Endemic Goiter

The thyroid gland is considered to be very important when it comes to generating hormones, balancing the metabolic rate of the heart, to support bone and in brain growth.

The thyroid gland is nestled just beneath Adam’s apple, its shape resembles the butterfly. When enough iodine is not provided to the body, disturbances begin in the neck part which results in thyromegaly, it can occur either by excess use of iodine or very less consumption of iodine. Thyromegaly or goitre can affect one or multiple areas of the gland, depending upon its severity.

Goitre condition is also known as thyromegaly. When the swelling happens, sudden enlargement in the thyroid gland occurs. Mostly forms due to hyperthyroidism and hypothyroidism.

Normal thyroid hormone levels can also sometimes cause thyromegaly. If not treated initially, abnormal growth can convert goitre into malignant tumour or cancer.  Around 20% of the world’s population is suffering from goitres. More than 250 million people are suffering from various kinds of thyroid gland disease. Goitre or Thyromegaly is rarely seen in the UK, US and Western European people and more in Asian and African countries. Goitre is often seen in females than males, as per 2019 report, around 230,000 deaths of females and only 70,000 deaths of males happened because of thyromegaly.

Symptoms

The most visible and discomfort creating symptoms of goitre are:

1. Enlarged Thyroid
2. Tightness in throat 
3. Trouble in breathing
4. Hoarseness
5. Voice changes and produces wheezing sound
6. Swollen face
7. Windpipe torture
8. Heartbeat fluctuates
9. Fragile nails and dry hair
10. Weight imbalance
11. Problem in sleeping
12. Infrequent bowel movements
13. Pain in muscles and weakness
14. Common cold
15. Fever

Causes

Goiter is caused by diet fluctuation, physical dysfunctioning and genetic defects. Some causes are shown below:

• LESS INTAKE OF IODINE

One of the primary and frequently seen causes is an iodine deficiency in people which drags them in the thyromegaly condition. There are two hormones present in the thyroid

1. L-Thyroxine or tetraiodothyronine commonly known as T4 hormone.
2. L- Triiodothyronine or T3 hormone

For both these hormones, the requirement of iodine is very necessary. The main source of iodine is sea salt and secondary sources are seaweed, shrimp and dairy products. Many people who live far from coastal areas are prompt to this and it is not wrong to say that 30-35% of people take less iodine.

• HASHIMOTO’S THYROIDITIS: Chronic lymphocytic thyroiditis is a broad name for Hashimoto’s disease. This is an autoimmune disease and it makes every possible attempt to damage the thyroid gland.

• HEREDITARY FACTORS: In 5-10% of people, goitre happens because of family history so genes can cause thyromegaly to some extent.

• PREGNANCY: Though this cause is uncommon comparatively it is still responsible for goitre when HCG  i.e. Human chorionic gonadotropin increases in pregnant women which increases the swelling of the thyroid gland and it can cause goitre in females also.

• MEDICINES: Lithium, Perchlorate, Interleukin, Sulfonylureas. All these medicines can give a rise to thyroid diseases and goitre, so if you are taking then stop and take the doctor’s advice at this point.

• GRAVE’S DISEASE: When thyroxine spreads, antibodies of grave’s disease patients fight against the thyroid gland.

FAQ

• What Is an Endemic Goiter?

Another name for endemic goitre is a multinodular goitre. Mostly results due to hypothyroidism (less thyroid hormone level). Less iodine intake can lead a person to an endemic goitre. It is usually seen in people who are living in hilly areas ( such as the Himalayas or Alps). 

• What Is Thyromegaly (Goiter) Treatment?

On the basis of the size of the goitre, patient’s age, your existing diseases, symptoms and cause doctor’s makes a list of treatments. Such as:

1. Medicine really helps to shrink the goitre naturally. 
   1. For the initial stage – Doctors usually recommend aspirin or corticosteroids.
   2. In extreme stage – Methimazole and propylthiouracil 

1. Opt for radioactive iodine – Typically given orally this is the best treatment as it vanishes the unnecessary thyroid cells in one go. 
2. Surgery: When you are intolerant to medicines and other tried and tested treatments that don’t work and to control the size of the goitre is becoming an issue, the only effective option is surgery.

        Such as Total Thyroidectomy and close to total thyroidectomy are reliable methods. This is very beneficial but for pregnant women or women who are in their lactation period surgery is not a good option. 

• Biopsy

When doctors have doubts regarding a particular cell or tissue which are responsible for the enlargement of the thyroid gland they give a sample to the laboratory to detect cancer or any other complications. Biopsy, medications and radioactive therapy are very efficient if you are looking for goitre treatment without surgery.