Goitre 12265 226130869 2008-07-16T23:19:06Z Edward321 2096436 [[WP:UNDO|Undid]] revision 225485872 by [[Special:Contributions/Brisvegas|Brisvegas]] ([[User talk:Brisvegas|talk]]) {{Infobox_Disease | Name = {{PAGENAME}} | Image = Kone_med_stor_struma.jpg | Caption = A woman with a goiter. | DiseasesDB = 5332 | ICD10 = {{ICD10|E|01|0|e|00}}-{{ICD10|E|01|2|e|00}} | ICD9 = {{ICD9|240.9}} | ICDO = | OMIM = | MedlinePlus = 001178 | eMedicineSubj = | eMedicineTopic = | MeshID = Goiter | }} A '''goitre''' ([[BrE]]), or '''goiter''' ([[AmE]]) ([[Latin]] ''struma''), also called a '''bronchocele''', is a swelling in the neck (just below the [[Adam's apple]] or [[larynx]]) due to an enlarged [[thyroid|thyroid gland]]. ==Classification== They are classified in different ways: * A "diffuse goiter" is a goiter that has spread through all of the thyroid (and can be a "simple goitre", or a "multinodular goitre"). * "Toxic goitre" refers to goitre with [[hyperthyroidism]]. These most commonly due to [[Graves' disease]], but can be caused by [[inflammation]] or a multinodular goitre. * "Nontoxic goitre" (associated with normal or low thyroid levels) refers to all other types (such as that caused by [[lithium]] or certain other [[autoimmune]] diseases). Other type of classification: *I - palpation struma - in normal posture of head it cannot be seen. Only found when palpating. *II - struma is palpative and can be easily seen. *III - struma is very big and is retrosternal. Pressure and compression marks. == Causes == Other causes are: * [[Hashimoto's thyroiditis]] (E06.3) * [[Graves-Basedow disease]] (E05.0) * Inborn errors of thyroid hormone synthesis, causing [[congenital hypothyroidism]] (E03.0) * [[Thyroiditis]] (acute, chronic) (E06) * [[Adverse drug reaction|Side-effects]] of pharmacological therapy (E03.2) * [[Thyroid cancer]] * [[Iodine deficiency]] == Occurrence == Iodine is necessary for the synthesis of the thyroid [[hormone]]s [[thyroxine]] (T<sub>4</sub>) and [[triiodothyronine]] (T<sub>3</sub>). In endemic goitre, iodine deficiency leaves the thyroid gland unable to produce its hormones because the hormones are made out of iodine. When levels of thyroid hormones fall, thyrotropin-releasing hormone ([[TRH]]) is produced by the hypothalamus. TRH then prompts the pituitary gland to make thyrotropin or thyroid stimulating hormone ([[TSH]]), which stimulates the thyroid gland’s production of T<sub>4</sub> and T<sub>3</sub>. It also causes the thyroid gland to grow in size by increasing cell division. 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. ==Treatment== Treatment may not be necessary if the goitre is small. Goitre may be related to [[hyperthyroidism|hyper]]- and [[hypothyroidism]] (especially Graves' disease) and may be reversed by treatment of hyper- and hypothyroidism. Grave's disease can be corrected with antithyroid drugs (such as [[propylthiouracil]] and [[methimazole]]), [[thyroidectomy]] (surgical removal of the thyroid gland), and [[iodine-131]] (a radioactive isotope of iodine that is absorbed by the thyroid gland and destroys it). Hypothyroidism may raise the risk of goitre because it usually increases the production of TRH and TSH. Levothyroxine, used to treat hypothyroidism, can also be used in euthyroid patients for the treatment of goitre. Levothyroxine suppressive therapy decreases the production of TRH and TSH and may reduce goitre, thyroid nodules, and thyroid cancer. Blood tests are needed to ensure that TSH is still in range and the patient has not become subclinically hyperthyroid. If TSH levels are not carefully monitored, levothyroxine may increase the risk of osteoporosis. Thyroidectomy or <sup>131</sup> may be necessary in euthyroid goitrous patients who do not respond to levothyroxine treatment, especially if the patients have difficulty breathing or swallowing. <sup>131</sup>, with or without the pre-injection of synthetic TSH, can relieve obstruction and reduce the size of the goitre by thirty to sixty-five percent. Depending on how large the goitre is and how much of the thyroid gland must be removed or destroyed, thyroidectomy or <sup>131</sup> may produce hypothyroidism requiring life-long treatment. == History and future == In the 12th century, [[al-Jurjani]], a [[Islamic medicine|Persian physician]], provided the first description of [[Graves' disease]] after noting the association of goitre and [[exophthalmos]] in his ''Thesaurus of the Shah of Khwarazm'', the major medical dictionary of its time.<ref name=WNI>{{WhoNamedIt|synd|1517|Basedow's syndrome or disease}} - the history and naming of the disease</ref><ref>{{citation|journal=Lakartidningen|year=1983|date=August 10, 1983|volume=80|issue=32-33|title=Who was the man behind the syndrome: Ismail al-Jurjani, Testa, Flagani, Parry, Graves or Basedow? Use the term hyperthyreosis instead|last=Ljunggren|first=J. G.|pages=2902}}</ref> Al-Jurjani also established an association between goitre and [[palpitation]].<ref>{{citation|journal=International Journal of Endocrinology and Metabolism|year=2003|volume=1|pages=43–45 [45]|title=Clinical Endocrinology in the Islamic Civilization in Iran|last=Nabipour|first=I.}}</ref> The disease was later named after Irish doctor Robert James Graves,<ref>{{WhoNamedIt|doctor|695|Robert James Graves}}</ref> who described a case of goiter with exophthalmos in 1835. The German [[Karl 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,<ref>{{WhoNamedIt|doctor|1471|Giuseppe Flajani}}</ref> and by the English physician Caleb Hillier Parry (a friend of [[Edward Jenner]]) in the late 18th century.<ref>{{cite journal |author=Hull G |title=Caleb Hillier Parry 1755-1822: a notable provincial physician |journal=Journal of the Royal Society of Medicine |volume=91 |issue=6 |pages=335–8 |year=1998 |pmid=9771526 |doi= |url=http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=9771526}}</ref> [[Paracelsus]] (1493–1541) was the first person to propose a relationship between goitre and minerals (particularly lead) in drinking water.<ref>[http://www.britannica.com/EBchecked/topic/442424/Paracelsus/5505/Assessment "Paracelsus"] Britannica</ref> [[Iodine]] was later discovered by [[Bernard Courtois]] in 1811 from seaweed ash. Goitre was previously common in many areas that were deficient in iodine in the [[soil]]. For example, in the [[English Midlands]], the condition was known as '''Derbyshire Neck'''. In the [[United States]], goitre was found in the [[Great Lakes]], [[Midwestern United States|Midwest]], and Intermountain regions. The condition now is practically absent in affluent nations, where [[Sodium chloride|table salt]] is [[Iodized salt|supplemented with iodine]]. However, it is still prevalent in [[India]],<ref>[http://www.nytimes.com/2006/12/16/health/16iodine.html "In Raising the World’s I.Q., the Secret’s in the Salt"], article by Donald G. McNeil, Jr., December 16, 2006, ''[[New York Times]]''</ref> [[Central Asia]] and [[Central Africa]]. Some health workers fear that a resurgence of goitre might occur because of the trend to use [[rock salt]] and/or [[sea salt]], which has not been fortified with [[iodine]]. New research indicates that there may in fact be a tendency to inherit an increased vulnerability to goitre. == Famous goitre sufferers == *[[President]] [[George H. W. Bush]] and his wife [[Barbara Bush (First Lady)|Barbara Bush]] both were diagnosed with [[Graves' disease]] and goitres, within two years of each other. In the president's case, the disease caused [[hyperthyroidism]] and [[cardiac arrythmia|cardiac dysrhythmia]]. Even the Bushs’ dog Millie was diagnosed with an autoimmune disease: lupus.<ref>[http://www.doctorzebra.com/prez/t41.htm The Health and Medical History of President George Bush] DoctorZebra.com. [[8 August]] 2004. Retrieved [[8 October]] 2006.</ref><ref>[http://www.nndb.com/people/362/000022296/ "George H.W. Bush." NNDB.]</ref><ref>[http://books.google.com/books?id=QLy42Bu3I6oC&pg=PT170&lpg=PT170&dq=George+H.+W.+Bush+Graves'+disease&source=web&ots=vltg1l208P&sig=MIiwGNrpBy7ojSzz3LvpSoZtM_E&hl=en Robert G. Lahita and Ina Yalof. Women and Autoimmune Disease: The Mysterious Ways Your Body Betrays Itself. Page 158.]</ref><ref>[http://query.nytimes.com/gst/fullpage.html?res=9D0CE6DB1439F937A2575AC0A967958260 Lawrence K. Altman, M.D. “Doctors Say Bush Is in Good Health.” The New York Times. September 14, 1991.]</ref> Scientists said that the odds of both George and Barbara Bush having Graves’ disease might be 1 in 100,000 or as low as 1 in 3,000,000<ref>[http://query.nytimes.com/gst/fullpage.html?res=9D0CE7DD1039F93BA15756C0A967958260&sec=&spon=&pagewanted=1 Lawrence K. Altman, M.D. “The Doctor’s World; A White House Puzzle: Immunity Ailments.” The New York Times. May 28, 1991]</ref> *[[Andrea True]] (according to an interview on VH-1) <ref>[ http://celebrity.elle.com/celebrity-Andrea+True “Andrea True.” Elle.]</ref> *[[Jose Fadul]] *[[Kim Il-sung]] ==See also== {{Commonscat|Goiters}} *[[Struma ovarii]] (a kind of [[teratoma]]) *[[David Marine]] conducted substantial research on the treatment of goiter with [[iodine]]. ==References== <!-- ---------------------------------------------------------- See http://en.wikipedia.org/wiki/Wikipedia:Footnotes for a discussion of different citation methods and how to generate footnotes using the <ref>, </ref> and <reference /> tags ----------------------------------------------------------- --> <div class="references-small"> <references /> </div> {{refimprove|date=October 2006}} == External links == * [http://www.thyroidproblems.org/goiter.php Goiter] * [http://www.nhsdirect.nhs.uk/articles/article.aspx?articleId=179 National Health Services, UK] * [http://www.iodinenetwork.net Network for Sustained Elimination of Iodine Deficiency] * [http://www.sph.emory.edu/PAMM/sang/partnership/ Network for Sustained Elimination of Iodine Deficiency] - alternate site at [[Emory University]]'s School of [[Public Health]] {{Endocrine pathology}} [[Category:Thyroid disease]] [[Category:Malnutrition]] [[ar:تورم درقي]] [[bs:Strume]] [[da:Struma]] [[de:Struma]] [[es:Bocio]] [[eu:Bozio]] [[fr:Goitre]] [[id:Gondok]] [[it:Gozzo endemico]] [[he:זפקת]] [[nl:Schildkliervergroting]] [[ja:甲状腺腫]] [[no:Struma]] [[pl:Wole (tarczyca)]] [[pt:Bócio]] [[fi:Struuma]] [[sv:Struma]] [[ta:முன்கழுத்துக் கழலை]]