Goiter

The growth of the thyroid; in other words, the increase in its size and weight is called goiter albeit in small amounts. This abnormal growth may occur in one or more areas of the thyroid gland and nodules may protrude out or may grow inward. Whether it is diffuse or nodular goiter, the hormone levels should be normal (euthyroid) and there should be no inflammation or growth due to a tumoral cause.

What Causes Goiter?

The most common cause of goiter is iodine deficiency. If iodine is not found in sufficient quantities in foods, the thyroid gland will not receive iodine appropriately and deficiency of the thyroid gland in synthesizing appropriate levels of hormones will occur. Consequently, the level of TSH is elevated. TSH aims to stimulate the growth of the thyroid gland and the synthesis of thyroid hormones to normalize T3 and T4 levels. Lithium used in psychiatric patients and amiodarone used for the treatment of cardiac diseases may cause problems in the thyroid gland. Genetically inherited disorders affecting one or more of the hormone production stages may cause reductions in hormone synthesis and may cause the thyroid to grow. Hormone requirement increases during pregnancy and childhood. In the presence of familial predisposition in these individuals, the involvement of one or more of the abovementioned factors may cause goiter to occur.

How Is It Treated?

The aim of treatment in euthyroid goiter is to eliminate the symptoms or to alleviate the compression caused by the growth of the thyroid gland. For this purpose, a reduction in the size of the thyroid gland or prevention of its further growth is aimed.

The methods used in the treatment can be grouped under 4 headings:

1. Thyroid Suppression Therapy With Medication (Levothyroxine)

2. Thyroid Ablation with Radioactive Iodine

3. Surgery

4. Follow-up

One of the most important problems of the drug treatment is the inability to maintain the obtained reduction in the thyroid size after treatment cessation. Other issues are the side effects (atrial arrhythmias and decreased bone mineral density). Therefore, the administration of medical treatment has declined in recent years. Although radioactive iodine treatment (RAI) treatment is mostly used in the treatment of hyperthyroidism and well-differentiated thyroid cancers, it can be used safely and effectively in euthyroid nodular diseases. RAI is not commonly used in euthyroid goiter in our country. This method is mostly used in Europe and especially in the northern countries.

Surgery may be necessary for patients with obstructive symptoms or having a growing thyroid gland during the follow-up period. Surgery may also be preferred for cosmetic reasons. If there is a nodule, surgery should be decided based on the findings of the fine needle aspiration biopsy. If the biopsy findings reveal malignancy or suspected malignancy, the treatment will be surgery definitely.

Asymptomatic patients having a small euthyroid goiter (whether benign diffuse or nodular) do not need any specific treatment. These patients are followed up with hormone tests and USG at regular intervals.

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