Speaking of the neck, have you seen something like this?
If you notice carefully, the neck seems to enlarge a little and contain a few lumps underneath the skin. This condition could be a multinodular goitre.
What is a multinodular goitre?
It is a condition in which the thyroid gland enlarges for any reason. Usually, it is asymptomatic and painless. On palpation, it is firm (but not hard), and can slightly move around under the skin. However, once the goitre has enlarged to a certain degree, it might cause compressive symptoms like shortness of breath, difficulty in swallowing, choking sensation and hoarseness of voice. Albeit it sounds terrifying and worrisome, it is a common condition that can happen to anyone especially females.
What exactly causes this condition?
Iodine is one of the components needed for thyroid hormone synthesis. Without adequate iodine in the body initially, the body will enter a state of hypothyroidism (low thyroid hormone). To compensate, the brain will stimulate the thyroid gland to produce more thyroid hormone. Thus, the thyroid will become enlarged and eventually turn the body into a state of hyperthyroidism (excess thyroid hormone).
Pregnancy can cause iodine deficiency. No doubt the mother is transferring all the nutrients including thyroid hormone to the fetus, thus the mother herself loses some nutrients in her body.
This increases the need for iodine in a pregnant lady. Also, during pregnancy, the kidneys tend to lose more iodine than usual! However, this condition is physiological and will return to normal once the baby is born.
With a family history of thyroid disease or goitre, an individual has a higher risk of developing the same problem too. Research has shown that there is a connection between goitre and mutations in genes. Fortunately, the mutated genes do not produce malignancy, instead, they alter the growth and function of the thyroid.
There are specific substances in food that interfere with the iodine uptake in the body, which subsequently cause iodine deficiency and induce the increased production of thyroid hormone. Goitrogens are substances (whether in food or drugs) which disrupt the production of thyroid hormones by interfering with uptake of iodine in the thyroid gland.
Below is the list of goitrogenic foods:
- millet, soy beans
- cassava, sweet potato
- babassu coconut
- cabbage, cauliflower, broccoli, turnips
- selenium-containing diet (tuna, cod, chicken, beef, egg, turkey)
Always remember to mind your diet!
Thiocyanate is the culprit in a multinodular goitre case caused by smoking. It is shown that heavy smokers have a higher incidence of developing this condition. Thiocyanate is one of the substances in cigarette smoke and it works just the same as goitrogens where it inhibits the iodine uptake in the body. It is also proven that smoking decreases the efficacy of some therapeutic modalities.
Multinodular goitre is categorized as toxic and non-toxic. The toxic condition is where there is excessive thyroid hormone in the body, which has already been explained. On the other hand, non-toxic multinodular goitre does not cause any hormone abnormalities, despite the enlargement of thyroid gland.
Since most of the factors will eventually lead to a hyperthyroid state as stated above, the symptoms of a multinodular goitre are almost the same with hyperthyroidism. With time passing by, it takes years (approximately 17 years) to develop thyrotoxicosis from hyperthyroidism (if not treated well), which is a condition where the thyroid hormone is extremely in excess. The heart literally cannot handle and will resort to cardiac irregularities and congestive cardiac failure.
What if the lumps really are tumors?
Benign or malignant, the mere mention of a tumor is simply a nightmare to most of the people. Chances are, 4-17% of multinodular goitre will transform into a malignancy. Thus, investigations of choice have to be done to rule out malignancy, and of course, to confirm the diagnosis and treat the condition.
- Level of serum TSH (thyroid stimulating hormone) and serum T4.
- Ultrasound scan of the lumps in the neck.
- Fine needle aspiration cytology (FNAC), in which a fine needle is inserted in the nodules and the content is aspirated to be sent to the laboratory for investigations.
- Thyroid scintigraphy. (radiological scanning of the thyroid)
- CT scan and MRI scan to provide high-resolution visualization of the extent of the goitre.
“I won’t let my goitre choke me to death”
To treat multinodular goitre, there are medications to lower the thyroid hormones. Besides, radioactive iodine (RAI) is one of the treatments too. Believe it or not, one single dose is enough to destroy the toxic nodules and return the body to a euthyroid state (normal thyroid hormone level). To minimize the risk of developing a malignancy, surgical measures are to be considered. However, each of the measures has its own pros and cons.
Consult your nearest doctor for the best advice if you are facing the same condition. Take care of your neck, stay healthy, stay sexy.
by Angie Loh
A medical student with nothing but passion and a pen. Poems and novels never fail to make me feel alive. I'm inspired to make the world a better place and fill it with a little bit more love. But first, where's my coffee? View all articles by Angie Loh.