Causes
Worldwide, the most common cause for goitre is iodine deficiency, usually seen in countries that do not use iodized salt. Selenium deficiency is also considered a contributing factor. In countries that use iodized salt, Hashimoto's thyroiditis is the most common cause.
Cause | Pathophysiology | Resultant thyroid activity | Growth pattern | Treatment | Incidence and prevalence | Prognosis |
---|---|---|---|---|---|---|
Iodine deficiency | Hyperplasia of thyroid to compensate for decreased efficacy | Can cause hypothyroidism | Diffuse | Iodine | Constitutes over 90% cases of goitre worldwide | Increased size of thyroid may be permanent if untreated for around five years |
Congenital hypothyroidism | Inborn errors of thyroid hormone synthesis | Hypothyroidism | ||||
Goitrogen ingestion | ||||||
Adverse drug reactions | ||||||
Hashimoto's thyroiditis | Autoimmune disease in which the thyroid gland is gradually destroyed | Hypothyroidism | Diffuse and lobulated | Thyroid hormone replacement | Prevalence: 1 to 1.5 in a 1000 | Remission with treatment |
Pituitary disease | Hypersecretion of thyroid stimulating hormone, almost always by a pituitary adenoma | Diffuse | Pituitary surgery | Very rare | ||
Graves' disease—also called Basedow syndrome | Autoantibodies (TSHR-Ab) that activate the TSH-receptor (TSHR) | Hyperthyroidism | Diffuse | Antithyroid agents, radioiodine, surgery | 1 to 2 cases per 1,000 population per year | Remission with treatment, but still lower quality of life for 14 to 21 years after treatment, with lower mood and lower vitality, regardless of the choice of treatment |
Thyroiditis | Acute or chronic inflammation | Can be hyperthyroidism initially, but progress to hypothyroidism | ||||
Thyroid cancer | Usually uninodular | Overall relative 5-year survival rate of 85% for females and 74% for males | ||||
Benign thyroid neoplasms | Usually hyperthyroidism | Usually uninodular | Mostly harmless | |||
Thyroid hormone insensitivity | Secretional hyperthyroidism, Symptomatical hypothyroidism |
Diffuse |
- Sarcoidosis
- amyloidosis
- hydatidiform mole
- cysts
- acromegaly
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