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Goiter

Synonyms: Goitre, thyroid enlargement, struma
Latin: Struma
German: Struma

1 Definition

Any enlargement of the thyroid size beyond the upper limit of its referene range is referred to as goiter.

The opposite of goiter is thyroid atrophy.

2 Classification

2.1 ...according to clinical criteria

  • Stadium 0: no goiter
  • Stadium I: palpable goiter
    • Stadium Ia: palpable goiter that is not visible in reclination of the head.
    • Stadium Ib: palpable goiter that is visible with the head reclined.
  • Stadium II: goiter visible without reclination of the head.
  • Stadium III: very large goiter that is visible from distance and that may be associated with local complications.

2.2 ...according to ultrasonographic structure

  • Diffuse goiter (Struma diffusa): homogenous ultrasonographic structure.
  • Nodulous goiter (Struma nodosa): solid lesions in ultrasonographic structure.
  • Cystic goiter (Struma cystica): liquid lesions in ultraonographic structure.
  • Nodulous and cystic goiter (Struma nodosa et cystica): solid and liquid lesions in ultrasonography.

3 Etiology

Different causales lead to the development of goiter. Most common are lack of trace elements like iodine or selenium, inflammatory thyroid diseases like autoimmune thyroiditis and "goitrogenous" agents like certain drugs and toxins. In countries with very high iodine supply like Japan also the surplus of this trace element may lead to the development of goiter via two different mechanisms (Wolff-Chaikoff-Effect and Plummer-Effect).

4 Therapy

The delivery of therapy depends from the indiviual cause of the goiter. The common goiter caused by iodine deficiency may be treated with sufficient supply of iodine (100 to 200 µg per day) or, if this is not successfull substitution with a combination of iodine and levothyroxine in non-TSH suppressive dose (e. g. 50 µg per day).

Goiter in autoimmune thyroiditis does not respond to substitution with iodine. In Graves' disease it degenerates often spontaneously. In cases that are resistant to therapy definitive therapy like surgery or radio-iodine ablation may be necessary. Caution may be advisable in Graves' disease where existing endocrine ophthalmophathy may be worsened by radioiodine therapy.

5 Literature

Grussendorf M, Reiners C, Paschke R, Wegscheider K; LISA Investigators. Reduction of thyroid nodule volume by levothyroxine and iodine alone and in combination: a randomized, placebo-controlled trial. J Clin Endocrinol Metab. 2011 Sep;96(9):2786-95. doi: 10.1210/jc.2011-0356. Epub 2011 Jun 29. [PMID 21715542]

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