The thyroid gland, which is a butterfly-shaped endocrine gland located in front of the trachea in the anterior lower half of the neck, is larger than the normal size for the age and gender of the patient. Goiter is more common in women. In goiter, the hormone production of the thyroid gland may be increased (hyperthyroidism), normal (euthyroidism), or decreased (hypothyroidism). Iodine deficiency in the diet is the most important cause of goiter all over the world. An important task of the thyroid gland is to take iodine from the blood to produce thyroid hormone. In an iodine-deficient person, the thyroid gland produces less thyroid hormone. The pituitary gland in the brain senses that the level of thyroid hormone is too low and sends a warning to the thyroid gland. This stimulating signal is TSH. When the thyroid gland tries to compensate for its production of thyroid hormone, it gradually enlarges and a goiter occurs. Over time, round oval shaped glands called nodules and nodules may form in the thyroid gland. While the incidence of goiter is 0-5% in non-iodine-deficient regions, it is over 30% in severe iodine-deficient regions. It is very important that iodine deficiency is a preventable cause. As the iodine deficiency in a population is corrected, the frequency of goiter decreases. When more than 10% of the population has a goiter, it is called endemic = diffuse goiter. If this rate is below 5%, it is defined as sporadic = infrequent goiter.
Goiter developing as a result of iodine deficiency can be nodular, multinodular or diffuse (nodular). Nodular goiter is seen at a rate of 25% after the age of 40 in our country. While 95% of thyroid nodules are benign, 5% become cancerous. If the nodule has developed as a result of radiation (radiation) to the neck region, the risk of cancer is higher. About 20% of thyroid biopsies are reported as suspicious nodules. While the probability of cancer is 15-20% in cold nodules detected on scintigraphy, this probability is around 5% in hot nodules. When the nodular goiter is very large, it can compress the neck area and cause shortness of breath. Large and calcified nodules can become cancerous. Cancerization is also possible in small nodules. In addition, the nodules may gain autonomy and cause excessive secretion of thyroid hormone.
The most common cause of goiter formation in countries where iodine deficiency is not present is Hashimoto thyroiditis. The body's immune system It is a condition in which it becomes manic and attacks the thyroid gland (autoimmune). The thyroid gland is damaged in this process and cannot produce enough thyroid hormone. The pituitary gland senses a low level of thyroid hormone and releases more TSH to stimulate the thyroid. This stimulus can cause the thyroid to enlarge. Another common cause of goiter is Graves disease. Graves' disease is also autoimmune. In this case, the person's immune system produces a protein called thyroid stimulating immunoglobulin (TSI). The protein called TSI stimulates the thyroid gland, causing the gland to enlarge. Also, this protein called TSI stimulates the thyroid gland to produce too much thyroid hormone. Thus, hyperthyroidism occurs. As the pituitary gland senses that too much thyroid hormone is being produced, it reduces TSH secretion. Rare causes that can trigger goiter development other than iodine deficiency: radiation to the neck area, smoking, some foods called natural goiter (goiter-former), selenium deficiency, zinc deficiency, emotional stress, chemicals, industrial wastes, some drugs, some inflammatory diseases and familial predisposition. Foods called natural goitrogens include corn, soy, sweet potato, flaxseed, kale, cauliflower, broccoli, turnip, and coconut. These products should be consumed in moderation.
Symptoms and complaints in thyroid diseases are usually faint. The thyroid may be palpable when there is swelling in the neck. While palpitation, increased heart rate, nervousness, shortness of breath, sweating, tremor, diarrhea, euphoria, hot flashes, and weight loss are observed in patients with hyperthyroidism; In hypothyroidism, fatigue, weakness, drowsiness, menstrual irregularity, coarsening of the voice, hoarseness, constipation, brittle hair and nails, edema, decrease in heart rate are expected. Physical examination, blood tests, ultrasonography, scintigraphy and thyroid biopsies are very valuable in diagnosis.
The aim of treatment in goiter is to stop and/or reduce the growth of the thyroid gland, to relieve the pressure due to growth, to normalize the level of thyroid hormones in the blood if they are abnormal, and to treat if there is concomitant thyroid cancer. If the goiter is not very large, does not cause any complaints, and the thyroid gland makes enough thyroid hormone, no treatment is usually required. In such cases, the doctor Instead of starting the treatment immediately, your doctor can follow your goiter at regular intervals.
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