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GoitreWikipedia

Goitre
FromWikipedia,thefreeencyclopedia

Agoitre(BritishEnglish)orgoiter(AmericanEnglish)(from
theLatingutteria,struma)isaswellingoftheneckorlarynx
resultingfromenlar
gementofthethyroidgland(thyromegaly),
associatedwithathyroidglandthatisnotfunctioningproperly
.

Goitre

Worldwide,over90%casesofgoitrearecausedby
iodine
deficiency.[1]

Contents
1
2
3
4
5
6
7

Signsandsymptoms
Morphology
Causes
Treatment
Epidemiology
History
Societyandculture
7.1 Notablecases
8 Heraldry
9 Seealso
10 References
11 Externallinks

Signsandsymptoms

Diffusehyperplasiaofthe thyroid
Classificationandexternalr esources
Specialty

Goiter,associatedwithhypothyroidism
orhyperthyroidism
,maybe
ICD10
presentwithsymptomsoftheunderlyingdisorder
.For
hyperthyroidism,themostcommonsymptomsareassociatedwith
adrenergicstimulation:tachycardia,palpitations,nervousness,
tremor,increasedbloodpressureand
heatintolerance.Clinical
manifestationsareoftenrelatedtohypermetabolism,(increased
ICD9CM
metabolism),excessivethyroidhormone,anincreaseinoxygen
consumption,metabolicchangesinproteinmetabolism,immunologic
DiseasesDB
stimulationofdif
fusegoitre,andocularchanges(
exophthalmos).[2]
Hypothyroidindividualsmayhaveweightgaindespitepoorappetite,
coldintolerance,constipationandlethar
gy.However,these
MedlinePlus
symptomsareoften
nonspecificandmakediagnosisdif
ficult.

Morphology
Regardingmorphology
,goitresmaybeclassifiedeitherasthe
growthpatternorasthesizeofthegrowth
:
https://en.wikipedia.org/wiki/Goitre

MeSH

Endocrinology
E01(http://apps.who.int/classification
s/icd10/browse/2016/en#/E01)E05(h
ttp://apps.who.int/classifications/icd1
0/browse/2016/en#/E05)
240.9(http://www .icd9data.com/getI
CD9Code.ashx?icd9=240.9)
5332(http://www .diseasesdatabase.co
m/ddb5332.htm)
001178(http://www .nlm.nih.gov/medl
ineplus/ency/article/001178.htm)
D006042(https://www .nlm.nih.gov/c
gi/mesh/2016/MB_cgi?field=uid&term
=D006042)

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Growthpattern
Uninodulargoitre:canbeeitherinactiveoratoxicnodule
Multinodulargoitre:canlikewisebeinactiveortoxic,thelattercalled
toxicmultinodulargoitre
Diffusegoitre:thewholethyroidappearingtobeenlar
ged.
Size
ClassI(palpationgoitre):innormalpostureofthehead,itcannotbeseenitisonlyfoundbypalpation.
ClassII:thegoitreispalpableandcanbeeasilyseen.
ClassIII:thegoitreisverylar
geandisretrosternalpressureresultsincompressionmarks.

Goitre(ClassII)

Goitrewithautonomousadenoma

GoitreClassIII

Causes
Worldwide,themostcommoncauseforgoitreis
iodinedeficiency
,usuallyseenincountriesthatdonotuseiodizedsalt.
Seleniumdeficiencyisalsoconsideredacontributingfactor
.Incountriesthatuse
iodizedsalt,Hashimoto'sthyroiditis
isthe
mostcommoncause.[3]Goitrecanalsoresultfromcyanidepoisoningthisisparticularlycommonintropicalcountries
[4]
wherepeopleeatthecyaniderichcassavarootasthestaplefood.

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Cause

Iodine
deficiency

GoitreWikipedia

Pathophysiology

Resultant
thyroid
activity

Growth
pattern

Hyperplasiaofthyroid
Cancause
tocompensatefor
Diffuse
hypothyroidism
decreasedefficacy

Inbornerrorsof
Congenital
thyroidhormone
hypothyroidism
synthesis

Treatment

Incidence
and
prevalence

Iodine

Constitutes
over90%
casesofgoitre
worldwide[1]

Prognosis
Increasedsizeof
thyroidmaybe
permanentif
untreatedfor
aroundfiveyears

Hypothyroidism

Goitrogen
ingestion
Adversedrug
reactions
Hashimoto's
thyroiditis

Autoimmunedisease
inwhichthethyroid
Prevalence:1
Diffuseand Thyroid
Remissionwith
glandisgradually
Hypothyroidism
hormone
to1.5ina
[5]
treatment
lobulated
destroyed.Infiltration
replacement 1000
oflymphocytes.

Pituitary
disease

Hypersecretionof
thyroidstimulating
hormone,almost
alwaysbyapituitary
adenoma[6]

Graves'
diseasealso
called
Basedow
syndrome

Thyroiditis

Diffuse

Autoantibodies
(TSHRAb)that
activatetheTSH
receptor(TSHR)

HyperthyroidismDiffuse

Acuteorchronic
inflammation

Canbe
hyperthyroidism
initially
,but
progressto
hypothyroidism

https://en.wikipedia.org/wiki/Goitre

Pituitary
surgery

Veryrare[6]

Antithyroid
agents,
radioiodine,
surgery

Remissionwith
treatment,butstill
lowerqualityoflife
1to2cases for14to21years
aftertreatment,
per1,000
populationper withlowermood
andlowervitality
,
year
regardlessofthe
choiceof
treatment[7]

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Cause

GoitreWikipedia

Pathophysiology

Thyroidcancer

Resultant
thyroid
activity

Growth
pattern

Usually
uninodular

Benignthyroid
neoplasms

Usually
Usually
hyperthyroidism uninodular

Thyroid
hormone
insensitivity

Secretional
hyperthyroidism
,
Diffuse
Symptomatic
hypothyroidism

Treatment

Incidence
and
prevalence

Prognosis
Overallrelative
5
yearsurvivalrate
of85%forfemales
and74%for
males[8]
Mostlyharmless

Sarcoidosis
Amyloidosis
Hydatidiformmole
Cysts
Acromegaly
Pendredsyndrome

Treatment
Goitreistreatedaccordingtothecause.Ifthe
thyroidglandisproducingtoomuch
T3andT4,radioactiveiodine
isgiven
tothepatienttoshrinkthegland.Ifgoitreiscausedby
iodinedeficiency,smalldosesofiodideintheformof
Lugol'sIodine
orKIsolutionaregiven.Ifthegoitreisassociatedwithanunderactive
thyroid,thyroidsupplementsareusedastreatment.
Inextremecases,apartialorcomplete
thyroidectomyisrequired.[9]

Epidemiology

Goitreismorecommonamongwomen,butthisincludesthemanytypesofgoitrecausedbyautoimmuneproblems,andn
onlythosecausedbysimplelackofiodine.

History
Chinesephysiciansofthe
TangDynasty(618907)werethefirsttosuccessfullytreatpatientswithgoitrebyusingthe
[11]ThiswasoutlinedinZhen
iodinerichthyroidglandofanimalssuchassheepandpigsinraw
,pill,orpowderedform.
[12]OneChinesebook,ThePharmacopoeiaoftheHeavenly
Quan's(d.643AD)book,aswellasseveralothers.
Husbandman,assertedthatiodinerich
sargassumwasusedtotreatgoitrepatientsbythe1stcenturyBC,butthisbook

waswrittenmuchlater
.[13]
Inthe12thcentury
,ZaynalDinalJurjani
,aPersianphysician
,providedthefirstdescriptionof
Graves'diseaseafternoting
theassociationofgoitreandadisplacementoftheeyeknownas
exophthalmosinhisThesaurusoftheShahof
[14][15]
Khwarazm,themajormedicaldictionaryofitstime. AlJurjanialsoestablishedanassociationbetweengoitreand
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palpitation.[16]Thediseasewas
laternamedafterIrishdoctor
RobertJamesGraves,who
describedacaseofgoitrewith
exophthalmosin1835.The
GermanKarlAdolphvon
Basedowalsoindependently
reportedthesameconstellationof
symptomsin1840,whileearlier
GoitreandcretinisminStyria,copper
reportsofthediseasewerealso
engraving,1815
publishedbytheItalians
GiuseppeFlajaniandAntonio
GiuseppeTesta,in1802and1810respectively
,[17]andbytheEnglish
physicianCalebHillierParry
(afriendofEdwardJenner)inthelate18th
[18]
century.

Disabilityadjustedlifeyearforiodine
deficiencyper100,000inhabitantsin
2002.[10]

Paracelsus(14931541)wasthefirstpersontoproposearelationship
betweengoitreandminerals(particularlylead)indrinkingwater
.[19]Iodine
waslaterdiscoveredbyBernardCourtoisin1811fromseaweedash.

nodata

300350

fewerthan50

350400

50100

400450

100150

450500

150200

500800

200250

morethan800

250300

Goitrewaspreviouslycommoninmanyareasthatweredeficientiniodineinthe
soil.Forexample,inthe
EnglishMidlands
,theconditionwasknownas
DerbyshireNeck .IntheUnitedStates,goitrewasfoundinthe
GreatLakes,
Midwest,andIntermountainregions.Theconditionnowispracticallyabsentin
affluentnations,where
tablesaltissupplementedwithiodine
.However,itisstill
prevalentinIndia,China,[20]CentralAsia,andCentralAfrica.
Goitrehadbeenprevalentinthealpinecountriesforalongtime.Switzerland
reducedtheconditionbyintroducing
iodisedsaltin1922.TheBavarian
trachtin
theMiesbachandSalzbur
gregions,whichappearedinthe19thcentury
,includes
achoker,dubbedKropfband(strumaband)whichwasusedtohideeitherthe
goitreortheremnantsofgoitresur
gery.[21]

Societyandculture

WomeninMiesbacherTracht,
includingagoitrechoker

[22]
Inthe1920swearingbottlesofiodinearoundtheneckwasbelievedtopreventgoitre.

Notablecases
FormerUSPresidentGeorgeH.W.BushandhiswifeBarbaraBushwerebothdiagnosedwith
Graves'diseaseand
goitres,withintwoyearsofeachother
.Thediseasecausedhyperthyroidism
andcardiacdysrhythmia
.[23][24]
ScientistssaidthattheoddsofbothGeor
geandBarbaraBushhavingGraves'diseasemightbe1in100,000oras
[25]
lowas1in3,000,000.
AndreaTrue(accordingtoaninterviewon
VH1).[26]

Heraldry
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ThecoatofarmsandcrestofDieKrpfner
,ofTyrolshowedaman"afflictedwithalar
gegoitre",anapparentpunonthe
[27]
Germanfortheword("Kropf").

Seealso
DavidMarineconductedsubstantialresearchonthetreatmentofgoitrewith
iodine.
Endemicgoitre
Strumaovariiakindofteratoma

References
1.R.Hrmann:Schilddrsenkrankheiten.ABW
Wissenschaftsverlag,4.Auflage2005,Seite1537.ISBN3936072272
2.Porth,C.M.,Gaspard,K.J.,&Noble,K.A.(2011).Essentialsofpathophysiology:Conceptsofalteredhealthstates(3rd
ed.).Philadelphia,PA:WoltersKluwer/LippincottWilliams&Wilkins.
3.Mitchell,RichardSheppardKumar
,VinayAbbas,AbulK.Fausto,Nelson.RobbinsBasicPathology(8thed.).
Philadelphia:Saunders.ISBN1416029737.
4.http://www.atsdr.cdc.gov/toxprofiles/tp8c2.pdf
5.BabademezMA,TuncayKS,ZaimM,AcarB,KaraenRM(2010)."HashimotoThyroiditis
andThyroidGlandAnomalies".
JournalofCraniofacialSurgery.21(6):18071809.doi:10.1097/SCS.0b013e3181f43e32.PMID21119426.
6.Thyrotropin(TSH)secretingpituitaryadenomas.(http://www.uptodate.com/contents/thyrotropintshsecretingpituitarya
denomas)ByRoyEWeissandSamuelRefetoff.Lastliteraturereviewversion19.1:January2011.Thistopiclastupdated:
July2,2009
7.AbrahamNordling,Torring,Hamberger,Lundell,Tallstedt,Calissendorff,Wallin.Graves'Disease:Alongtermqualityof
lifefollowupofpatientsrandomizedtotreatmentwithantithyroiddrugs,radioiodine,orsur
gery,Thyroid15,no.
11(2005),127986
8.NumbersfromEUROCARE,fromPage10(https://books.google.com/books?id=u1aFpFEcgwC&pg=P
A10)in:F.
GrnwaldBiersack,H.J.Grunwald,F.(2005).Thyroidcancer.Berlin:Springer.ISBN3540223096.
9."GoiterSimple".TheNewYorkTimes.
10."MortalityandBurdenofDiseaseEstimatesforWHOMemberStatesin2002"
(xls).WorldHealthOrganization.2002.
11.Temple,Robert.(1986).TheGeniusofChina:3,000YearsofScience,Discovery,andInvention.Withaforewordby
JosephNeedham.NewYork:SimonandSchuster,Inc. ISBN0671620282.Pages133134.
12.Temple,Robert.(1986).TheGeniusofChina:3,000YearsofScience,Discovery,andInvention.Withaforewordby
JosephNeedham.NewYork:SimonandSchuster,Inc. ISBN0671620282.Page134.
13.Temple,Robert.(1986).TheGeniusofChina:3,000YearsofScience,Discovery,andInvention.Withaforewordby
JosephNeedham.NewYork:SimonandSchuster,Inc. ISBN0671620282.Pages134135
14.Basedow'ssyndromeordisease(http://www.whonamedit.com/synd.cfm/1517.html)atWhoNamedIt?thehistoryand
namingofthedisease
15.LjunggrenJG(August1983)."[Whowasthemanbehindthesyndrome:IsmailalJurjani,T
esta,Flagani,Parry,Gravesor
Basedow?Usethetermhyperthyreosisinstead]".Lakartidningen.80(3233):2902.PMID6355710.
16.Nabipour,I.(2003)."ClinicalEndocrinologyintheIslamicCivilizationinIran".
InternationalJournalofEndocrinologyand
Metabolism.1:4345[45].
17.GiuseppeFlajani(http://www.whonamedit.com/doctor.cfm/1471.html)atWhoNamedIt?
18.HullG(1998)."CalebHillierParry17551822:anotableprovincialphysician"
.JournaloftheRoyalSocietyofMedicine.
91(6):3358.PMC1296785 .PMID9771526.
19."Paracelsus"(http://www.britannica.com/EBchecked/topic/442424/Paracelsus/5505/Assessment)
Britannica
20."InRaisingtheWorld'sI.Q.,theSecret'sintheSalt"(http://www.nytimes.com/2006/12/16/health/16iodine.html)
,articleby
DonaldG.McNeil,Jr.,December16,2006,NewYorkTimes
21.Kropfbandbeiplanetwissen.de(http://www.planetwissen.de/pw/Artikel,,,,,,,FC2D0E589CC1
1ACEE0340003BA5E090
5,,,,,,,,,,,,,,,.html)
22."ARCHIVEDWhytakeiodine?"
.Nrccnrc.gc.ca.201 10930.Retrieved20121101.
23.Lahita,RobertG.Yalof,Ina.WomenandAutoimmuneDisease.HarperCollins.p.158.ISBN9780060081492.
24.LawrenceK.Altman,M.D."DoctorsSayBushIsinGoodHealth"
(http://query.nytimes.com/gst/fullpage.html?res=9D0CE
6DB1439F937A2575AC0A967958260)
.TheNewYorkTimes.September14,1991.
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25.LawrenceK.Altman,M.D."TheDoctor'sWorldAWhiteHousePuzzle:ImmunityAilments"
(http://query.nytimes.com/gs
t/fullpage.html?res=9D0CE7DD1039F93BA15756C0A967958260&sec=&spon=&pagewanted=1)
,TheNewYorkTimes.
May28,1991
26."HearstMagazines".elle.com.
27.FoxDavies,ArthurCharles(1904).TheArtofHeraldry:AnEncyclopdiaofArmory.NewYorkandLondon:Benjamin
Blom,Inc.p.413.

Externallinks
NationalHealthService,UK
(http://www.nhsdirect.nhs.uk/en/Search?q=g
WikimediaCommonshas
oitres&x=16&y=14&filter=All)
mediarelatedtoGoiters.
IodineGlobalNetwork(http://www.ign.org)
Acase(http://s711.photobucket.com/albums/ww1
11/doctorjk/?action=view&current=Goiter
.jpg)andphotograph
(http://i711.photobucket.com/albums/ww1
11/doctorjk/Goiter.jpg)ofahugegoitrefromPhotobucket.comand
Doctorkhodadoust.net
Retrievedfrom"
https://en.wikipedia.or
g/w/index.php?title=Goitre&oldid=744266906
"
Categories: Endocrinediseases Thyroid Thyroiddisease
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