A goitre can be defined as an abnormal enlargement or increase of the thyroid gland. The thyroid gland is a small butterfly-shaped gland that is found beneath the Adam apple just a bit closer to the base of the neck. The thyroid gland produces a set of hormones that control a lot of activities that go on in the body.
Usually, goitres are almost painless. However, some large goitres cause pain and also cough likewise cause difficulties in eating and swallowing due to the weight it brings. The most common cause of goitre is the lack of adequate iodine in the body. This, however, isn’t the only cause.
In the United States of America, the only endorsed salt to be used is iodised salt, and in this case, the cause of goitre can’t be due to the lack of iodine. The cause of goitre here is mostly due to the underproduction or overproduction of the hormones produced by the thyroid gland.
Sometimes, it may not be due to the hormones, but it could be due to the overgrowth of nodules on the thyroid gland itself.
How the thyroid hormones are produced?
We have discussed about the thyroid gland, its shape and its location. There are two main hormones produced by the thyroid gland. They are T3 (Triiodothyronine) and T4 (Thyroxine). The function of these two hormones is to help maintain your body’s metabolism as they travel along the bloodstream.
Specifically, these two hormones help to maintain the rate at which your body distributes and uses both fats and carbohydrates as well as they also help to maintain and regulate your body temperature. They also are involved in the regulation of your heart rate, and they also influence and control the production and metabolism of protein in your body.
Asides these significant hormones produced by your thyroid gland, the thyroid gland also produces a hormone known as calcitonin. The function of calcitonin in the body is to help regulate the production and the metabolism of calcium in the bloodstream.
Although it is your thyroid gland that primarily produces these hormones, however, both your pituitary gland and your hypothalamus controls and regulates the production of these hormones and this regulation is based on the amount of hormones needed and how frequently it is required by the body.
The pituitary gland and the hypothalamus also regulate the mode of release of these hormones from the thyroid gland into the bloodstream. You may be wondering, what has the pituitary gland and hypothalamus got to do with all this? Well, here is how it works.
The entire process begins when the hypothalamus which is an area of your brain that is in control of the regulation of your whole body system receives an alert by the body that signals the low amount of these hormones in the bloodstream.
The hypothalamus then responds by sending signals to the pituitary gland to produce a certain hormone known as the Thyroid Stimulating Hormone also known as TSH.
The pituitary gland which is located at the lower part of your brain produces and release a certain amount of TSH which is required by the hypothalamus. The amount of TSH produced and released is based on the type of hormone needed to be produced by the thyroid gland.
This means that the release of TSH depends on how much T3 or T4 is required by your bloodstream for the balanced metabolism of the body. Once this TSH is produced and released, it stimulates the Thyroid gland to begin to produce these hormones.
The thyroid gland in turn then regulates the production of the thyroid hormones which is carefully controlled by the amount of TSH produced and released by the pituitary gland.
Causes of Goiter
We have established the fact that not all goitres are developed due to the lack of adequate iodine in the body. Asides iodine deficiency, there are a number of other factors which can lead to the swelling of the thyroid gland. The factors that cause goitre include:
1. Iodine deficiency
Iodine is one of the most essential components that is required in large quantities by the body. This is because it is the element that is needed primarily for the production of the thyroid hormones. This means that if iodine is too much or too little in circulation, the thyroid gland gets to suffer for it.
Iodine is mostly found in seawater and also in any soil that is located around the coastal area. In most developing countries, most people who live in the inland areas or at areas where they are at a high altitude, are usually found to be iodine deficient, and they have a higher tendency to develop a goitre.
This is because their thyroid gland expands in the hope to receive more iodine and when it doesn’t get it, it keeps increasing, and this will lead to the patient developing goitre.
A person who is initially suffering from iodine deficiency is not encouraged to eat some certain kinds of food, and this is because it will simply worsen their conditions.
Foods such as cabbage, broccoli and cauliflower are not encouraged to be taken by people who are iodine deficient because these foods are considered to be hormone inhibiting substances.
In other words, they keep tricking your body to inhibit the release of TSH hormone, and this will lead to the patient’s thyroid gland enlarging much more than it already is.
2. Grave’s Disease
Grave’s disease is a unique disease that is developed as a result of the overproduction and oversecretion of the thyroid hormones. This means that when there is an oversecretion of the thyroid hormone, it can lead to graves disease and after that lead to goitre.
In a patient who has Grave’s disease, the antibodies that are produced by your immune system in order to fight off infections and foreign bodies end up attacking the thyroid gland mistakenly and in turn, this causes it to produce the thyroid hormone in excess and in turn causes goitre.
3. Hashimoto’s Disease
Just the same way a goitre can develop due to hyperthyroidism as seen in the case of Grave’s disease, a goitre can also result due to hypothyroidism as in the case of Hashimoto’s disease.
Hashimoto’s Disease also results from an autoimmune disorder such that the immune system begins to fight against the very system it is supposed to be protecting.
Hashimoto’s disease results as a result of the fact that the autoimmune disorder destroys the thyroid gland such that it cant produce the normal amount of thyroid hormones it is meant to produce hence hypothyroidism signs and symptoms begin to be experienced.
When the level of thyroid hormones reduces in the body, the hypothalamus receives signals and sends messages across to the pituitary gland to release TSH, and this causes the thyroid gland to enlarge without actually producing any hormones.
4. Goitre as a result of multiple nodules appearing on the thyroid gland
This is the condition that is caused as a result of several solidified nodules or liquidised nodules or lumps as they start to develop on both sides of the thyroid gland causing the thyroid gland to swell up and causing goitre.
5. Solitary thyroid nodules
Solitary thyroid nodules occur when a single bulge or lump is seen to be developed on one part of the thyroid gland causing it to begin to swell.
However, most of the nodules and lump developed this way are non-cancerous growths; hence, it is impossible for them to cause cancer because they are benign. They are usually common among the lot.
6. Cancer of the thyroid gland
Unlike the solitary thyroid nodules, cancer of the thyroid gland is far less common among the causes of goitre. As a form of diagnosis, a biopsy of the thyroid nodule can be very accurate to determine if the tumour or lump is cancerous or not.
7. Pregnancy
As unlikely as this may sound, pregnancies can also cause an inflammation of the thyroid gland. This is because a particular hormone known as the Human Chorionic Gonadotropin hormone also known as the HCG hormone is usually produced and released when a woman is pregnant.
One of the side effects of the production of this hormone is that it can cause a mild inflammation to the thyroid gland and hence cause goitre.
8. Thyroiditis
Inflammation to the thyroid gland as a result of infection can cause a goitre to form. Thyroiditis is an inflammatory condition which is due to a different infection, and this can cause intense pain and swelling to the thyroid gland hence causing it to lead to goitre.
Sometimes, thyroiditis can also be due to the underproduction or the oversecretion of the T4 hormone which is known as the thyroxine.
Signs to take note of to know if you are having goitre
- You will notice a very visible inflammation or swelling just below your Adam’s apple whenever you shave as a male or when you are applying makeup as a female.
- You will always notice a tight feeling around your throat which may cause swallowing to become difficult.
- You will notice severe cough bouts.
- You will have some form of hoarseness in your voice.
- You may have difficulty while breathing because the swelling may have crushed your pharynx.
- You will notice some difficulties in swallowing due to the weight of the swelling in your oesophagus.
Risk factors associated with Goiters
Goitres can affect anyone of any age and any sex. They can be present from birth and run all through the lifetime of the person.
However, there are some risk factors that are particularly common to people who develop a goitre. They include
1. Lack or inadequate iodine gotten from one’s diet
One of the common risk factors of goitre is an insufficient amount of iodine obtained from the food the person eats.
People who are seen to live in areas where the supply of iodine is inadequate, as well as those who are in these areas but don’t have the provision of iodine supplements, are at a higher risk of developing goitres.
2. Gender
Research has shown that most females are at a higher risk of developing any form of thyroid problems and as such stand higher chances of developing goitres.
3. Age
Another common risk factor is age. Research studies have shown that people above the age of 40 will likely develop goitres.
4. Family history
If any member of your family or your generation have once had a goitre, then there is a huge tendency that you may also have it.
Also, even if it wasn’t goitre but any thyroid related problem, then you may most likely develop it.
5. Pregnancy and Menopause
A lady who is pregnant may likely develop goitre due to her body’s production of the Human Chorionic Gonadotropin also known as the HCG hormone.
However, for some reasons yet unknown, women who have undergone menopause stand a chance of developing a goitre.
6. Drugs and Medications
Some drugs have been known to have specific side effects, and one of those side effects may be goitres.
Medications like the amiodarone family which includes Cordarone, Pacerone and so on which are used to treat heart-related disease, psychiatric lithium drugs such as lithibiod and so on.
Complications
Having small goitres may not pose problems. Because of their size, they may go unnoticed, and it may cause little or no physical or cosmetic issues. However, in the case of having a large goitre, breathing problems, swallowing problems can arise as complications, and this is as a result of the size of the goitre.
Also, cough and hoarseness of voice can also pose as a complication of having a goitre. Also, other conditions can have goitres as a complication.
Conditions such as hypothyroidism, hyperthyroidism and so on can have a goitre, fatigue, weight gain, unintended weight loss, irritability, difficulty in sleeping and so on as complications associated to them respectively.
Treatments
Most small goiters resolve themselves, however, some large goiters have to be removed via surgery. Surgery such as thyroidectomy may be required to remove the infected part of the thyroid gland.
Also for thyroid cancer, surgery is also required. Asides surgery, radioactive iodine is also needed to treat an overactive thyroid gland.
