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Goitre
Classification & external resources

a woman with a goitre
ICD-10	E01.0-E01.2
ICD-9	240.9
DiseasesDB	5332
MedlinePlus	001178
MeSH	Goiter

A goitre (BrE), or goiter (AmE) (Latin struma), also called a bronchocele, is a swelling in the neck (just below Adam's apple or larynx) due to an enlarged thyroid gland.

Contents 1 Classification 2 Causes 3 Occurrence 4 Treatment 5 History and future 6 Famous goitre sufferers 7 See also 8 References 9 External links

They are classified in different ways:

• A "diffuse goitre" is a goitre that has spread through all of the thyroid (and can be a "simple goitre", or a "multinodular goitre").
• "Toxic goitre" refers to goitre with hyperthyroidism. These most commonly due to Graves disease, but can be caused by inflammation or a multinodular goitre.
• "Nontoxic goitre" (associated with normal or low thyroid levels) refers to all other types (such as that caused by lithium or certain other autoimmune diseases).

Other type of classification:

• I - palpation struma -in normal posture of head it cannot be seen. Only found when palpating
• II - struma is palpative and can be easily seen
• III - struma is very big and is retrosternal. Pressure and compression marks.

Other causes are:

• Hashimoto's thyroiditis (E06.3)
• Graves-Basedow disease (E05.0)
• inborn errors of thyroid hormone synthesis, causing congenital hypothyroidism (E03.0)
• Thyroiditis (acute, chronic) (E06)
• Side-effects of pharmacological therapy (E03.2)
• Thyroid cancer
• Iodine deficiency

Iodine is necessary for the synthesis of the thyroid hormones triiodothyronine and thyroxine (T3 and T4). In conditions producing endemic goitre, 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 increase synthesis of T3 and T4, but it also causes the thyroid gland to grow in size by increasing cell division.

Goitre is more common among women, but this includes the many types of goitre caused by autoimmune problems, and not only those caused by simple lack of iodine.

Treatment for goitre may not be necessary if the goitre is small. Hypothyroidism should be treated, and this treatment often leads to a substantial reduction in the size of the goitre. Removal of the goitre may be necessary if it causes difficulty with breathing or swallowing. There is now an alternative to surgery in large goitres. Radioiodine therapy with or without the pre-injection of a synthetic thyroid stimulating hormone, TSH, can relieve obstruction and reduce the size of the goitre by 30-65%. But removal of a goitre requires removing the thyroid. The complete removal of the thyroid gland removes the body's ability to produce thyroid hormone. In this case, oral thyroxine supplements are necessary to avoid harm from hypothyroidism.

Paracelsus (born Philippus Aureolus Theophrastus Bombastus von Hohenheim) (1493–1541) was the first to describe the connection between goitre and the consumption of minerals, specifically lead in drinking water.^[1]

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. In the United States, goitre was found in the Great Lakes, Midwest, and Intermountain regions. The condition now is practically absent in affluent nations, where table salt is supplemented with iodine. However, it is still prevalent in India,^[2] Central Asia and Central Africa.

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.

New research indicates that there may in fact be a tendency to inherit an increased vulnerability to goitre.

• President George H. W. Bush and his wife Barbara Bush both were diagnosed with Graves disease and enlarged thyroid glands, within 2 years of each other. In the president's case, the disease caused hyperthyroidism and cardiac dysrhythmia ^[3]
• Andrea True
• Kim Il-sung

• Struma ovarii (a kind of teratoma)

This article needs additional citations for verification. Please help improve this article by adding reliable references. Unsourced material may be challenged and removed. (October 2006)

• National Health Services, UK
• Network for Sustained Elimination of Iodine Deficiency
• Network for Sustained Elimination of Iodine Deficiency - alternate site at Emory University's School of Public Health

v • d • e Endocrine pathology: endocrine diseases (E00-35, 240-259)
Thyroid	Hypothyroidism (Iodine deficiency, Cretinism, Congenital hypothyroidism, Goitre, Myxedema) - Hyperthyroidism (Graves disease, Toxic multinodular goitre, Teratoma with thyroid tissue or Struma ovarii) - Thyroiditis (De Quervain's thyroiditis, Hashimoto's thyroiditis, Riedel's thyroiditis) - Euthyroid sick syndrome
Pancreas	Diabetes mellitus (type 1, type 2, coma, angiopathy, ketoacidosis, nephropathy, neuropathy, retinopathy) - Hypoglycemia - Hyperinsulinism - Zollinger-Ellison syndrome
Parathyroid	Hypoparathyroidism (Pseudohypoparathyroidism) - Hyperparathyroidism (Primary, Secondary, Tertiary)
Pituitary	Hyperpituitarism (Acromegaly, Hyperprolactinaemia, SIADH) - Hypopituitarism (Simmonds' disease/Sheehan's syndrome, Kallmann syndrome, Growth hormone deficiency, Diabetes insipidus) - Adiposogenital dystrophy - Empty sella syndrome
Adrenal	Cushing's syndrome (Nelson's syndrome, Pseudo-Cushing's syndrome) - CAH (due to 21-hydroxylase deficiency) - Hyperaldosteronism (Conn syndrome, Bartter syndrome) - Adrenal insufficiency (Addison's disease) - Hypoaldosteronism
Gonads	ovarian dysfunction (Polycystic ovary syndrome, Premature ovarian failure) - testicular dysfunction (5-alpha-reductase deficiency) - general (Hypogonadism, Delayed puberty, Precocious puberty)
Other	Autoimmune polyendocrine syndrome - Carcinoid syndrome - Short stature (Laron syndrome, Psychogenic dwarfism) - Gigantism - Androgen insensitivity syndrome - Progeria - Multiple endocrine neoplasia (1, 2)