Goitre#Types

A goitre can present as a palpable or visible enlargement of the thyroid gland at the base of the neck. A goitre, if associated with hypothyroidism or hyperthyroidism, may be present with symptoms of the underlying disorder. For hyperthyroidism, the most common symptoms are associated with adrenergic stimulation: tachycardia (increased heart rate), palpitations, nervousness, tremor, increased blood pressure and heat intolerance. Clinical manifestations are often related to hypermetabolism (increased metabolism), excessive thyroid hormone, an increase in oxygen consumption, metabolic changes in protein metabolism, immunologic stimulation of diffuse goitre, and ocular changes (exophthalmos).{{cite book |last1=Porth |first1=Carol Mattson |last2=Gaspard |first2=Kathryn J |last3=Noble |first3=Kim A |title=Essentials of Pathophysiology: Concepts of Altered Health States |date=2011 |publisher=Lippincott Williams & Wilkins |isbn=978-1-58255-724-3 }}{{pn|date=May 2025}} Hypothyroid people commonly have poor appetite, cold intolerance, constipation, lethargy and may undergo weight gain. However, these symptoms are often non-specific and make diagnosis difficult.{{citation needed|date=August 2020}}

According to the WHO classification of goitre by palpation, the severity of goitre is currently graded as grade 0, grade 1, grade 2.{{cite book |title=Goitre as a determinant of the prevalence and severity of iodine deficiency disorders in populations |date=2014 |publisher=World Health Organization |hdl=10665/133706 |hdl-access=free |last1=Organization |first1=World Health }}

File:Struma 001.jpg|Goitre Class II, WHO grade 2

File:Kone med stor struma.jpg|Goitre Class III, WHO grade 2

Worldwide, the most common cause for goitre is iodine deficiency, commonly seen in countries that scarcely use iodized salt. Selenium deficiency is also considered a contributing factor. In countries that use iodized salt, Hashimoto's thyroiditis is the most common cause.{{cite book | vauthors = Mitchell RS, Kumar V, Abbas AK, Fausto N |title=Robbins Basic Pathology|publisher=Saunders |location=Philadelphia |year= 2007|isbn=978-1-4160-2973-1 |edition=8th}} Goitre can also result from cyanide poisoning, which is particularly common in tropical countries where people eat the cyanide-rich cassava root as the staple food.{{cite web|url=http://www.atsdr.cdc.gov/toxprofiles/tp8-c2.pdf |archive-url=https://web.archive.org/web/20040728092929/http://www.atsdr.cdc.gov/toxprofiles/tp8-c2.pdf |archive-date=2004-07-28 |url-status=live |title=Toxicological Profile For Cyanide |website=Atsdr.cdc.gov |access-date=2017-03-16}}

{{Clear}}

• Sarcoidosis
• Amyloidosis
• Hydatidiform mole
• Cysts
• Acromegaly
• Pendred syndrome

File:Struma 004.jpg]]

Goitre may be diagnosed via a thyroid function test in an individual suspected of having it.{{cite web |title=Goitre |url=https://www.nhs.uk/conditions/goitre/ |website=nhs.uk |access-date=27 March 2019 |language=en |date=19 October 2017}}

A goitre may be classified either as nodular or diffuse. Nodular goitres are either of one nodule (uninodular) or of multiple nodules (multinodular).{{cite book |doi=10.1016/B978-0-323-53114-6.00007-9 |chapter=Thyroid and Parathyroid Glands |title=Gnepp's Diagnostic Surgical Pathology of the Head and Neck |date=2021 |last1=Chernock |first1=Rebecca |last2=Williams |first2=Michelle D. |pages=606–688 |isbn=978-0-323-53114-6 }} Multinodular goiter (MNG) is the most common disorder of the thyroid gland.{{cite book |last1=Medeiros-Neto |first1=Geraldo |title=Endotext |date=2000 |publisher=MDText.com, Inc. |chapter-url=https://www.ncbi.nlm.nih.gov/books/NBK285569/ |chapter=Multinodular Goiter |pmid=25905424 }}

;Growth pattern:

• Uninodular goitre: one thyroid nodule; can be either inactive, or active (toxic) – autonomously producing thyroid hormone.
• Multinodular goitre: multiple nodules;{{cite journal | vauthors = Frilling A, Liu C, Weber F | title = Benign multinodular goiter | journal = Scandinavian Journal of Surgery | volume = 93 | issue = 4 | pages = 278–81 | year = 2004 | pmid = 15658668 | doi = 10.1177/145749690409300405 }} can likewise be inactive or toxic, the latter is called toxic multinodular goitre and associated with hyperthyroidism. 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.{{cite web |title=Toxic multinodular goitre - Symptoms, diagnosis and treatment {{!}} BMJ Best Practice |url=https://bestpractice.bmj.com/topics/en-gb/714 |website=bestpractice.bmj.com |language=en-us}} Thyroid cancer is identified in 13.7% of the patients operated for multinodular goitre.{{cite journal | vauthors = Gandolfi PP, Frisina A, Raffa M, Renda F, Rocchetti O, Ruggeri C, Tombolini A | title = The incidence of thyroid carcinoma in multinodular goiter: retrospective analysis | journal = Acta Bio-Medica | volume = 75 | issue = 2 | pages = 114–7 | date = August 2004 | pmid = 15481700 }}
• Diffuse goitre: the whole thyroid appearing to be enlarged due to hyperplasia.

;Size:

• Class I: the goitre in normal posture of the head cannot be seen; it is only found by palpation.
• 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 the sternum), pressure results in compression marks.

Goitre is treated according to the cause. If the thyroid gland is producing an excess of thyroid hormones (T3 and T4), radioactive iodine is given to the patient to shrink the gland. If goitre is caused by iodine deficiency, small doses of iodide in the form of Lugol's iodine or KI solution are given. If the goitre is associated with an underactive thyroid, thyroid supplements are used as treatment. Sometimes a partial or complete thyroidectomy is required.{{cite news| url=http://health.nytimes.com/health/guides/disease/goiter/overview.html | work=The New York Times | title=Goiter – Simple}}

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.{{Citation |last=Hetzel |first=Basil S. |title=The Iodine Deficiency Disorders |date=1993 |work=Iodine Deficiency in Europe |pages=25–31 |url=http://dx.doi.org/10.1007/978-1-4899-1245-9_3 |access-date=2024-08-06 |place=Boston, MA |publisher=Springer US |doi=10.1007/978-1-4899-1245-9_3 |isbn=978-1-4899-1247-3}}

File:Iodine deficiency world map - DALY - WHO2002.svg for iodine deficiency per 100,000 inhabitants in 2002.{{cite web |url=https://www.who.int/entity/healthinfo/statistics/bodgbddeathdalyestimates.xls |title=Mortality and Burden of Disease Estimates for WHO Member States in 2002|format=xls |work=World Health Organization|year=2002 }}{{Div col|small=yes|colwidth=10em}}

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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.1

Iodine mainly accumulates in the sea and in the topsoil. 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.[https://web.archive.org/web/20210606021115/https://apps.who.int/iris/bitstream/handle/10665/133706/WHO_NMH_NHD_EPG_14.5_eng.pdf Goitre as a determinant of the prevalence and severity of iodine deficiency disorders in populations], World Health Organization - 2014

Examples of such regions include the alpine regions of Southern Europe (such as Switzerland), the Himalayans, the Great 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 in Pemberton Meadows that it was difficult to raise young animals there.{{Cite journal |last=Kimball |first=O. P. |title=The Prevention of Simple Goiter |date=February 1923 |journal=American Journal of Public Health |volume=13 |issue=2 |pages=81–87 |doi=10.2105/ajph.13.2.81-a |pmid=18010882 |pmc=1354367 }}

File:Cretinnen aus Steiermark, 1819 gez. Loder, gest. Leopold Müller.jpg in Styria, copper engraving, 1815]]

File:Miesbacher gebirgstracht frau.jpg

Chinese physicians of the Tang 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.{{cite book | vauthors = Temple R | date = 1986 | title = The Genius of China: 3,000 Years of Science, Discovery, and Invention | location = New York | publisher = Simon and Schuster, Inc. | isbn = 0-671-62028-2 | pages = 134–5}} This was outlined in Zhen Quan's (d. 643 AD) book, as well as several others. One Chinese book, The Pharmacopoeia of the Heavenly Husbandman, asserted that iodine-rich sargassum was used to treat goitre patients by the 1st century BC, but this book was written much later.

In the 12th century, Zayn al-Din al-Jurjani, a Persian physician, provided the first description of Graves' disease after noting the association of goitre and a displacement of the eye known as exophthalmos in his Thesaurus of the Shah of Khwarazm, the major medical dictionary of its time.{{WhoNamedIt|synd|1517|Basedow's syndrome or disease}} – the history and naming of the disease{{cite journal | vauthors = Ljunggren JG | title = [Who was the man behind the syndrome: Ismail al-Jurjani, Testa, Flagani, Parry, Graves or Basedow? Use the term hyperthyreosis instead] | journal = Läkartidningen | volume = 80 | issue = 32–33 | pages = 2902 | date = August 1983 | pmid = 6355710 }} The disease was later named after Irish doctor Robert James Graves, who described a case of goitre 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,{{WhoNamedIt|doctor|1471|Giuseppe Flajani}} and by the English physician Caleb Hillier Parry (a friend of Edward Jenner) in the late 18th century.{{cite journal | vauthors = 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 | date = June 1998 | pmid = 9771526 | pmc = 1296785 | doi = 10.1177/014107689809100618 }}

Paracelsus (1493–1541) was the first person to propose a relationship between goitre and minerals (particularly lead) in drinking water.[https://www.britannica.com/EBchecked/topic/442424/Paracelsus/5505/Assessment "Paracelsus"] Britannica Iodine was later discovered by Bernard Courtois in 1811 from seaweed ash.{{cite journal |title=VI. Some experiments and observations on a new substance which becomes a violet coloured gas by heat |journal=Philosophical Transactions of the Royal Society of London |date=31 December 1814 |volume=104 |pages=74–93 |doi=10.1098/rstl.1814.0007 }}

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 Appalachian,{{Cite web|url=https://www.thyroid.org/iodine-deficiency/|title=Iodine Deficiency|access-date=27 February 2021|archive-date=18 November 2022|archive-url=https://web.archive.org/web/20221118193754/https://www.thyroid.org/iodine-deficiency/|url-status=dead}}{{Cite journal|url=https://jamanetwork.com/journals/jamapediatrics/article-abstract/507625|doi = 10.1001/archpedi.1977.02120210044010|title = Kentucky Appalachian Goiter Without Iodine Deficiency|year = 1977|last1 = Hollingsworth|first1 = Dorothy R.|journal = American Journal of Diseases of Children|volume = 131|issue = 8| pages=866–869 | pmid=888801 }} Great Lakes, Midwest, and Intermountain regions. The condition is now practically absent in affluent nations, where table salt is supplemented with iodine. However, it is still prevalent in India, China,[https://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., 16 December 2006, The New York Times Central Asia, and Central Africa.

Goitre had been prevalent in the alpine countries for a long time. Switzerland reduced the condition by introducing iodized salt in 1922. The Bavarian tracht in the Miesbach and Salzburg regions, which appeared in the 19th century, includes a choker, dubbed Kropfband (struma band) which was used to hide either the goitre or the remnants of goitre surgery.{{cite web|url=http://www.planet-wissen.de/pw/Artikel,,,,,,,FC2D0E589CC11ACEE0340003BA5E0905,,,,,,,,,,,,,,,.html|title=Planet Wissen|first=Planet|last=Wissen|date=16 March 2017}}

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.{{Cite journal |last1=Dunn |first1=John T. |last2=Delange |first2=Francois |date=June 2001 |title=Damaged Reproduction: The Most Important Consequence of Iodine Deficiency |journal=The Journal of Clinical Endocrinology & Metabolism |volume=86 |issue=6 |pages=2360–2363 |doi=10.1210/jcem.86.6.7611 |pmid=11397823 }}

In the 1920s wearing bottles of iodine around the neck was believed to prevent goitre.{{cite web|url=http://www.nrc-cnrc.gc.ca/eng/dimensions/issue8/iodine.html |title=ARCHIVED – Why take iodine? |publisher=Nrc-cnrc.gc.ca |date=2011-09-30 |access-date=2012-11-01}}

• Former U.S. President George H. W. Bush and his wife Barbara Bush were both diagnosed with Graves' disease and goitres, within two years of each other. The disease caused hyperthyroidism and cardiac dysrhythmia.{{cite book |url=https://books.google.com/books?id=QLy42Bu3I6oC&q=George+H.+W.+Bush+Graves'+disease&pg=PT170 |title=Women and Autoimmune Disease| vauthors = Lahita RG, Yalof I |author-link1=Robert G. Lahita |page=158 |publisher=HarperCollins |isbn=978-0-06-008149-2|date=2004-07-20 }}{{cite web | url = https://www.nytimes.com/1991/09/14/us/doctors-say-bush-is-in-good-health.html | vauthors = Altman LK | title = A White House Puzzle: Immunity Ailments | quote = Doctors Say Bush Is in Good Health | work = The New York Times | date = 14 September 1991 }} 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.{{cite web | url = https://www.nytimes.com/1991/05/28/science/the-doctor-s-world-a-white-house-puzzle-immunity-ailments.html | vauthors = Altman LK | title = The Doctor's World; A White House Puzzle: Immunity Ailments | work = The New York Times | date = 28 May 1991 }}

The coat of arms and crest of Die Kröpfner, of Tyrol, showed a man "afflicted with a large goitre", an apparent pun on the German for the word ("Kropf").{{cite book| vauthors = Fox-Davies AC |author-link=Arthur Charles Fox-Davies| title=The Art of Heraldry: An Encyclopædia of Armory|title-link=The Art of Heraldry: An Encyclopædia of Armory |year=1904 |publisher=Benjamin Blom, Inc. |location=New York and London |page=413}}

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.{{Cite journal |last=Norling |first=Bernard |date=October 1977 |title=Plagues and Peoples - William H. McNeill: Plagues and Peoples. (Garden City, New York: Anchor Press, Doubleday, 1976. Pp. 369. $10.00.) |journal=The Review of Politics |volume=39 |issue=4 |pages=557–560 |doi=10.1017/s0034670500025043 }}

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.{{fact|date=May 2025}}

• David Marine conducted substantial research on the treatment of goitre with iodine.
• Endemic goitre
• Struma ovarii—a kind of teratoma
• Thyroid hormone receptor

{{Reflist}}

• {{Wiktionary-inline}}
• {{Commons-inline|Goiters}}

{{Medical resources

| DiseasesDB = 5332

| ICD11 = {{ICD11|5A00.00}}, {{ICD11|5A00.1}}, {{ICD11|5A01}}, {{ICD11|5A02.0}}

| ICD10 = {{ICD10|E01}}–{{ICD10|E05}}

| ICD9 = {{ICD9|240.9}}

| ICDO =

| OMIM =

| MedlinePlus = 001178

| eMedicineSubj =

| eMedicineTopic =

| MeshID = D006042

}}

{{Thyroid disease}}

{{Authority control}}

Category:Endocrine diseases

Category:Thyroid

Category:Thyroid disease