A goiter is an abnormal enlargement of the thyroid gland, a butterfly-shaped tissue located at the base of the neck, just below the Adam’s apple.

Although the lump that forms is usually painless, when it grows excessively it can cause coughing and make breathing and swallowing difficult.

The most common cause of the condition is lack of iodine in food.

In Bulgaria, where the salt offered on the market is necessarily enriched with iodine, the enlargement of the thyroid gland is due to a lack or overproduction of thyroid hormones or to nodules, which develop more often.

Treatment is determined depending on the size of the enlargement, the symptoms and the underlying cause.

When the thyroid gland is small in size and causing no problems, usually no treatment is needed.

What are the symptoms?

Not always when the thyroid gland enlarges clinical manifestations occur. When they do occur, they may consist of:

• A visible bump at the base of the neck that is especially noticeable when shaving or applying makeup;
• Tightness in the throat;
• Cough;
• Hoarse voice;
• Difficulty swallowing;
• Reduced breathing capacity;

What are the reasons?

The thyroid gland synthesizes two hormones – thyroxine /T4/ and triiodothyronine /T3/. These hormones circulate in the blood and help regulate metabolism.

They support the rate at which the body uses fats and carbohydrates, help control body temperature, affect heart rate and help regulate protein production.

The thyroid gland also produces calcitocin – a hormone that helps regulate the amount of calcium in the blood.

The pituitary gland and hypothalamus control the rate at which these hormones are synthesized and released into the bloodstream.

An enlarged thyroid does not necessarily mean that it is not functioning normally.

Even when enlarged, it can synthesize and release the usual amount of hormones into the bloodstream. But it is also possible to produce too much or too little thyroxine and T-3.

A number of factors can cause an enlarged thyroid gland.

Among the most common are:

• Iodine deficiency – iodine is essential for the production of thyroid hormones, it is found mainly in sea water and in the soil of coastal areas. In some parts of the world, people who live inland or at high altitude are often iodine deficient and may develop thyroid enlargement.

Based’s disease – enlargement of the thyroid gland can occur due to its increased production of hormones.

In Graves’ disease, antibodies produced by the immune system mistakenly attack the thyroid gland, which stimulates the synthesis and release of excess hormones. And this overstimulation causes swelling of the thyroid gland.

Goiter treatment

Observation – if the enlargement is minor and does not cause problems and the thyroid gland is functioning normally, the attending physician may recommend only active observation. In this case, hormonal levels and possible subsequent swelling are monitored.

Drugs – when hypothyroidism is diagnosed, hormone replacement therapy is prescribed, in which levothyroxine, a synthetic form of thyroid hormone, is prescribed.

In most cases, this way relieves the symptoms of thyroid hypofunction and reduces the size of the goiter.

In case of inflammation of the thyroid gland, doctors prescribe aspirin or corticosteroids.

When the enlargement of the gland is due to Based’s disease, it may be necessary to prescribe drug therapy to normalize the increased hormone levels.

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