Goiter Symptoms, Signs, and Treatment

What is Goiter

Goiter is Enlargement of the thyroid gland causing a swelling in the front part of the neck

Etiology:

1. is a non-specific indication of thyroid pathology

2. there are many causes for thyroid enlargement:

a.     Grave’s disease (hyperthyroidism)

b.     Plummer’s disease (toxic multinodular goiter)

c.      toxic adenoma

d.     silent thyroiditis

e.     hypothyroidism

f.      congenital goiter (this can occur with or without hypothyroidism and is classified into tyypes based upon the causative defect: Hashimoto’s thyroiditis, subacute thyroiditis (aka. DeQuervain’s thyroiditis), euthryoid goiter (aka. Non-toxic nodular goiter, simple/endemic/non-toxic diffuse goiter)

Goiter Signs and Symptoms:

1. Grave’s disease: (hypothyroidism) See Grave’s disease

2. Plummer’s disease: this occurs when one nodule of the thyroid hyperfunctions idiopathically; hyperthyroidism does not always occur with the multinodular goiter

3. toxic adenoma: essentially the same as for Plummer’s disease

4. silent thyroiditis: recognized by mild to moderate thyroid gland enlargement; lack of tenderness upon palpation

5. hypothyroidism goiter: typically occurs in areas where goiters are endemic from lack of ingested iodine (See euthyroid goiter below) See Hypothyroidism

6. congenital goiter:

a.  Hashimoto’s thyroiditis: disease is theorized to be the leading cause of primary hypothyroidism; it is characterized by a painless enlargement of the thyroid that is not tender to palpation; it is much more common in women, esp. between the ages of 30-50; other autoimmune diseases are frequently seen in these patients, such as RA, SLE and Sjogren’s syndrome

b.  Subacute thyroiditis: disease is thought to be caused by a virus and not infrequently, there is a history of mumps or UTI; the patient presents with a sore throat/neck pain, fever of 100-101^oF and tenderness on throat palpation; the thyroid is enlarged and firm; typically the patient develops hyperthyroidism that usually spontaneously resolves to euthyroidism

c.   Euthyroid goiter: enlargement of the thyroid gland from decreased thyroid hormone production but without the clinical presentation of hypothyroidism; it can be due to lack of dietary iodine (endemic goiter); ingestion of goitrogens and drugs; this type of thyroid enlargement is the most common and is often seen at puberty, during pregnancy, and at menopause

Lab Findings:

1.  Grave’s disease: see Grave’s disease

2. Plummer’s disease: increased T3 and T4 and increased RAI uptake only in the hyperfunctioning nodule

3.   toxic adenoma: same as Plummer’s disease

4.   silent thyroiditis: increased ESR, normal WBC indices

5.  Hashimoto’s thyroiditis: high levels of anti-thyroid antibodies and decreased T4 and RAI uptake

6.  Subacute thyroiditis: increased T4, decreased RAI uptake, increased ESR and leukocytosis

7.  Euthyroid goiter: usually normal results for RAI uptake, T4 and T3-resin uptake

Course/Prognosis:

1.  Grave’s disease: see Grave’s disease

2.  Plummer’s disease: this disease is more common in the elderly and is treated with surgery or radioiodine

3.   toxic adenoma: essentially the same as for Plummer’s disease

4.  silent throiditis: after a self-limiting hyperthyroid episode lasting weeks to months, the patient returns to being euthyroid

5.   hypothyroidism goiter: prognosis good with increased iodine intake

6.  congenital goiter: this can occur with  or without hypothroidism and is classified into 4 types based upon the causative defect:

a.     Hashimoto’s thyroiditis: conventional treatment consists of lifelong replacement with thyroid hormone

b.     Subacute thyroiditis: conventional treatment is usually not needed

c.      Euthyroid goiter: treatment consist of identifying and removing the cause; conventional treatment may consist of blocking TSH and ten administering full thyroid HRT or surgery if the goiter grows too large

 Differential Diagnosis:

1.  thyroid cancer

2.  cyst

3.  other neoplasms

Nutrition:

1. foods high in iodine, silicon, phosphorus: kelp, Swiss chard, turnip greens, egg yolks, wheat germ, cod roe, lecithin, sesame seed butter, seed and nuts, raw goat’s milk

2.  garlic, crab, lobster, dulse, ocean fish, seaweed, pineapple

Supplements:

1. zinc

2. copper (2-3mg QD)

3. KI (<5 drops)

4. protomorphagens: thyroid, pituitary

5. kelp (level tsp. QD)

6. atomidine

Hydrotherapy:

1. ice pack

Manipulation:

1. check and align lower cervicals and T6-8

Botanicals:

1.     Alaria esculenta (kelp)

2.     Echinacea angustifolia

3.     Fucus vesiculosus: simple goiter, exopthalmic goiter

4.     Hydrastis canadensis

5.     Iris versicolor (toxic):of recent onset

6.  Lycopus europaeus: Grave’s disease with cardiac involvement; thyrotoxicosis with dyspnea, tachycardia and tremor

7.     Phytolacca decandra (toxic): in combination with other remedies

8.     Quercus alba: compress from strong decoction

9.     Selenicereus grandiflorus (toxic): exophthalmic goiter with feeble heart

10.   Strophanthus kombe (toxic): in combination with other remedies

Formulas:

a.  Anemone pulsatilla (toxic), Selenicereus grandiflorus (toxic), Cimicifuga racemosa

Homeopathy:

1.     Ammonium carbonicum: 30c BID or Crocus 30c BID; balance endocrine system

2.     Adrenalin: exophthalmic goiter with quick pulse, rapid heart action and dyspnea

3.   Bromium: when Iodine 1M fails; enlargement with softness; can’t lie on right side because of palpation; patient is light complexion, cheerful

4.     Calcarea carbonica: simple goiter in fat person with sweating; use 200c every 4 hours till improvement

5.     Ferrum metallicum: after suppression of menses

6.     Fucus vesiculosis: mother tincture in drop doses; indigestion, flatulence, constipation

7.     Ignatia: pain in goiter in nervous patient

8.   Iodine: main remedy, dark, active patient 1M; marked hardness with sense of constriction; both lobes, more swollen and painful at menses; patient thin but eats heartily; soft with heat and rapid pulse; patient depressed, low spirited, suicidal

9.  Lachesis: slight tremor with hot flushes; awakes from sleep with palpitation and hot feeling

10.   Lycopodium: right side, tense, smooth, shining appearance, with feeling of constriction

11. Natrum muriaticum: early stages; fears being alone at night, in thunderstorms; exophthalmic goiter with emaciation, weakness, trembling, palpitation, thirst, nervous irritability, sleeplessness

12. Spongia tosta: painful; asthma with anemorrhea; pain on swallowing; complexion and glandular enlargement of  Bromium and mental anxiety and low vitality of Iodum

13.  Thyroidin: 3x or 6x if Iodine or Bromium fails

Adapted from: http://www.aaronsworld.com

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