Goiter is an enlargement of the thyroid gland for any reason. In case of enlargement of the thyroid gland, abnormalities in thyroid hormones occur in many different types of goiter, while in non-toxic goiter, the thyroid gland enlarges without any abnormality in thyroid hormone levels.
The most common cause of non-toxic goiter is iodine deficiency. It is rarely seen for reasons such as inflammatory or cancer. Thyroid hormones are secreted by stimulating the secretion of TSH from the pituitary gland. In cases where thyroid production is insufficient, TSH secretion increases and the thyroid gland works more. In order to maintain the thyroid hormone level that the body needs, thyroid follicles also develop and the thyroid gland grows.
Non-toxic goiter may occur as the entire thyroid enlarges by spreading evenly or enlarges by forming nodules in it.
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The most common possible causes of non-toxic goiter are:
- Physiological goiter
- Puberty
- Pregnancy
- Iodine deficiency
- Dysmorphogenesis
- Goitrogens
- Cabbage
- Goitrogenic drugs such as para-aminosalicylic acid
- Radiation exposure
- TSH release from the pituitary glands
- Autoimmunity
- Infections
- Granulomatous disease
Most patients with non-toxic goiter do not have symptoms. Some patients may experience symptoms due to excessive growth of the thyroid gland and pressure around it. Hoarseness, difficulty in swallowing, tightness in the neck and limitation of movement, cosmetic disorders and rarely shortness of breath may occur.
Although non-toxic goiter has a good prognosis, non-toxic goiter stage can be seen in the early stages of all other thyroid diseases. Therefore, a situation that can turn into other diseases may occur. May cause bleeding or infections or inflammatory conditions. Regular follow-up of these patients is required. It is also necessary to investigate other thyroiditis and a possible malignancy.
Diagnosis of non-toxic goiter:
The level of thyroid hormones is evaluated in the patient whose thyroid gland enlargement is detected by examination. Thyroid ultrasonography is performed to evaluate the structure of the thyroid gland. Fine-needle aspiration biopsy can be performed in doubtful cases.
In advanced cases, a chest X-ray may also be required. Some patients may require CT and MRI. A radionuclide screening test may be performed to evaluate thyroid anatomy and function. Sometimes even laryngoscopy may be required to examine the vocal cords.
Treatment of non-toxic goiter:
In cases where non-toxic goiter does not cause any symptoms and there is no abnormality of thyroid hormone balance, it can be followed up with frequent follow-up.
In some cases, if there are signs of excessive growth and compression on the surrounding tissues, surgical treatment can be applied. A total thyroidectomy is usually performed. Thyroidectomy is a faster and more adaptable treatment method. The possibility of surgical complications is always present. In case of hypothyroidism after surgical treatment, thyroid replacement therapy is applied.
Radioactive iodine ablation can be performed in patients for whom surgical treatment is not appropriate. However, this treatment also has risks of radiation thyroiditis and hypothyroidism.