Thyroid enlargement (large thyroid, goiter, Goiter)

This is an automatically translated article.

The article was written by Dr. MSc Nguyen Thuc Vy - Doctor of Radiology, Department of Diagnostic Imaging - Vinmec Nha Trang International General Hospital
An enlarged thyroid (goiter, goiter) is defined as an abnormally large thyroid gland caused by many factors. The most common cause of thyroid enlargement worldwide is a lack of iodine in the diet. Treatment depends on the size of the thyroid gland, the symptoms, and the cause of the enlarged thyroid gland. A thyroid gland that is moderately large, unnoticeable, and causing no problems usually does not require treatment.

1. Thyroid volume

The thyroid gland is an endocrine organ located above the midline in the anterior neck region responsible for the production of thyroid hormone. The thyroid gland is butterfly-shaped or H-shaped, consisting of two lobes, connected by a thin strip of parenchyma in front of the trachea called the isthmus.
Thyroid volume varies depending on age and sex, below is the upper limit of normal for thyroid volume (including isthmus):
Adult men: 25 mL Adult women: 18 mL Children 13-14 years old: 8-10 mL Children 3-4 years old: 3 mL Infants: 0.8-1.5 mL

2. Epidemiology

The incidence of thyroid enlargement varies widely depending on the degree of iodine deficiency. In areas of severe iodine deficiency, prevalence can be as high as 80%. Thyroid enlargement is more common in women with a male:male ratio (M:F=1:4).

3. Symptoms

Not all cases of an enlarged thyroid cause signs and symptoms. Symptoms occur when the enlarged thyroid gland compresses surrounding structures: feeling of a lump in the neck, dry cough, hoarseness, difficulty swallowing, difficulty breathing. An enlarged thyroid due to other conditions, such as hypothyroidism or hyperthyroidism, can be associated with a number of symptoms, from fatigue and weight gain to unintended weight loss, irritability, and trouble sleeping.

4. Causes of disease

Some of the most common causes of thyroid enlargement include:
Iodine deficiency. Iodine is required for the production of thyroid hormone, and is found mainly in seawater and soil in coastal areas. In developing countries, people who live inland or in the highlands often suffer from iodine deficiency and lead to an enlarged thyroid gland in an effort to obtain more iodine. Iodine deficiency can be made worse by a diet high in foods that inhibit thyroid hormone synthesis, such as cabbage, broccoli, and cauliflower. Graves' disease (Baseow's tumor). Hashimoto's disease. Multinodular goiter or multinodular goiter. Lonely human armor. Thyroid cancer is less common than benign thyroid nodules. A thyroid nodule biopsy is very accurate in determining whether it is cancer. Pregnancy. A hormone produced during pregnancy, human chorionic gonadotropin (HCG), can cause your thyroid gland to enlarge a bit. Inflammatory condition. Thyroiditis is an inflammatory condition that can cause pain and swelling of the thyroid gland. Goitrogens: are a group of substances that inhibit the synthesis of thyroid hormone found in foods such as cauliflower, cabbage, ... or drugs containing lithium, amiodarone, ... Deposition diseases such as amyloidosis or diseases other causes such as Plummer-Vinson syndrome.

5. Ultrasonic characteristics

Ultrasound is the simplest and most commonly used imaging modality. On ultrasound the size of each thyroid lobe is normal:
Height: 4-7 cm Depth and width: <2 cm Waist area thickness 0.5 cm Thyroid volume can be estimated by measuring each lobe and apply the following correction factor: height (cm) x width (cm) x depth (cm) x 0.5*
The different adjustment factors range from 0.494-0.554.
Normal thyroid volume on ultrasound (excluding isthmus):
10-15mL for adult women. 12-18mL for adult men. Thus, on ultrasound, an enlarged thyroid is determined if the measured thyroid volume exceeds 18 mL for men and 15 mL for women.
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Articles source references: mayoclinic.org, radiopaedia.org