Goiter can be defined as the enlargement and swelling of the thyroid gland located in the lower part of the anterior part of the neck. We can say that this disorder, which is quite common in our country, is more common in those with iodine deficiency. At the same time, the incidence in women is 5 times higher than in men. In this disease, the thyroid gland can grow as a nodule as well as without a nodule. When it gets too big, it sometimes causes shortness of breath and difficulty swallowing.
However, in case of excessive secretion of thyroid hormones, treatment must be done. The development of hyperthyroidism is also called “toxic” among the people. We will also explain what symptoms this health problem causes, its treatment and who is more common. But first, let’s review the reasons.
What are the causes of goiter?
Until now, many studies have been conducted on the causes of goiter around the world. These research results show that the most common cause of the health problem in question is iodine deficiency. This problem often occurs in those who live in regions that are poor in iodine and those who have iodine deficiency in their diet. Therefore, the most prominent reason is iodine deficiency. In addition, the factors listed below are the causes of this health problem.
- Graves’ disease (toxic goiter)
- Those with a family history of nodules
- Those whose neck area has been exposed to radiation
- Thyroid cancer
- Hashimoto’s disease
- Inflammation of the thyroid
- Those with unilateral swelling or nodules in the thyroid gland
What are the Goiter Symptoms?
First of all, we need to state that symptoms do not occur in every individual with goiter disease. For this reason, it would be beneficial not to think that some symptoms will be seen in all patients. In general, we can list the symptoms of this ailment as follows:
- Swelling in the neck area
- Difficulty breathing
- Difficulty swallowing
In addition to these symptoms, different symptoms can be observed if the disease develops due to reasons such as hypothyroidism or hyperthyroidism. These symptoms are as follows:
- Irritable mood
- Weight loss
- Sleep problems
- Feeling tired all the time
Of course, even if only one of the symptoms is felt, it is necessary to consult a doctor. Any abnormal symptom can be a harbinger of some illness. Taking the symptoms seriously by the patient and consulting a doctor will ensure early diagnosis. Therefore, the treatment can be completed in a shorter time.
How is Goiter Diagnosed?
A meticulous evaluation must be made before the diagnosis of goiter is made. If nodules are present, it is of great importance to investigate the possibility of malignancy of these nodules. In the case of excessive hormone production, it is also taken into account how much pressure the large nodules put on the trachea. In addition, the doctor will need to perform a manual examination of the neck area. During this examination, it is checked for any swelling by hand.
The patient also needs to have some tests. The results of the blood tests are important in terms of accurate diagnosis.
It is a simple procedure and the USG shows us whether there is a nodule in the goiter. Its feature looks at the size and structure of the nodule in the goiter. If the nodules are over 3 cm, the treatment is mostly surgical.
- It is generally requested from patients with nodules, where the desired thing decides that the nodule is bad.
- If the thyroid nodule is called cold, there is a risk of developing cancer in the future. Therefore, we recommend you to see your surgeon.
- It is the process of removing parts from the thyroid. It is done to find out if it is cancer or not.
- It is decided by usg or scintigraphy.
- It is a simple procedure, with the help of a small needle in your neck, a piece is taken from the nodule.
- According to the pathology (examination result) opinion, surgical medical treatment is decided.
- In fact, the test is still very simple. Today in Turkey can be seen in every health center.
- T3 T4 TSH tests are requested.
- This shows us whether you are Basedow Graves (poisonous goiter) or Hashioma (low work of the guatar).
- Anti-TPO and anti-troglobulin should also be checked in hashioma disease. Except for these two diseases, tests may be normal. It should not be forgotten that blood tests are usually normal in goiter cancers.
How is Goiter Treatment?
After the necessary examinations and tests are performed, the patient is diagnosed with goiter. Afterwards, the most suitable treatment options for the patient are evaluated. The level of thyroid hormones and the characteristics of the thyroid gland are also taken into account when deciding which treatment will be applied. It should also be noted that the treatment can be done in the form of follow-up. At the same time, treatment with medication, atomic therapy or surgical intervention may be preferred.
The duration of the treatment and the dosage of the drugs to be used in drug treatment are decided by considering the degree of goiter disease. Sometimes, depending on the condition of the disease, radioactive therapy or surgical intervention options may be considered after drug therapy. Of course, in determining the treatment, the general health status, age and gender of the patient are also taken into consideration.
Who Has Goiter More?
Of course, who has this disorder more often is among the curious issues. First of all, we should state that those who live in regions that are not rich in iodine are definitely at risk. Those who do not include iodine-containing foods in their diet are also at risk for goiter disease. Being female also means being in the risk group. Because, as we mentioned before, the incidence of this disease in women is exactly 5 times higher than in men. Hormones secreted during pregnancy can cause an enlargement of the thyroid gland. Therefore, pregnancy also ensures that the person is included in the risk table.
In addition, the risk of developing this disorder is higher for those who have diseases related to the immune system. Those who use drugs such as amiodarone, interferon and lithium should be evaluated in this group. The risk of developing the disease in question is also higher for women who are in the menopausal period. Finally, the risk of disease is higher for all people over the age of 40.
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When to See a Doctor?
We talked about the symptoms of goiter above. Let us underline that even if only one of these symptoms occurs, a doctor should be consulted without wasting time. In case of difficulty in breathing or swelling while swallowing, it should not be ignored that there may be a health problem, and it is necessary to consult a doctor. Sometimes, patients may notice a swelling in the neck area while shaving or applying makeup. Even if there is no pain or ache, a physician should be consulted to examine this swelling.
Who and When Is Goiter Surgery Performed?
It should be noted that, in general, goiter surgery can be explained as the surgical removal of the thyroid glands from the body. When this surgery was performed, we can tell you in a short list:
- Growth of the thyroid glands and pressure on the neck
- Failure to achieve success with medication
- Thyroid gland size exceeding 2-3 cm
- Nodules at risk of cancer
- Swelling in the neck poses a danger in any way.
- In such cases, surgical intervention is required without making the patient wait any longer.
First of all, let’s state that goiter surgery is performed under general anesthesia. As a result, the patient is prevented from feeling any pain or ache. The duration of the operation is not the same in every patient. However, it should be noted that this period usually varies between 90 minutes and 120 minutes. In surgery, an incision is made on the front of the neck. Thyroid gland is reached through this incision and this gland is evacuated from the body. In addition, the vessels of the thyroid gland are also tied. It is also extremely important that the surgery in question is performed by an experienced surgeon. Because during the operation, maximum care must be taken not to damage the nerves.
Generally, the vocal cord device has been used recently. Thanks to this device, vocal cord injuries are considerably reduced. Because the biggest problem of this surgery is the damage to the vocal cord, which causes hoarseness, you should definitely investigate when you think about having this surgery.
We can say that the recovery period after this surgery is not very long. There may be mild pain complaints, but the patient can be relieved with the use of pain medication. You can immediately write your questions about this disease in the comment section.
Graves’ disease (toxic goiter)
- Goiter ranks second after iodine deficiency.
- Graves’ disease is actually a disease caused by overwork of goiter, which we call hyperthyroidism as a result of impaired thyroid stimulating immunoglobulin secretion. It is known as an autoimmune disease for him.
- The symptoms of the eyes, which we call exophthalmos, may be images.
- Again, these patients are quite angry. Most patients are treated psychologically.
- Hair loss is very much.
- They can’t stand the heat
- There is excessive weight loss
- They have insomnia at night
- Menstrual periods are disturbed in women
- Sweating is more in these patients.
- It is very common in these patients.
- Although the skin of these patients gets thin, they become very sensitive.
- High blood pressure and palpitations
It can be treated in three ways:
Graves’ disease treatment
First of all, medical treatment, then surgery, if necessary, can be radioactive iodine treatment.
First of all, medical treatment is recommended, but the drug dose is very important, if used too much, it harms the kidneys. Drugs used in hashioma do no harm to our body.
If it does not respond to medical treatment, then surgery should be considered.
Radioactive iodine therapy:
Radioactive iodine (atom) therapy can be given to patients whose Graves’ disease cannot be operated sometimes, and those who cannot afford the elderly surgery.
It was discovered by the Hakura hashimato in 1912. It is an autoimmune disease. Unlike toxic goiter, it occurs as a result of less work of the thyroid homone. Sometimes it can be seen alone or can be seen together in other diseases. It may be together with diseases such as type diabetes, adisson hst, testicular inflammation, parathyroid hormone deficiency.
Its symptoms are as follows:
- The first symptom is obesity and fatigue.
- Hair loss is very common
- The skin is edematous (swollen)
- There is excessive constipation
- They are intolerant of cold
- Some patients have tongue enlargement
- Especially in pregnant women, it may cause disabled birth of the child.
- Often there can be forgetfulness
- Menstrual irregularity can be seen
How is Hashioma Treatment:
- The treatment is very simple, you can be treated with a medication, most of which we call medical treatment, that you will only take in the morning on an empty stomach.
- How is the treatment applied in cold nodules?
- Since most of the cold nodules are benign, the operation is performed only if malignant or suspicious cells are seen in the fine needle aspiration biopsy.
- Seeing benign cells in biopsy does not require surgery. Levothyroxine treatment is applied in these patients and they are followed at regular intervals.
- Levothyroxine (tefor, levothyron) is a synthetic T4 hormone that prevents the growth and proliferation of nodules.
- Nodules under treatment are followed up ultrasonographically and clinically. Few of the nodules under treatment shrink or grow, while most retain the same size.
- In case of doubt, a needle biopsy is performed once more in a year and the nodule is checked. In the case of benign results, the biopsy is repeated only if the nodule is enlarged.
- In thyroid cysts, fluid is completely drained with fine needle aspiration. After the fluid is drained, the cyst may disappear completely. Some cysts refill after a while after they have been emptied. Although the possibility of thyroid cancer in these cysts is very low (3%), the operation is recommended.
- In case of benign results in mixed nodules (semi-cyst and semi-solid), the possibility of cancer is higher (10%), so the surgical operation can be applied depending on the patient’s decision.
How are solitary nodules evaluated?
Although the possibility of cancer is low in those with many nodules, especially if there is a large nodule between the nodules (dominant nodule), this nodule should be examined in terms of cancer like solitary (single) nodules.
In the examination of nodules after examination:
- Thyroid ultrasonography: It provides information about the number and size of the nodules. The distinction between benign and malignant nodules should be investigated thoroughly, especially in solitary cold nodules, as there is a possibility of cancer. Normally, there are 4-7% thyroid nodules in a population. Surgical removal of each nodule is not correct, since only a few of these nodules have cancer. Especially the evaluation of solitary nodules requires attention.
- In the evaluation, the age of the patient, whether he received radiation to the neck region, his complaints, the type and family history are taken into consideration.
- The formation of a nodule in children before puberty or the sudden appearance of a nodule in the very elderly suggests thyroid cancer. Observation of nodules in patients treated with radiotherapy to the neck region for Hodgkin’s disease or other reasons requires more careful investigation.
- Sudden changes in voice and difficulty in swallowing suggest the spread of thyroid cancer. Sudden growth and pain in the thyroid nodule is primarily a bleeding into the cyst and rarely a sign of thyroid cancer.
- Observation of a single nodule in men increases the suspicion of cancer.
- Family thyroid cancer, especially medullary thyroid cancer, increases the likelihood of thyroid cancer.
Examination findings are very important. Sometimes it is possible to diagnose cancer only by examination. In these patients, the nodule is palpable very hard, it is attached to the surrounding tissue and the lymph node comes to the hand due to metastasis in the same area. However, it is not possible to diagnose cancer metastasis in every lymph node swelling. Because lymph node swelling can also occur as a result of infection. Not used in diagnosis.
- Thyroid scintigraphy: It shows whether the nodules are cold or hot. It cannot distinguish between benign and malignant tumors.
- Thyroid biochemistry
- Thyroid hormones (shows the function of the nodule)
- Calcitonin (a symptom of medullary thyroid cancer)
- Thyroid antibodies (required for the diagnosis of Hashimoto’s thyroiditis)
- Fine needle aspiration biopsy (FNAB): It shows whether the nodule is malignant or benign. Information was given on this issue before (see FNAB).
How is the treatment done in hot nodules?
In nodular cases, thyroid scintigraphy is performed first and it is investigated whether the nodule is hot (hyperactive) or cold (hypoactive). By determining thyroid hormone in hot nodules, hyperthyroidism (Plummer’s Disease) is investigated and treated accordingly. Hot nodule cases that do not show hyperthyroidism are followed up at regular intervals. Some of these nodules will be asymptomatic by degenerating, while others will grow and cause hyperthyroidism. The probability of future hyperthyroidism is higher especially in large nodules larger than 3 cm.
What is plongeus or substernal goiter?
The condition that the thyroid grows and extends below the sternum (bellybone) is called substernal or plonjan goiter. It is more common in elderly patients. It usually contains nodules. Surgical intervention is required in its treatment because it often causes distress and shortness of breath.
What is an internal goiter? Is this naming also correct?
This naming can be regarded as an expression put forward either for goiter that works too much or for goiters that are not very pronounced from the outside. It has sometimes become a term used by the surgeon to explain to the patient how difficult the operation he has performed. However, from a medical point of view, it can be said that this term is also not correct.
What is a female goiter? Is this naming correct?
Some of the patients who have been operated for goiter have a chance of recurrence of the goiter due to various reasons. The goiter of the patients whose goiter has recurred is called female goiter. It is difficult to say where this naming originated from. It is probably a nomenclature that emerged among the people. However, some patients whose goiter recurred a while after the operation stated that their physicians said “your goiter was a female, that’s why it grew “. Regardless of how it may appear, it is a fact that this statement is not scientifically correct.
What is the importance of nodular goiter?
Nodul or nodules that develop in the thyroid can be visible or palpated. Sometimes it occurs as a result of examinations incidentally. Especially in recent years, with the widespread use of examination tools such as ultrasound, tomography, and magnetic resonance (MR), nodules that cannot be felt by hand can be detected in early stages.
Therefore, if there is no disorder in the functioning of the thyroid, small nodules may not be asymptomatic and the patient may not have any complaints. However, as with proper growth, they can cause poor cosmetic appearance and shortness of breath. Sometimes, a condition called toxic nodular goiter occurs as a result of the nodules or nodules overworking (gaining autonomy) independently of the thyroid.
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