Types of Goitre: Its Causes, Diagnosis And Treatment Options

Types of Goitre: Its Causes, Diagnosis And Treatment Options . Goiter is defined as non-inflammatory, non-neoplastic enlargement of thyroid glands. More cases of goiter are found in women as compare to men. Goiter may become toxic and lead to hyperthyroidism.

Enlargement of thyroid glands (Goitre) is related to several factors causing:

• Primary hyperplasia.
• Compensatory hyperplasia to meet the increased demand to thyroxin by the body.
• Increased storage of colloid.

Types Or Classification Of GoitreI. Simple goiter

• Physiological (puberty goiter)
• Parenchymatous goiter
• Colloid goiter
• Nodular or adenomatous goiter

II. Secondary goitre

• Primary thyrotoxicosis
• Secondary thyrotoxicosis arising from nodular or colloid goiter

Causes Of GoiterFollowing are some of the common causes of goiter:

• Iodine deficiency
• Idiopathic
• Physiological- puberty and pregnancy
• Grave’s disease
• Goitrogens- Anti-thyroid drugs, iodine containing medicine, aminoglutethimide, lithium.
  
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  Foods- soybean and cassava.
• Thyroiditis – Hashimoto’s, acute or sub acute (de Quervain’s) and reidel’s septic.
• Dyshormonogenesis- Iodine trapping defect, organification defect and resistance of thyroid hormones.
• Tumors- Adenoma, carcinoma and lymphoma.
• Others- Sarcoidosis and syphilis.

Diagnosis And Investigation For Goiter

Diagnosis of the common condition of simple goiter is arrived at by the exclusion of other causes, such as Hashimoto’s thyroiditis, sub-acute thyroiditis, dyshormonogenesis or carcinoma of the thyroid gland.

• Thyroid function test- the level of the thyroid activity should be determined by the test.
• Serum cholesterol- elevated in primary thyroid failure.
• Tendon reflex duration- tendon reflexes are prolonged.
  
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• Thyroid antibodies- antibodies to thyroglobulin or thyroid peroxidase are typically strongly positive in Hashimoto’s thyroiditis.
• Thyroid scan- it can be done to differentiate between a diffuse and nodular goiter. Metastatic goiter can also be detected.

Treatment Options For Goiter

• An adequate intake of iodine, particularly in the early life, is the only really satisfactory way of preventing sporadic simple goiter.
• Sub-total thyroidectomy-
  • Indications- Recurrent hyperthyroidism, sensitive reaction to anti-thyroid drugs, severe thyrotoxicosis, frankly large goiter with respiratory obstruction and poor drug compliance.
  • Advantages- Cures higher percentage of persons and in shorter time.
• Replacement therapy- Thyroxin (T4) is the treatment of choice in conditions of thyroiditis like Hashimoto’s disease and acute and sub-acute de Quervain’s thyroiditis. Duration of therapy is usually life long.