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Goitre

Condition Overview:

A goitre is an enlargement of the thyroid gland. This gland is situated at the front of the throat, below the Adam's apple (larynx). It comprises two lobes that lie on either side of the windpipe and are joined in front by an isthmus. The thyroid gland secretes hormones to regulate many metabolic processes, including growth and energy expenditure. The thyroid gland is controlled by the pituitary gland, which is located in the brain. The pituitary prompts the thyroid to make its hormones - including thyroxine (T4) and tri-iodothyronine (T3) - by releasing thyroid-stimulating hormone (TSH). However, the thyroid can't manufacture its hormones without sufficient dietary iodine. If a person's diet is low in iodine, the pituitary keeps sending chemical messages to the thyroid, but in vain. The thyroid gland enlarges as it attempts to comply with the pituitary's demands. Apart from iodine deficiency, other causes of goitre involve conditions of the thyroid - such as nodules, cancer, hyperthyroidism and hypothyroidism.

The symptoms of a goitre include:

• Enlargement of the throat, ranging from a small lump to a huge mass.
• Swallowing problems, if the goitre is large enough to press on the oesophagus.
• Breathing problems, if the goitre is large enough to press on the windpipe (trachea).

Goitres are broadly classified into two groups including:

• Endemic goitre - in which a whole community is affected by insufficient dietary iodine. One common reason is that the soil in which foods are grown is iodine depleted. Certain areas of Australia, including Tasmania and areas along the Great Dividing Range (for example, the Australian Capital Territory), have low iodine levels in the soil. There is also evidence of a re-emergence of iodine deficiency in cities like Melbourne and Sydney. Mountainous areas and areas far from the sea are the ones most likely to be iodine deficient. However, endemic goitres tend to be more prevalent in developing countries. They are rare in developed countries because of widespread iodine supplementation.
• Sporadic goitre - in which only the individual is affected. Risk factors for sporadic goitre include family history, diet, age (over 40 years) and gender (women are more susceptible than men).

Goitre can be caused by a range of factors, including:

• Insufficient iodine in the diet.
• High consumption of certain foods that neutralise iodine, such as cabbage, broccoli and cauliflower. Other foods, like soy, may also induce goitres.
• Certain drugs, such as lithium and phenylbutazone.
• Thyroid cancer.
• Nodules growing on the thyroid gland.
• Hyperthyroidism (overactive thyroid gland).
• Hypothyroidism (underactive thyroid gland).

A goitre, and its underlying causes, is diagnosed using a number of tests, including:

• Physical examination
• Blood tests - to check for thyroid hormone levels and particular antibodies
• Ultrasound scan
• Fine needle biopsy
• Radioactive iodine scan.