Goiter

WHAT YOU SHOULD KNOW

Goiter is the medical term for enlargement of the thyroid gland. A butterfly shaped structure located in the front, lower section of the neck, the thyroid controls the speed at which the body's metabolism operates. In children, the thyroid is essential for normal growth and development.

Goiter is often merely a symptom of a more serious thyroid condition, such as:

If a child is born with an enlarged thyroid gland, it is referred to as congenital goiter. In some cases, a child may have Pendred's Syndrome, a condition in which congenital goiter and deaf-mutism are both present. Goiter in a newborn can press on the windpipe, making breathing difficult.

Causes

There are various types and causes of goiter. In underdeveloped parts of the world, it is often brought on by a lack of iodine in the diet. Iodine---found in fish products, drinking water and table salt---is essential for the production of thyroid hormone. Without it, the gland enlarges in an attempt to increase the output of the hormone. The World Health Organization estimates that 750 million people still suffer from this problem, earning it the name endemic goiter.

The overactivity of the thyroid found in Graves' disease is believed to be caused by an antibody that stimulates the thyroid to produce too much of the hormone. Goiter caused by Graves' disease is accompanied by other problems such as bulging eyes, a rapid heartbeat, sweating, and anxiety.

In another form of goiter, called toxic nodular goiter, one or more nodules in the thyroid get out of control and produce too much thyroid hormone. In this case, the nodules are benign thyroid tumors and are not associated with other disorders.

Sporadic goiter is caused by an overgrowth of the thyroid gland. In certain other types of goiter, the cause is unknown.

Signs/Symptoms

The hallmark of goiter is swelling in or disfigurement of the neck. The swollen area is usually painless, but can be bothersome and psychologically disturbing due to its appearance.

Care

To confirm that the swelling is a goiter, your doctor will first conduct a blood test to determine the amount of thyroid hormone in your blood and measure the activity of the pituitary gland, which controls the thyroid. Treatment depends on the type of goiter the doctor identifies.

Often the problem can be controlled with medications such as methimazole or propylthiouracil that interfere with the production of thyroid hormones. Radioactive iodine to destroy part of the gland is another common treatment. In some cases, surgical removal of all or part of the thyroid gland, called a thyroidectomy, may be required. If the thyroid gland is removed, you'll need to take thyroid tablets for the rest of your life to replace the missing natural supply.

Risks

Because goiter typically signals an underlying problem, any swelling of the neck should immediately be checked by a doctor. Both under- and overactive thyroid, if left untreated, can eventually lead to life-threatening complications.

WHAT YOU SHOULD DO

• If you notice a swelling in the neck, see your doctor without delay. You cannot treat this problem on your own.
• Eat a diet high in protein to replace tissue lost from thyroid overactivity.
• Eat a diet low in fat if you are overweight. Try to lose the excess pounds.

IF YOU'RE HEADING FOR THE HOSPITAL

What to Expect While You're There

You may encounter the following procedures and equipment during your stay.

• Taking Vital Signs: These include your temperature, pulse, blood pressure, and respiration. A stethoscope is used to listen to your heart and lungs. Your blood pressure is taken by wrapping a cuff around your arm. The tests may be performed hourly.
• IV: A tube placed in your vein for giving medications or liquids. It will either be capped or have tubing connected to it.
• Blood: Samples for testing are taken from a vein in your hand or the bend in your elbow. When blood gases must also be evaluated, additional samples may be drawn from either the wrist, elbow, or groin.
• CT Scan: Computerized axial tomography, also know as a CAT scan, may be used to obtain a picture of the thyroid gland.
• Anesthesia: Prior to the operation, you'll probably be put to sleep with medications given by injection and through a tube placed in your windpipe.
• Surgery: The surgeon will make an incision along the skin lines in the neck, then remove all or part of the thyroid gland. Some normal thyroid tissue may be left in place. Surrounding tissue is then returned to its normal position and the incision is closed.

After You Leave

• Your doctor will prescribe pain relievers and thyroid hormone medicine. Take your medications exactly as directed.
• DO NOT take any other medications without first checking with your doctor.
• DO NOT take prescription pain medication for more than 4 to 7 days.
• Rest in bed and limit your normal activities as much as possible for a few days. Afterwards, you may resume your normal activities when you feel up to it.
• Follow your doctor's instructions regarding wound care. The stitches are typically removed within 2 to 10 days following surgery.
• Use an electric heating pad, a heat lamp, or a warm compress to relieve any pain or discomfort at the incision site.
• Wash the incision gently with warm water and a mild unscented soap.

Call Your Doctor If...

• You develop any pain, redness, swelling, bleeding, or drainage at the surgical site.
• You develop any signs of an infection, such as a headache, fever, or run-down feeling.
• You become weak, fatigued, or sensitive to cold, or develop dry, rough skin.
• You develop cramp-like spasms in your hands, feet or throat. These could be signs of hypoparathyroidism, a condition in which the parathyroid glands do not produce enough hormones for bone growth. The problem is sometimes seen in patients who have had surgery on their thyroid gland.