyperthyroidism initially, but progress to hypothyroidism
Thyroid cancer Usually uninodular Overall relative 5-year survival rate for of 85% for females and 74% for males[7]
Benign thyroid neoplasms Usually hyperthyroidism Usually uninodular Harmless
Thyroid hormone insensitivity Secretional hyperthyroidism,
Symptomatical hypothyroidism		 Diffuse

Epidemiology

Disability-adjusted life year for iodine deficiency per 100,000 inhabitants in 2002.[8]
  no data
  less than 50
  50-100
  100-150
  150-200
  200-250
  250-300
  300-350
  350-400
  400-450
  450-500
  500-800
  more than 800

Iodine is necessary for the synthesis of the thyroid hormones thyroxine (T4) and triiodothyronine (T3). In endemic goitre, iodine deficiency leaves the thyroid gland unable to produce its hormones because the mature hormone molecules require iodine atoms to be attached. When levels of thyroid hormones fall, thyrotropin-releasing hormone (TRH) is produced by the hypothalamus. TRH then prompts the pituitary gland to make thyrotropin or thyroid stimulating hormone (TSH), which stimulates the thyroid gland’s production of T4 and T3. It also causes the thyroid gland to grow in size by increasing cell division.

Goitre is more common among women, but this includes the many types of goitre caused by autoimmune problems, and not only those caused by simple lack of iodine.

Some researchers [9] showed a correlation between Iodine-deficient goitre and gastric cancer, and reported in goitrous territories a decrease of the incidence of goitre and of stomach cancer after implementation of iodine-prophylaxis.[10] The proposed mechanism of action is that iodide ion (I-) can function in thyroid gland and in gastric mucosa as an antioxidant [11] reducing species that can detoxify poisonous reactive oxygen species, such as hydrogen peroxide.

History

Chinese physicians of the Tang Dynasty (618–907) were the first to successfully treat patients with goitre by using the iodine-rich thyroid gland of animals such as sheep and pigs—in raw, pill, or powdered form.[12] This was outlined in Zhen Quan's (d. 643 AD) book, as well as several others.[13] One Chinese book, The Pharmacopoeia of the Heavenly Husbandman, asserted that iodine-rich sargassum was used to treat goitre patients by the 1st century BC, but this book was written much later.[14]

In the 12th century, Zayn al-Din al-Jurjani, a Persian physician, provided the first description of Graves' disease after noting the association of goitre and exophthalmos in his Thesaurus of the Shah of Khwarazm, the major medical dictionary of its time.[15][16] Al-Jurjani also established an association between goitre and palpitation.[17] The disease was later named after Irish doctor Robert James Graves, who described a case of goitre with exophthalmos in 1835. The German Karl Adolph von Basedow also independently reported the same constellation of symptoms in 1840, while earlier reports of the disease were also published by the Italians Giuseppe Flajani and Antonio Giuseppe Testa, in 1802 and 1810 respectively,[18] and by the English physician Caleb Hillier Parry (a friend of Edward Jenner) in the late 18th century.[19]

Paracelsus (1493–1541) was the first person to propose a relationship between goitre and minerals (particularly lead) in drinking water.[20] Iodine was later discovered by Bernard Courtois in 1811 from seaweed ash.

Goitre was previously common in many areas that were deficient in iodine in the soil. For example, in the English Midlands, the condition was known as Derbyshire Neck. In the United States, goitre was found in the Great Lakes, Midwest, and Intermountain regions. The condition now is practically absent in affluent nations, where table salt is supplemented with iodine. However, it is still prevalent in India, China[21] Central Asia and Central Africa.

Goitre had been prevalent in the alpine countries for a long time. Switzerland reduced the condition by introducing iodised salt in 1922. The Bavarian tracht in the Miesbach and Salzburg regions, which appeared in the 19th century, includes a choker, dubbed Kropfband (struma band) which was used to hide either the goitre or the remnants of goitre surgery.[22]

Society and culture

Famous goitre sufferers

See also

Wikimedia Commons has media related to Goiter.

References

  1. ^ "goiter" at Dorland's Medical Dictionary
  2. ^ a b R. Hörmann: Schilddrüsenkrankheiten. ABW-Wissenschaftsverlag, 4. Auflage 2005, Seite 15-37. ISBN 3-936072-27-2
  3. ^ Mitchell, Richard Sheppard; Kumar, Vinay; Abbas, Abul K.; Fausto, Nelson. Robbins Basic Pathology. Philadelphia: Saunders. ISBN 1-4160-2973-7.{{cite book}}: CS1 maint: multiple names: authors list (link) 8th edition.
  4. ^ Attention: This template ({{cite doi}}) is deprecated. To cite the publication identified by doi:10.1097/SCS.0b013e3181f43e32, please use {{cite journal}} (if it was published in a bona fide academic journal, otherwise {{cite report}} with |doi=10.1097/SCS.0b013e3181f43e32 instead.
  5. ^ a b Thyrotropin (TSH)-secreting pituitary adenomas. By Roy E Weiss and Samuel Refetoff. Last literature review version 19.1: January 2011. This topic last updated: July 2, 2009
  6. ^ Abraham-Nordling, Torring, Hamberger, Lundell, Tallstedt, Calissendorff, Wallin. Graves' Disease: A long-term quality-of-life follow-up of patients randomized to treatment with antithyroid drugs, radioiodine, or surgery, Thyroid 15, no. 11(2005), 1279-86
  7. ^ Numbers from EUROCARE, from Page 10 in: F. Grünwald; Biersack, H. J.; Grںunwald, F. (2005). Thyroid cancer. Berlin: Springer. ISBN 3-540-22309-6.{{cite book}}: CS1 maint: multiple names: authors list (link)
  8. ^ "Mortality and Burden of Disease Estimates for WHO Member States in 2002" (xls). World Health Organization. 2002.
  9. ^ Abnet CC, Fan JH, Kamangar F; et al. (2006). "Self-reported goitre is associated with a significantly increased risk of gastric noncardia adenocarcinoma in a large population-based Chinese cohort". Int. J. Cancer. 119 (6): 1508–10. doi:10.1002/ijc.21993. PMID 16642482. {{cite journal}}: Explicit use of et al. in: |author= (help); Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
    Venturi S, Venturi A, Cimini D, Arduini C, Venturi M, Guidi A (1993). "A new hypothesis: iodine and gastric cancer". Eur. J. Cancer Prev. 2 (1): 17–23. doi:10.1097/00008469-199301000-00004. PMID 8428171. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
    Venturi S, Donati FM, Venturi A, Venturi M, Grossi L, Guidi A (2000). "Role of iodine in evolution and carcinogenesis of thyroid, breast and stomach". Adv Clin Path. 4 (1): 11–7. PMID 10936894. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  10. ^ Gołkowski F, Szybiński Z, Rachtan J; et al. (2007). "Iodine prophylaxis--the protective factor against stomach cancer in iodine deficient areas". Eur J Nutr. 46 (5): 251–6. doi:10.1007/s00394-007-0657-8. PMID 17497074. {{cite journal}}: Explicit use of et al. in: |author= (help); Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link) CS1 maint: numeric names: authors list (link)
  11. ^ Venturi S, Venturi M (1999). "Iodide, thyroid and stomach carcinogenesis: evolutionary story of a primitive antioxidant?". Eur. J. Endocrinol. 140 (4): 371–2. doi:10.1530/eje.0.1400371. PMID 10097259. {{cite journal}}: Unknown parameter |month= ignored (help)
  12. ^ Temple, Robert. (1986). The Genius of China: 3,000 Years of Science, Discovery, and Invention. With a forward by Joseph Needham. New York: Simon and Schuster, Inc. ISBN 0671620282. Pages 133–134.
  13. ^ Temple, Robert. (1986). The Genius of China: 3,000 Years of Science, Discovery, and Invention. With a forward by Joseph Needham. New York: Simon and Schuster, Inc. ISBN 0671620282. Page 134.
  14. ^ Temple, Robert. (1986). The Genius of China: 3,000 Years of Science, Discovery, and Invention. With a forward by Joseph Needham. New York: Simon and Schuster, Inc. ISBN 0671620282. Pages 134–135
  15. ^ Basedow's syndrome or disease at Who Named It? - the history and naming of the disease
  16. ^ Ljunggren JG (1983). "[Who was the man behind the syndrome: Ismail al-Jurjani, Testa, Flagani, Parry, Graves or Basedow? Use the term hyperthyreosis instead]". Lakartidningen. 80 (32–33): 2902. PMID 6355710. {{cite journal}}: Unknown parameter |month= ignored (help)
  17. ^ Nabipour, I. (2003). "Clinical Endocrinology in the Islamic Civilization in Iran". International Journal of Endocrinology and Metabolism. 1: 43–45 [45].
  18. ^ Giuseppe Flajani at Who Named It?
  19. ^ Hull G (1998). "Caleb Hillier Parry 1755-1822: a notable provincial physician". Journal of the Royal Society of Medicine. 91 (6): 335–8. PMC 1296785. PMID 9771526.
  20. ^ "Paracelsus" Britannica
  21. ^ "In Raising the World’s I.Q., the Secret’s in the Salt", article by Donald G. McNeil, Jr., December 16, 2006, New York Times
  22. ^ Kropfband bei planet-wissen.de
  23. ^ The Health and Medical History of President George Bush DoctorZebra.com. 8 August 2004. Retrieved 8 October 2006.
  24. ^ "George H.W. Bush." NNDB.
  25. ^ Robert G. Lahita and Ina Yalof. Women and Autoimmune Disease: The Mysterious Ways Your Body Betrays Itself. Page 158.
  26. ^ Lawrence K. Altman, M.D. “Doctors Say Bush Is in Good Health.” The New York Times. September 14, 1991.
  27. ^ Lawrence K. Altman, M.D. “The Doctor’s World; A White House Puzzle: Immunity Ailments.”, The New York Times. May 28, 1991]
  28. ^ “Andrea True.” Elle.

External links

Wikimedia Commons has media related to Goiters.

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