Uninodular Goitre: One Thyroid Nodule Can Be Either Inactive, or Active (Toxic)

A goitre, or goiter, is a swelling in the neck resulting from an enlarged thyroid gland.
[1][2] A
goitre can be associated with a thyroid that is not functioning properly.
Worldwide, over 90% of goitre cases are caused by iodine deficiency.[3] The term is from the
Latin gutturia, meaning throat. Most goitres are of a benign nature.
Types
A goitre may be classified either as nodular or diffuse. Nodular goitres are either of
one nodule (uninodular) or of multiple nodules (multinodular).
Growth pattern
Uninodular goitre: one thyroid nodule; can be either inactive, or active (toxic) –
autonomously producing thyroid hormone.
Multinodular goitre: multiple nodules;[4] can likewise be inactive or toxic, the

latter is called toxic multinodular goitre and associated with hyperthyroidism.
These nodules grow up at varying rates and secrete thyroid hormone
autonomously, thereby suppressing TSH-dependent growth and function in the rest
of gland. Inactive nodules in the same goitre can be malignant.[5] Thyroid cancer
is identified in 13.7% of the patients operated for multinodular goitre.[6]
Diffuse goitre: the whole thyroid appearing to be enlarged due to hyperplasia.
Size
Class I: the goitre in normal posture of the head cannot be seen; it is only found by
palpation.
Class II: the goitre is palpable and can be easily seen.
Class III: the goitre is very large and is retrosternal (partially or totally lying below
the sternum), pressure results in compression marks.
Causes
Goiter can be caused by a number of different conditions:
Iodine deficiency
Seafood
Deficiency of iodine - found in seafood - is a major cause of goiter.
Iodine deficiency is the major cause of goiter worldwide, but this is rarely a cause
in more economically developed countries where iodine is routinely added to salt.
As iodine is less commonly found in plants, vegan diets may lack sufficient iodine.
This is less of a problem for vegans who live in countries such as the United States
that add iodine to salt.
Dietary iodine is found in:
seafood
plant food grown in iodine-rich soil
cow's milk
In some parts of the world, the prevalence of goiters can be as high as 80 percent,
such as in the remote mountainous regions of southeast Asia, Latin America, and
central Africa. In these places, daily intake of iodine can fall below 25 micrograms
(mcg) per day, and children are often born with hypothyroidism.
The thyroid gland needs iodine to manufacture thyroid hormones, which regulate
the metabolism.
Autoimmune disease
The main cause of goiter in developed countries is autoimmune disease. Women
over the age of 40 are at greater risk of goiter, as are people with a family history
of the condition.
Hypothyroidism is the result of an underactive thyroid gland, and this causes

goiter. Because the gland produces too little thyroid hormone, it is stimulated to
produce more, leading to the swelling.
This usually results from Hashimoto's thyroiditis, a condition in which the body's
immune system attacks its own tissue and causes inflammation of the thyroid
gland.
Hyperthyroidism
Hyperthyroidism, or an overactive thyroid gland, is another cause of goiter. Too

much thyroid hormone is produced. This usually happens as a result of Graves'
disease, an autoimmune disorder where the body's immunity turns on itself and
attacks the thyroid gland, causing it to swell.
Other causes
Less common causes of goiter include the following:
Smoking: Thiocyanate in tobacco smoke interferes with iodine absorption.
Hormonal changes: Pregnancy, puberty, and menopause can affect thyroid

function.
Thyroiditis: Inflammation caused by infection, for example, can lead to goiter.
Lithium: This psychiatric drug can interfere with thyroid function.

Overconsumption of iodine: Too much iodine can cause a goiter.
Radiation therapy: This can trigger a swollen thyroid, particularly when

administered to the neck.
Symptoms
The degree of swelling and the severity of symptoms produced by the goiter
depends on the individual.
Most goiters produce no symptoms. When symptoms do occur, the following are
most common:
throat symptoms of tightness, cough, and hoarseness
trouble swallowing
in severe cases, difficulty breathing, possibly with a high-pitch sound
Other symptoms may be present because of the underlying cause of the goiter, but
they are not because of the goiter itself. For example, an overactive thyroid can
cause symptoms such as:
nervousness
palpitations
hyperactivity
increased sweating
heat hypersensitivity
fatigue
increased appetite
hair loss
weight loss
In cases where goiter is a result of hypothyroidism, the underactive thyroid can

cause symptoms such as:
cold intolerance
constipation
forgetfulness
personality changes
hair loss
weight gain
Aside from the swelling itself, many people with goiter present no symptoms or
signs at all.
Other symptoms
A goiter can present as a palpable or visible enlargement of the thyroid gland at the
base of the neck. A goiter, if associated with hypothyroidism or hyperthyroidism,
may be present with symptoms of the underlying disorder. For hyperthyroidism,
the most common symptoms are associated with adrenergic stimulation:
tachycardia (increased heart rate), palpitations, nervousness, tremor, increased
blood pressure and heat intolerance. Clinical manifestations are often related to
hypermetabolism, (increased metabolism), excessive thyroid hormone, an increase
in oxygen consumption, metabolic changes in protein metabolism, immunologic
stimulation of diffuse goitre, and ocular changes (exophthalmos).[7] Hypothyroid
individuals may have weight gain despite poor appetite, cold intolerance,
constipation and lethargy. However, these symptoms are often non-specific and
make diagnosis difficult.
DIAGNOSIS
Several tests can be used to diagnose and evaluate goiter, including the following:
Physical exam: Your doctor may be able to tell if the thyroid gland has grown by
feeling the neck area for nodules and signs of tenderness.
Hormone test: This blood test measures thyroid hormone levels, which tell if the
thyroid is working properly.
Antibody test: This blood test looks for certain antibodies that are produced in
some forms of goiter. An antibody is a protein made by white blood cells.
Antibodies help defend against invaders (for example, viruses) that cause disease
or infection in the body.
Ultrasound of the thyroid: Ultrasound is a procedure that sends high-frequency

sound waves through body tissues. The echoes are recorded and transformed into
video or photos. Ultrasound of the thyroid reveals the gland's size and finds
nodules.
Thyroid scan: This imaging test provides information on the size and function of
the gland. In this test, a small amount of radioactive material is injected into a vein
to produce an image of the thyroid on a computer screen. This test is not ordered
very often, since it is only useful in certain circumstances.
CT scan or MRI (magnetic resonance imaging) of the thyroid: If the goiter is very
large or spreads into the chest, a CT scan or MRI is used to measure the size and
spread of the goiter.
TREATMENT

Uninodular Goitre: One Thyroid Nodule Can Be Either Inactive, or Active (Toxic)

Uploaded by

Document Information

Original Description:

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Uninodular Goitre: One Thyroid Nodule Can Be Either Inactive, or Active (Toxic)

Uploaded by

Copyright:

Available Formats

A goitre, or goiter, is a swelling in the neck resulting from an enlarged thyroid gland.

Multinodular goitre: multiple nodules;[4] can likewise be inactive or toxic, the

Diffuse goitre: the whole thyroid appearing to be enlarged due to hyperplasia.

Class II: the goitre is palpable and can be easily seen.

Goiter can be caused by a number of different conditions:

Deficiency of iodine - found in seafood - is a major cause of goiter.

Dietary iodine is found in:

plant food grown in iodine-rich soil

Hypothyroidism is the result of an underactive thyroid gland, and this causes

Hyperthyroidism, or an overactive thyroid gland, is another cause of goiter. Too

Less common causes of goiter include the following:

Smoking: Thiocyanate in tobacco smoke interferes with iodine absorption.

Hormonal changes: Pregnancy, puberty, and menopause can affect thyroid

Thyroiditis: Inflammation caused by infection, for example, can lead to goiter.

Lithium: This psychiatric drug can interfere with thyroid function.

Radiation therapy: This can trigger a swollen thyroid, particularly when

throat symptoms of tightness, cough, and hoarseness

in severe cases, difficulty breathing, possibly with a high-pitch sound

In cases where goiter is a result of hypothyroidism, the underactive thyroid can

Ultrasound of the thyroid: Ultrasound is a procedure that sends high-frequency

You might also like