A goiter, also known as goiter, is an enlargement of the thyroid gland. The cause of such thyroid swelling is often an iodine deficiency, which can lead to nodules in the thyroid gland. According to estimates, every third German has a goiter - often without him knowing. For just at the beginning of the struma is often not associated with a noticeable or visible swelling on the neck, so that many sufferers notice no signs. Learn more about symptoms and treatment of such thyroid swelling.
Symptoms of a goiter
Initially, goiter usually causes no symptoms or minor discomfort and is therefore often discovered late or only accidentally. First signs may be difficulty swallowing or a feeling of pressure and tightness in the throat ("lump in the throat"). Even a thick neck, which shows itself on a tight collar shirt, can be a sign of a goiter.
Since the thyroid gland is close to the trachea, it can press on it when enlarged. In some people, this causes shortness of breath or whistling breath sounds. Also, vocal cord nerves or blood vessels can be affected by the swollen thyroid gland causing hoarseness or congestion in the head. These symptoms increase as the thyroid glands swell.
Struma can affect thyroid hormone production. If it is associated with hyperthyroidism or hyperthyroidism, typical symptoms may occur.
Thyroid swelling detect by self-test
To detect at an early stage whether the thyroid gland is swollen, doctors advise to regularly do a "mirror test". To do this, place the head back and use a hand mirror to observe the area below the larynx while drinking a sip of water.
If swelling appears below the larynx during swallowing, you should consult a doctor. The same applies to sudden dysphagia or pressure in the throat. With a palpation examination, the doctor can determine the size and nature of the thyroid gland and thus determine whether there is actually a goiter.
Struma: diagnosis and examinations
If the palpation test indicates a swelling of the thyroid gland, an additional diagnosis can be made with the help of further examinations:
- A blood test shows if there is over or under thyroid function.
- The TSH level (thyroid stimulating hormone) in the blood also allows conclusions as to whether the goiter is due to a tumor.
- With an ultrasound examination, the size and structure of the thyroid can be examined. This will determine if there are any struma nodes.
- If there are nodules, thyroid scintigraphy can be used to measure thyroid iodine accumulation and check for hot or cold nodules.
- A tissue sampling (biopsy) from the thyroid gland provides clarity on suspicion of a malignant nodule.
- X-rays can show if the struma presses on the trachea or esophagus, for example.
The examinations can also exclude other possible diseases, such as Hashimoto's thyroiditis.
Shapes of a goiter
There are different forms of a goiter. The classification depends on various criteria, including the structure: In most cases, one or more nodes in the thyroid ("goiter nodosa") form. Depending on the number of nodes, a distinction is made between "goiter uninodosa" and "goiter multinodosa". If the entire thyroid is swollen, it is called a "struma diffusa".
Another classification is based on the production of thyroid hormones. In over 90 percent of cases, this hormone production is not affected, then there is an "euthyroid goiter" or "euthyroidism". Increased production of hormones is called a "hyperthyroid goiter". Reduced hormone production is called "hypothyroid goiter".
Struma: graduation in degrees
In addition, a goiter is classified according to its size in different degrees, also called stadiums:
- Grade 0: Neither visible nor palpable, only detectable by ultrasound
- Grade Ia: tactile, but not visible
- Grade Ib: Palpable, but visible only when the head is bent back
- Grade II: visible in normal head posture
- Grade III: Significantly enlarged thyroid gland, also visible from afar
In addition, there are other distinctions, for example with regard to the anatomical position of a goiter. A "goiter colli" is the name for a crop on the neck.
Hot knots and cold knots
In some individuals, part of the tissue of the thyroid gland transforms into a nodule. Depending on their activity, a distinction is made between cold and hot knots.
A hot knot is an almost always benign tissue change in the thyroid gland, which increases the absorption of iodine and the production of hormones. Often the consequence of a hot knot is hyperthyroidism.
A cold nodule is thyroid tissue that does not absorb iodine and does not release hormones. This may be, for example, scar tissue, a (usually benign) tumor or a cyst.
Treatment for a goiter
The treatment of a goiter is dependent on its size and whether the thyroid function is impaired and whether there are knots. There are basically three forms of therapy available.
- The drug treatment takes place, for example, with iodide tablets, thyroid hormones or - in case of hyperthyroidism - thyroid blockers (antithyroid drugs).
- In a radioactive iodine therapy, the victim swallows radioactive iodine, whose radiation destroys the thyroid cells.
- During an operation, the pathologically altered tissue parts (unilateral or bilateral) or, if necessary, the entire thyroid gland are removed.
The therapy of a goiter often requires the intake of iodine or hormone tablets over a long period of time. This is often necessary as a result of surgery or radio-iodine treatment.
In homeopathy, iodine-containing agents are often used to treat goiter, which can be used in conjunction with a doctor.
Struma: course and consequences
If a goiter continues to grow in the course of the disease, the symptoms also increase. In addition, the risk of hyperthyroidism ("functional autonomy") increases. Another possible consequence is the formation of a malignant tumor. However, the risk of contracting thyroid cancer ("goiter maligna") due to goiter is very low.
When a goiter with normal hormone production is usually sufficient treatment with iodine, often in combination with thyroid hormones, so that the goiter regresses within several months. In case of hyperthyroidism, however, no administration of iodine may take place: The excessive intake of iodine threatens a "thyrotoxic crisis" (thyroid poisoning), which can lead to death.
Iodine deficiency as the cause of a goiter
Cause of a goiter is usually an insufficient supply of iodine over a longer period. Since the body can not produce iodine itself, the trace element must be supplied through the diet. If the thyroid gland is low in iodine, it can not produce enough hormones and increases in size to make better use of the available iodine.
In some phases of life, the need for iodine due to hormonal changes is particularly high, which is why in this period increased attention must be paid to a sufficient supply of iodine. These include especially the menopause and puberty, but also pregnancy or lactation. Because iodine deficiency can cause pregnant women or newborns to develop a goiter.
Other causes of goiter
In addition to iodine deficiency, there are other possible causes of goiter, for example:
- Diseases such as the autoimmune diseases Graves disease or Hashimoto's thyroiditis, but also an over- or under-function of the thyroid gland
- thyroid inflammation
- Thyroid injuries
- Thyroid cancer or other tumors and metastases as well as cysts
- Medicines containing certain substances, such as lithium
- Peripheral hormone resistance
- excess of iodine
Stress is also suspected as a possible cause of thyroid disease.
A goiter is not hereditary. Nevertheless, in some families an accumulation of the disease can be detected, which may be due to the fact that the iodine is genetically degraded.
Prevent a goiter
The best way to prevent goiter is to have enough iodine. We recommend about 180 to 200 micrograms of iodine per day. This is found not only in iodine salt, but also in saltwater fish (for example salmon).
During pregnancy and breast-feeding, as well as in cases of family goitre, additional iodide tablets should be taken after consultation with a physician. In addition, older people are advised to regularly ask their doctor for a palpation to detect a goiter early.