What Are the Most Common Goiter Symptoms?
Simple goiter is a goiter with normal thyroid function. It is a compensatory goiter due to iodine deficiency, goiter-causing substances, or related enzyme defects. It is not accompanied by significant hyperthyroidism or hypothyroidism. It is called non-toxic goiter, which is characterized by being spread in non-endemic goiter endemic areas without tumors and inflammation. The thyroid gland is mostly diffuse in the early stage of the disease and can develop into multi-nodular enlargement in the future.
Basic Information
- nickname
- Non-toxic goiter, endemic goiter, sporadic goiter
- English name
- simple goiter
- Visiting department
- Endocrinology
- Common locations
- thyroid
- Common causes
- Caused by iodine deficiency, goiter-causing substances, or related enzyme defects
- Common symptoms
- Goiter or neck mass, wheezing, dyspnea, cough, etc.
- Contagious
- no
Causes of simple goiter
- Most patients with simple goiter have no obvious etiology, and the incidence of some patients may be related to the following factors:
- Iodine deficiency
- Iodine is an essential element for the synthesis of thyroid hormones. The iodine deficiency is insufficient, and the body cannot synthesize sufficient thyroid hormones. The feedback stimulates the pituitary gland TSH to increase, which increases the thyroid gland and causes goiter. China is a country with severe iodine deficiency, and the national Iodine Salt Addition policy is the most effective measure to prevent iodine deficiency diseases.
- 2. Enzyme deficiency
- Congenital or acquired defects of certain enzymes during thyroid hormone synthesis can cause simple goiter, such as iodide transport enzyme deficiency, peroxidase deficiency, dehalogenase deficiency, iodine tyrosine coupling enzyme deficiency, etc. .
- 3. Drug
- Drugs such as iodide, fluoride, lithium salt, aminopyrine, amirumitide, sulfa drugs, butazone, amiodarone, sulfamethoxam, methimazole, propylthiouracil can cause simple goiter . These drugs interfere with or inhibit various aspects of the thyroid hormone synthesis process through different mechanisms, and ultimately affect thyroid hormone synthesis, which causes feedback to increase TSH and lead to goiter.
- 4. Smoking
- Smoking can cause simple goiter because inhaled thiocyanate, which is a goiter, causes smokers to have higher serum thyroglobulin levels than non-smokers.
- 5. Genetic factors
- Brix (1999) studied more than 5,000 cases of twins of the same sex and twins of the same sex in non-endemic goiter areas, and found that the genetic susceptibility of simple goiters accounted for 82%, and 18% was attributed to Environmental factors, the results of this study are important evidence that sporadic goiter can be caused by genetic factors. At present, the genetic factors related to the incidence of sporadic goiter are 14q, multi-nodular goiter gene-1, 3q26, Xp22, and thyroglobulin genes. Epidemiological data indicate that goiter often has familial aggregation.
- 6. Other diseases
- Simple goiter can occur in patients with hypercortisolism, acromegaly, and end-stage renal disease.
Clinical manifestations of simple goiter
- 1. Goiter or neck mass
- Goiter is a characteristic clinical manifestation of non-toxic goiter. Patients often complain of a thickened neck or tight collar. The thyroid is located in the front of the neck. Once the swelling is easy to be found by the patient or his family, sometimes the goiter can extend down into the chest, which may be caused by negative pressure in the thorax and the weight of the tumor; the goiter occurs occasionally in vagus Thyroid tissue.
- The early course of the disease is diffuse goiter. On examination, the enlarged thyroid surface is smooth and soft. It moves up and down with swallowing. There is no tremor and vascular murmur. With the development of the course, thyroid nodular enlargement gradually appears. Symmetric, multi-nodular Multiple nodules can be clustered together, manifested as a neck mass. Nodules vary in size, texture, and location. Goiter is usually painless, and pain can occur if there is bleeding within the nodule. If physical examination reveals poor thyroid nodular hard activity, you should be alert to the possibility of malignancy.
- 2. Symptoms of oppression
- Compression symptoms are the most important clinical manifestation of non-toxic goiter. Compression symptoms appear later in the course of the disease, but retrosternal goiter can appear compression symptoms early.
- (1) Compression of the trachea Mild tracheal compression is usually asymptomatic. Heavy compression can cause wheezing, dyspnea, and cough. Wheezing and dyspnea caused by retrosternal goiter often occur at night and can occur with changes in body position (such as the patient's upper extremity lift).
- (2) Compression of the esophagus The esophagus is relatively backward and generally not easily compressed. If the goiter grows backward and surrounds the esophagus, it can compress the esophagus and cause difficulty in swallowing.
- (3) Simple recurrent laryngeal nerve compression on the recurrent laryngeal nerve rarely compresses the recurrent laryngeal nerve. Unless a malignant thyroid tumor is combined, tumor infiltration of the unilateral recurrent laryngeal nerve can cause vocal cord paralysis and hoarseness, and bilateral recurrent laryngeal nerve involvement can cause breathing difficulties. . When the symptoms of recurrent laryngeal nerve compression occur, be vigilant against malignancy.
- (4) Compression of blood vessels Giant goiters, especially retrosternal goiters, can compress the jugular vein, subclavian vein and even the superior vena cava, causing facial edema and dilation of the superficial veins of the neck and upper chest
- (5) Compression of the sacral nerve The posterior sternum goiter can compress the sacral nerve, causing hiccups and swelling. Sacral nerve compression is rare.
- (6) Compression of the cervical sympathetic nerve chain. The posterior sternal goiter can compress the cervical sympathetic nerve chain and cause Horners syndrome.
Simple goiter test
- 1. Serum TSH, T 3 , T 4 detection
- Patients with simple goiter had normal serum TSH, T 3 and T 4 levels.
- 2. Iodine 131 uptake rate
- The iodine 131 uptake rate was normal or increased.
- 3. Serum TPOAb, TgAb
- Generally negative, a few may be mildly elevated, suggesting that they are more likely to have hypothyroidism in the future.
- 4. Fine needle aspiration cytology
- Fine-needle aspiration cytology should be performed for B-ultrasound substantial nodules, calcified nodules 1 mm in diameter, hard nodules or fast-growing nodules. Fine-needle aspiration cytology is The most effective method for evaluating benign and malignant thyroid nodules before surgery is 65% -98% and 72-100% specificity.
- 5. X-ray examination of the neck
- Patients with a long course of disease, obvious goiter, or symptoms of respiratory obstruction or retrosternal goiter should take X-rays of the trachea to understand whether there is tracheal displacement, trachea softening, and to determine the location and size of the retrosternal goiter.
- 6. Neck ultrasound
- Neck ultrasound is a convenient and reliable method for diagnosing goiter. Ultrasound can detect small nodules of 2 to 4mm. Therefore, ultrasound can detect nodules that cannot be touched by physical examination. Usually, the incidence of adult thyroid nodules is 4% to 7% on physical examination. 70% have thyroid nodules.
- Color Doppler examination showed that there was no significant increase in normal thyroid blood flow signals, with a few scattered blood flow signals.
- 7. Nuclide imaging
- Radionuclide imaging can evaluate thyroid morphology and thyroid nodule function. Diffuse goiter showed an increase in thyroid volume and a uniform distribution of radioactivity. Nodular goiter showed hot or cold nodules.
- 8. CT and MRI of the neck
- Neck CT or MRI does not provide more information than B ultrasound and is more expensive, but it has higher diagnostic value for retrosternal goiter.
- 9. Respiratory function test
- Large goiters or retrosternal goiters should be tested for pulmonary function to make a functional assessment of airway compression.
Simple goiter diagnosis
- Residents of non-endemic goiter endemic areas with diffuse thyroid enlargement or nodular enlargement. Excluding hyperthyroidism, hypothyroidism, Hashimoto goiter, acute thyroiditis, subacute thyroiditis, painless thyroiditis, Cancer and other diseases can be diagnosed as simple goiter.
- The diagnosis of nontoxic goiter must confirm that the thyroid function is normal and the serum T 3 and T 4 levels are normal. Thyroid function is sometimes difficult to evaluate clinically because some patients with hyperthyroidism, especially the elderly, have mild or atypical clinical manifestations.
Differential diagnosis of simple goiter
- 1. Hashimoto's goiter (chronic lymphocytic thyroiditis)
- Presented as bilateral or unilateral diffuse small nodular or massive masses, TPOAb, TgAb are positive, fine needle aspiration cytology can confirm the diagnosis.
- 2. Riedel's thyroiditis (chronic fibrous thyroiditis)
- Presented as a painless thyroid mass, hard and fixed, fine needle aspiration cytology is not significant, and requires a surgical biopsy to confirm the diagnosis
- 3. Thyroid adenoma
- Presented as a single thyroid mass, tough and difficult to distinguish from a single nodule of a non-toxic goiter. Ultrasound examination of the nodule has an envelope around it. Fine-needle aspiration cytology can help identify.
- 4. Thyroid cancer
- Presented as a single or multiple thyroid mass, hard, swollen adjacent lymph nodes, medullary carcinoma accompanied by elevated serum calcitonin levels, confirmed by pathological examination.
Simple goiter treatment
- For most patients with simple goiter, no special treatment is required, whether diffuse or nodular.
- Indications for treatment
- The following conditions require treatment:
- (1) There are local symptoms, ranging from neck discomfort to severe compression symptoms.
- (2) Affect the appearance.
- (3) Goiter progresses quickly.
- (4) retrosternal goiter.
- (5) Nodular goiter cannot exclude malignant patients.
- (6) Those with abnormal thyroid function (including clinical hyperthyroidism).
- 2. Principles of treatment
- The clinical manifestations of patients with simple goiter vary greatly, and the differences are large. Therefore, the treatment plan should be individualized. Because simple goiter's thyroid function is normal, no treatment is needed, unless surgical treatment is performed in the case of oppression or even suspected tumor.
- 3. No treatment, clinical follow-up
- In many patients with simple goiter, the goiter grows slowly, is asymptomatic locally, and the thyroid function is normal. No special treatment is required. Close clinical follow-up, regular physical examination, and B-ultrasound. In addition, the serum TSH level should be checked regularly, and the subclinical hyperthyroidism or hypothyroidism should be detected early. If there are obvious factors that cause goiter, they should be removed.
- 4.TSH inhibition therapy
- The pathogenesis of some simple goiters is related to the stimulation of TSH. Exogenous thyroid hormone can inhibit the secretion of endogenous TSH, thereby preventing the growth of goiter. TSH inhibitory therapy has been widely used in the treatment of simple goiter. .
- Before TSH suppression treatment, serum TSH level should be detected. If serum TSH level is normal, TSH suppression treatment can be performed. If serum TSH <0.1mU / L, it indicates that there is subclinical hyperthyroidism and TSH suppression treatment should not be performed. Serum TSH level or thyroid uptake rate (RAIU) should be detected during TSH inhibition treatment. Generally speaking, serum TSH <0.1mU / L or RAIU <5% is considered to be complete inhibition, and above this level is partial inhibition. It is generally believed that the serum TSH level can be suppressed to the lower limit of the normal range. The effectiveness of TSH inhibitory therapy is a controversial issue, and TSH needs to be suppressed below normal during treatment, and it should be noted that long-term inhibition of TSH therapy may cause heart and bone side effects.
- 5. Radioiodine 131 treatment
- Radioiodine 131 has been widely used in the treatment of toxic goiter, and has not been widely used in the treatment of non-toxic goiter. The situation has changed in recent years. Iodine 131 has been given more and more attention in the treatment of simple goiter. In the past 10 years, many literatures have reported good results in the treatment of simple goiter with one-time high-dose I, which can reduce the thyroid volume of 80% to 100% of patients by 40% to 60%.
- 6. Surgical treatment
- Surgical treatment can quickly relieve the symptoms of local compression. Therefore, surgical treatment of simple goiter has irreplaceable advantages.
- 7. puncture aspiration or injection of absolute alcohol
- For cystic nodules, it is possible to puncture and aspirate or inject absolute alcohol, which can play a role in shrinking the nodules.