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Goiter

A goitre (or goiter) (Latin struma) is a swelling in the neck (just below adam's apple or larynx) due to an enlarged thyroid gland. They are classified in different ways: more...

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  • A "diffuse goitre" is a goitre that has spread through all of the thyroid (and is contrasted with a "simple goitre", "single thyroid nodule" and "multinodular goitre".
  • "Toxic goitre" refers to goitre deriving from inflammation, neoplasm, or malfunction of the thyroid, while "nontoxic goitre" refers to all other types (such as that caused by lithium or an autoimmune reaction.)

Causes

The most common cause for goitre in the world is iodine deficiency (E01). Other causes are:

  • Hashimoto's thyroiditis (E06.3)
  • Graves-Basedow disease (E05.0)
  • juvenile goitre due to congenital hypothyroidism (E03.0)
  • neoplasm of the thyroid
  • thyroiditis (acute, chronic) (E06)
  • side-effects of pharmacological therapy (E03.2)

Occurrence

Iodine is necessary for the synthesis of the thyroid hormones, triiodothyronine and thyroxine (T3 and T4). When iodine is not available, these hormones cannot be made. In response to low thyroid hormones, the pituitary gland releases thyroid stimulating hormone (TSH). Thyroid stimulating hormone acts to try and increase synthesis of T3 and T4, but it also causes the thyroid gland to grow in size as a type of compensation.

Goitre is more common among women. Treatment may not be necessary if the goitre is not caused by disease and is small. Removal of the goitre may be necessary if it causes difficulty with breathing or swallowing.

History and future

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). The condition now is practically absent in affluent nations, where table salt is supplemented with iodine.

Some health workers fear that a resurgence of goitre might occur because of the trend to use rock salt and/or sea salt, which has not been fortified with iodine.

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Supports earlier findings: prevalence of goiter higher in breast Ca patients
From OB/GYN News, 9/15/04 by Norra MacReady

LOS ANGELES -- The prevalence of goiter and thyroid antibodies is higher than average in women with breast cancer, Dr. M. Ramazan Sekeroglu and colleagues said at the annual meeting of the American Association for Clinical Chemistry.

These data support the findings of other studies showing an increase in thyroperoxidase antibodies and thyroid disorders with breast carcinoma, suggesting that thyroid function in these patients should be closely monitored, said Dr. Sekeroglu, of the department of biochemistry at Yuzuncu Yil University, Van. Turkey, and associates in a poster presentation.

They studied serum levels of thyroid hormone. TSH, antibodies to thyroperoxidase and thyroglobulin, and the prevalence of goiter as identified on ultrasound examination in 50 women with breast cancer and 30 age-matched healthy controls.

Goiter prevalence and autoimmune antibodies were significantly higher in the patients compared with the control subjects. Of the breast cancer patients, 12 had diffuse goiters and 13 had nodular goiters, compared to 1 and 2 of the control patients, respectively, both significant differences. Serum antibody levels were significantly higher in cancer patients than in controls, but did not differ significantly between patients with metastatic and nonmetastatic cancer. (See table.)

The levels of thyroid hormone and TSH did not differ significantly between the cancer patients and the controls.

As yet, there is no evidence of a causal relationship between breast carcinoma and thyroid disease, although there is a direct relationship between breast carcinoma and thyroid enlargement, Dr. Sekeroglu said. Other investigators have suggested a possible connection between the two because breast tissue, like the thyroid, concentrates iodine through membrane active transport. There is also evidence that fatty tissue, "which is abundant in mammary glands," has receptors for TSH.

The prevalence of goiter is high in the region of Turkey where the study was conducted, and could be related to the incidence of hormone-dependent neoplasms in general, Dr. Sekeroglu said.

BY NORRA MACREADY

Los Angeles Bureau

COPYRIGHT 2004 International Medical News Group
COPYRIGHT 2004 Gale Group

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