Synonyms: Goitre, thyroid enlargement, struma
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.
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).
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 Âµg per day) or, if this is not successfull substitution with a combination of iodine and levothyroxine in non-TSH suppressive dose (e. g. 50 Âµg 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.
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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