Agoitre, orgoiter, is a swelling in theneck resulting from an enlargedthyroid gland.[1][2] A goitre can be associated with a thyroid that is not functioning properly.
Worldwide, over 90% of goitre cases are caused byiodine deficiency.[3] The term is from theLatingutturia, meaningthroat. Most goitres are notcancerous (benign), though they may be potentially harmful.
Worldwide, the most common cause for goitre isiodine deficiency, commonly seen in countries that scarcely useiodized salt.Selenium deficiency is also considered a contributing factor. In countries that use iodized salt,Hashimoto's thyroiditis is the most common cause.[6] Goitre can also result fromcyanide poisoning, which is particularly common in tropical countries where people eat the cyanide-richcassava root as the staple food.[7]
Cause
Pathophysiology
Resultant thyroid activity
Growth pattern
Treatment
Incidence and prevalence
Prognosis
Iodine deficiency
Hyperplasia of thyroid to compensate for decreased efficacy
Will develop in about 0.5% of males and 3% of females
Remission with treatment, but still lower quality of life for 14 to 21 years after treatment, with lower mood and lower vitality, regardless of the choice of treatment[10]
A goitre may be classified either as nodular or diffuse. Nodular goitres are either of one nodule (uninodular) or of multiple nodules (multinodular).[14] Multinodular goiter (MNG) is the most common disorder of the thyroid gland.[15]
Growth pattern
Uninodular goitre: onethyroid nodule; can be either inactive, or active (toxic) – autonomously producing thyroid hormone.
Multinodular goitre: multiple nodules;[16] can likewise be inactive or toxic, the latter is calledtoxic multinodular goitre and associated withhyperthyroidism. These nodules grow up at varying rates and secrete thyroid hormone autonomously, thereby suppressing TSH-dependent growth and function in the rest of gland. Inactive nodules in the same goitre can be malignant.[17]Thyroid cancer is identified in 13.7% of the patients operated for multinodular goitre.[18]
Diffuse goitre: the whole thyroid appearing to be enlarged due tohyperplasia.
Size
Class I: the goitre in normal posture of the head cannot be seen; it is only found bypalpation.
Class II: the goitre is palpable and can be easily seen.
Class III: the goitre is very large and is retrosternal (partially or totally lying below thesternum), pressure results in compression marks.
The discovery of iodine's importance in thyroid function and its role in preventing goiter marked a significant medical breakthrough. The introduction of iodized salt in the early 20th century became a key public health initiative, effectively reducing the prevalence of goiter in previously affected regions. This measure was one of the earliest and most successful examples of mass preventive health campaigns.[20]
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.[22]
Iodine mainly accumulates in the sea and in thetopsoil. Before iodine enrichment programs, goiters were common in areas with repeated flooding or glacial activities, which erodes the topsoil. It is endemic in populations where the intake of iodine is less than 10 μg per day.[23]
Examples of such regions include the alpine regions of Southern Europe (such as Switzerland), the Himalayans, theGreat Lakes basin, etc. As reported in 1923, all the domestic animals have goiter in some of the glacial valleys of Southern Alaska. It was so severe inPemberton Meadows that it was difficult to raise young animals there.[24]
Chinese physicians of theTang dynasty (618–907) were the first to successfully treat patients with goitre by using the iodine-rich thyroid gland of animals such as sheep and pigs—in raw, pill, or powdered form.[25] This was outlined in Zhen Quan's (d. 643 AD) book, as well as several others.[25] One Chinese book,The Pharmacopoeia of the Heavenly Husbandman, asserted that iodine-richsargassum was used to treat goitre patients by the 1st century BC, but this book was written much later.[25]
In the 12th century,Zayn al-Din al-Jurjani, aPersian physician, provided the first description ofGraves' disease after noting the association of goitre and a displacement of the eye known asexophthalmos in hisThesaurus of the Shah of Khwarazm, the major medical dictionary of its time.[26][27] The disease was later named after Irish doctorRobert James Graves, who described a case of goitre with exophthalmos in 1835. The GermanKarl Adolph von Basedow also independently reported the same constellation of symptoms in 1840, while earlier reports of the disease were also published by the Italians Giuseppe Flajani and Antonio Giuseppe Testa, in 1802 and 1810 respectively,[28] and by the English physicianCaleb Hillier Parry (a friend ofEdward Jenner) in the late 18th century.[29]
Paracelsus (1493–1541) was the first person to propose a relationship between goitre and minerals (particularly lead) in drinking water.[30]Iodine was later discovered byBernard Courtois in 1811 from seaweed ash.[31]
Goitre had been prevalent in the alpine countries for a long time. Switzerland reduced the condition by introducingiodized salt in 1922. The Bavariantracht in theMiesbach andSalzburg regions, which appeared in the 19th century, includes achoker, dubbedKropfband (struma band) which was used to hide either the goitre or the remnants of goitre surgery.[35]
In various regions around the world, particularly in mountainous areas, the prevalence of goiter was linked to iodine deficiency in the diet. For example, the Alps, the Himalayas, and the Andes had high rates of goiter due to the iodine-poor soil. In these regions, iodine deficiency led to widespread hormonal imbalances, particularly affecting thyroid function.[36]
Former U.S. PresidentGeorge H. W. Bush and his wifeBarbara Bush were both diagnosed withGraves' disease and goitres, within two years of each other. The disease causedhyperthyroidism andcardiac dysrhythmia.[38][39] Scientists said that, absent an environmental cause, the odds of both a husband and wife having Graves' disease might be 1 in 100,000 or as low as 1 in 3,000,000.[40]
The coat of arms and crest of Die Kröpfner, ofTyrol, showed a man "afflicted with a large goitre", an apparent pun on theGerman for the word ("Kropf").[41]
In some historical contexts, goiters were so prevalent that they became normalized within the culture. For instance, in certain Alpine regions, large goiters were sometimes considered a sign of beauty. Conversely, in other areas, individuals with goiters faced social stigma, which could lead to marginalization and discrimination.[42]
Goiter, resulting primarily from iodine deficiency, has historically been a widespread condition with significant health and social implications. Advances in nutrition and public health have greatly reduced its prevalence, but understanding its historical context helps in appreciating the development of endocrinology and public health measures.
^abHörmann R (2005).Schilddrüsenkrankheiten Leitfaden für Praxis und Klinik (4., aktualisierte und erw. Aufl ed.). Berlin. pp. 15–37.ISBN3-936072-27-2.{{cite book}}: CS1 maint: location missing publisher (link)
^Porth CM, Gaspard KJ, Noble KA (2011).Essentials of pathophysiology: Concepts of altered health states (3rd ed.). Philadelphia, PA: Wolters Kluwer/Lippincott Williams & Wilkins.
^Abraham-Nordling M, Törring O, Hamberger B, Lundell G, Tallstedt L, Calissendorff J, Wallin G (November 2005). "Graves' disease: a long-term quality-of-life follow up of patients randomized to treatment with antithyroid drugs, radioiodine, or surgery".Thyroid.15 (11):1279–86.doi:10.1089/thy.2005.15.1279.PMID16356093.
^Bukvic BR, Zivaljevic VR, Sipetic SB, Diklic AD, Tausanovic KM, Paunovic IR (August 2014). "Improvement of quality of life in patients with benign goiter after surgical treatment".Langenbeck's Archives of Surgery.399 (6):755–64.doi:10.1007/s00423-014-1221-7.PMID25002182.S2CID34137703.
^"Goitre".nhs.uk. 19 October 2017. Retrieved27 March 2019.
^Gandolfi PP, Frisina A, Raffa M, Renda F, Rocchetti O, Ruggeri C, Tombolini A (August 2004). "The incidence of thyroid carcinoma in multinodular goiter: retrospective analysis".Acta Bio-Medica.75 (2):114–7.PMID15481700.
^abcTemple R (1986).The Genius of China: 3,000 Years of Science, Discovery, and Invention. New York: Simon and Schuster, Inc. pp. 134–5.ISBN0-671-62028-2.
^Ljunggren JG (August 1983). "[Who was the man behind the syndrome: Ismail al-Jurjani, Testa, Flagani, Parry, Graves or Basedow? Use the term hyperthyreosis instead]".Läkartidningen.80 (32–33): 2902.PMID6355710.
