Goitre

"Many times, the only symptom that produces the goiter is the appearance of a lump in the anterior region of the neck".

DR. JUAN CARLOS GALOFRÉ FERRATER
SPECIALIST. THYROID DISEASE AREA

The term goiter describes an increase in the size of the thyroid gland.

According to its characteristics, goiter can be diffuse, that is, at the expense of an overall and regular enlargement of the gland; or nodular, in which focal increases in thyroid size occur, leading to the development of nodules.

Depending on the hormonal production of the goiter, it can be classified as normofunctional (normal thyroid hormones), hypofunctional (low thyroid hormones) or hyperfunctional (high thyroid hormones).

The mission of the thyroid is to produce thyroid hormones (T4 and T3), which are absolutely necessary for metabolic reactions and the functions of the body in general to develop normally.

With adequate treatment, it is a disease that does not generate major problems.

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What are the symptoms of goiter?

Many times the only symptom that produces the goiter is the appearance of a lump in the anterior region of the neck.

The natural tendency is towards slow growth. When the growth is important, it can give rise to compressive symptoms by displacement and pressure on neighboring structures, like the trachea, the esophagus or the recurrent nerve, which will produce breathing difficulty, for the swallowing or aphonia, respectively.
 
Apart from the compressive symptoms, the manifestations that can originate are related to the possible accompanying alterations of the thyroid function, such as hyperthyroidism (nervousness, palpitations, tiredness, weight loss, among others) or hypothyroidism (intolerance to cold, tiredness, drowsiness, dry skin...).

The most common symptoms are:

  • Lump in the anterior region of the neck.
  • Difficulty in swallowing.
  • Breathing difficulty.
  • Aphonia.

Do you have any of these symptoms?

You may have a goiter

What are the causes of goitre?

A very high percentage of goiters go without alterations in the thyroid hormones. Many times, they are due to the formation of cysts or an increase in the formation of a liquid called colloid, which is found between the thyroid cells that group together to form follicles.

On other occasions, cystic, hemorrhagic or solid nodules develop, due to focal proliferations of thyroid tissue.

When there are enzymatic deficiencies in the synthesis of thyroid hormones (disenzymatic goiters) or a maintained lack of food intake of iodine (endemic goiter), the decrease in thyroid function induces an increase in TSH, which results in an increase in glandular size in order to restore thyroid function, which is not always achieved.

In the great majority of cases of hyperthyroidism there is goiter, because for an increased production of thyroid hormones it is necessary that the gland is bigger and has more synthetic capacity.

In Graves-Basedow disease (hyperthyroidism of autoimmune cause), goiter is classically diffuse.

When thyroid cancer develops, the most common form of presentation is a hard, rapidly growing nodule.

Who can suffer from it?

It is a very frequent finding in the female sex.

When investigated by ultrasound, the frequency of goiter increases with age to reach 60% of cases in women over 60 years. However, it can also occur in men, although less frequently.

It is not uncommon to be observed temporarily in newborns of mothers treated during pregnancy with antithyroid drugs for hyperthyroidism.

It is also common to appear during pregnancy.

How is goiter diagnosed?

In the vast majority of cases of goitre the diagnosis is made by inspection and palpation by the doctor.

A thyroid ultrasound usually provides additional data related to function and morphology, especially regarding the existence of nodules.

The thyroid scan can identify hot or capturing nodules and cold or noncapturing nodules.

To complete the diagnosis, it is necessary to perform a thyroid hormone and TSH stimulation in the blood to know if the situation is normal, hypo or hyper.

When nodular formations are observed, it may be necessary to perform a fine needle aspiration to know the cellular structure of the nodule and to approach its possible benign or malignant nature.

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How is goiter treated?

We have an Area of Thyroid Pathology specialized in thyroid problems

Small diffuse or minimally nodulating goiters, which are non-working, only require periodic monitoring.

Patients with hypothyroidism should be treated with thyroxine, which may reduce the size of the goiter.

If hyperthyroidism exists, it has to be treated opportunely with antithyroid medicines, radioactive iodine or surgery. The appearance of suspicion, either as a result of the puncture-aspiration, the existence of rapid growth or the development of compressive symptoms, makes it necessary to consider surgical treatment, which may consist of hemitiroidectomy, subtotal thyroidectomy or total thyroidectomy.

If there is previous hypothyroidism or hyperthyroidism, it is essential to correct the thyroid function prior to the intervention.

Where do we treat it?

IN NAVARRE AND MADRID

OUR MEDICAL TEAM

Specialists in the Area of Thyroid Pathology

The Thyroid Pathology Area is made up of a multidisciplinary team of specialists who work together to offer patients with thyroid problems an accurate diagnosis.

After the diagnosis, the patient is indicated the most appropriate treatment for his or her case and a continuous follow-up is carried out to achieve the desired objectives.

The Clinic is a pioneer in the implementation of medical techniques in Spain and worldwide, and is an international reference in highly specialized procedures.

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