An enlarged thyroid, or goitre, is the most common thyroid disorder. If you have an enlarged thyroid, it does not necessarily mean that your thyroid gland does not function properly; it merely describes the size of the gland. Goitre is five to ten times more common in women than in men. Factors that affect the development of enlarged thyroid may be genetic, autoimmune and extrinsic influences.
Goitres attract attention because they appear as a mass at the lower front part of the neck. Others may see the mass as it moves up and down with the swallow, when the patient drinks some liquids. The patient may feel the goitre, because the enlarged thyroid puts pressure on the windpipe, making it difficult to breathe or to swallow food. The enlarged thyroid can also cause some hoarseness as it presses on nerves in the neck.
Majority of goitres are not caused by abnormal functioning of the thyroid gland and are termed non-toxic goitres; however, there are goitres associated with hyperthyroidism or hypothyroidism. Females are the most likely to be afflicted with non-toxic goitre, particularly during adolescence, at menopause, or when they have a pregnancy. During these phases, the body needs more output of thyroid hormone but there may be insufficient quantities produced.
Non-toxic enlarged thyroid is classified in two ways: endemic and sporadic. Endemic goitre is caused by iodine deficiency in the diet, which results in inadequacy of hormone synthesis by the thyroid. Without iodine, the thyroid has difficulty maintaining the required levels of T3 and T4 in the blood, which leads the pituitary gland to prod the thyroid gland into producing more hormones. Sporadic goitre, on the other hand, occurs randomly, and is related to the consumption of large quantities of goitrogenic foods or the use of goitrogenic drugs. The goitrogens in these foods or drugs tend to reduce T4 production.
Rutabagas, soybeans, cabbage, peas, peaches, spinach, radishes and strawberries are some of the goitrogenic foods. Goitrogenic drugs include iodides, cobalt, lithium, propylthiouracil, phenylbutazone, and aminosalicylic acid.
Signs and symptoms of non-toxic enlarged goitre include: stridor (a rasping noise produced when inhaling or exhaling because of the abnormal narrowing of the windpipe by the goitre); respiratory difficulties and dysphagia, as the windpipe and oesophagus are compressed; single- or multi-nodular, or irregularly enlarged thyroid; and, dizziness (or syncope) induced by raising the arms above the head, caused by obstructed downward flow of blood in the veins.
In treating non-toxic enlarged thyroid, the goal of doctors is to reduce thyroid hyperplasia. Hormone replacement, diet, radiation and sometimes, surgery, are the treatment for enlarged thyroid or non-toxic goitre.
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