Abnormal enlargement of the thyroid gland is known as goitre.
Often when the thyroid functions improperly, the result is goitre.
Usually the gland swells and the increased size is noticeable in the neck,but the thyroid disturbances are not necessarily accompanied by swelling.
Goitre inotherwords, is not a disease.
Until now causes of endemic goiter has not been completely determined.
Goitre never endangers the life of a person unless it gets complicates.
When you make a list of human diseases it will never be completed unless you mention the word of goitre.
Thus goitre or enlargement of the thyroid gland is the end result of improper function.
Goitre occours with varying intensity in almost every country only a few countries appear to be entirely free from it. Therefore goitre may occur in any locality, in any race, in any person, at any age,even in a new born baby.
Since it is found in every part of the world, it could mention that there is a goitre belt around the world.
If a simple goitre does not appear during childhood or adolescence it is sure for it to make its first appearance in adult males,but it is not at all uncommon for this to happen to women during pregnancy and location.
TYPES OF GOITRE
1. CONGENITAL GOITRE
In endemic areas the thyroid gland in the newborn baby is in the diffuse hyperplastic phase with well conserved lobules, though the number of follicles is increased, they contain no colloid. The connective tissue is congested and hyperemia may be so intense as to cause dyspnoea and endanger the baby's life immediately after birth. Such cases are seen in highly endemic areas as Northen Shan States.
Injection lipoidol 1cc stat as soon as possible. i.e. immediately after birth will safe the baby from asphysiated death.
To prevent congenital goitre you can also give 1cc of lipoidol injection to pregnant lady.<See Picture>
2.PUBERTY GOITRE ( PUBERTAL GOITRE )
In childhood the thyroid grows in size until the baby or girl is sexually matured.
When once they are sexually matured the goitre may regress in growth or if not it may stop for its enlargement.
Colloid goitre being physiological, it is smooth, soft, uniform and adds the beauty of a girl. <See Picture>
3. ADOLESCENT GOITRE
Puberty is a critical time for the thyroid and many cases of goitre known as adolescent goitre occur at that time.
The size or enlargement of the thyroid gland is also influenced by sexual disturbances.
It may become larger during menstruation and pregnancy.
It may also become larger in women following a number of childbirths close upon each other.
On the otherhand, a deficiency of thyroid influences the sex organs may lead to sterility.
Clinically the adolescent goitre could be classified or categorized by the following classification,
( A ) INVISIBLE GOITRE
Could not be seen for its enlargement but could be felt for its presence. Palpable not visible.
( B-i ) VISIBLE GOITRE TYPE I Survey Type
Palpable not visible in normal position. It could be easily seen when neck is fully extended and when ask to deglutade or swallow.
( B-ii ) VISIBLE GOITRE TYPE II
Presence of enlarged goitre is easily seen and noticed at closed range in a normal positon i.e. without extension of the neck.
( B-iii ) HUGE GOITRE
Occupying the whole neck seen from distance.
( B- iv ) GIGANTIC OR MONSTROUS TYPE
Huge goitre, solitary adenoma or nodular not only occupying but protruding anteriorly and also lateralward.<see picture>
4. TOXIC GOITRE
( A ) PRIMARY TOXIC GOITRE
. Common, prevalence in sporadic area rare in endemic area.
. Eye - exopthalmos ++
. Tremors - present
. Heartbeat - increased (tachycardia)
. Goitre not seen
. Nervousness +
. Irritable +
. Loss of weight +
( B ) SECONDARY TOXIC GOITRE
. Goitre +
. Eye - exopthalmos +
. Tremor +
. Loss of weight
. Tachycardia
5. MALIGNANT GOITRE (CARCENOMA THYROID)
May be solitary adenoma or nodular
Simple adenomas, solitary are pre cancerous in nature or bound to change into malignancy.
If you notice single solitary prominent adenomas in 5 persons in one locality in one day, that locality is said to be highly endemic and necessary preventive measures to be taken by health authorities.<see picture>
PREVALANCE OF GOITRE
. Goitre has probably afflicted people since the beginning of human race. Goitre is found in every part of the world with the exception of a few countries free of goitre.
. When higher percentage of the people suffers from goitre, such as section of that area is known as endemic goitre area.
. However, many cases of goiters are found outside the so called endemic area, than such goiter is know as sporadic goitre.
. Sporadic goiters are prome to become toxic goiter while endemic goiters have less chance.
. The reasons being endemic goitres are subthyroid in nature and is also its activity is subthyroid therefore rare to see or have toxic goitre.
. A simple goitre no matter big or small seldom gives any trouble itself, unless it becomes so large and heavy as to disturb or exert pressure symptoms such as difficulty in breathing and swallowing.
. They cannot be persuaded to undergo operation for its removal because it never endanger their life and asymptomatic except that it looks ugly and heavy.
PREVALANCE OF GOITRE IN MYANMAR
. Goitre is prevalent in the mountainous parts of Myanmar especially in Chin Hills in the west, the Kachin Hill in the north, the Shan States on the east.
. Also in Naga land in upper chindwin and nearer to eastern Assam.
. The disease is common among children than among adults but the adult goiters are much larger and frequently give rise to pressure symptoms.
. The incidence is higher in females than in males and is always greatest at puberty and pregnancy. On the North, and east where Myanmar abuts on China goitre rates are exceedingly high in Myitkyina area also around Bhamo, Namkham, Lashio etc.
. It is also high in Pegu Division especially Phyu, Kyauk-kyi, Thaung goo, Thandaung, Mone, and villages in Pegu Yoma area.
. Irrawaddy Division ( Bassein Division ) low land area, is not spare from endemicity and high incidence is noticed in Ahthauk, Engmai, Ah Phauk, Kyaung Gone, Ye Kyi, Kone Pyaw, Hinthada, Ngathaing Khaung, Bassein, Nga Pu Daw, Pyin Kha Yaing, Pantanaw, Myaung Mya, Ma Oo pin, Pharpone.
. Though it is not hilly region this low land seem to be high in its endemicity because of frequent flooding and intense glaciation.
TREATMENT OF GOITRE
. There is no drug for treatment of goitre. Iodine has been used in the treatment of goitre much longer than for its prevention.
. Success in treatment and prevention of endemic goitre depends upon a thorough knowledge of its etiology.
. The cause of endemic goitre has not been completely determined. A permanent falling off in thyroid function or activity results in hypertrophy and ends up with enlarged gland-goitre.
. The etiology of endemic goitre involves many factors, iodine deficiency in the diet plays an important part in most cases but it cannot be taken as certain that it is the primary cause of goitre.
. Therefore when once a goitre, always a goitre, treatment with iodine may produce involution with deposition of colloid but the gland does not revert completely to normal.
. Goitre regressed within a few weeks of the administration of iodine but some patients developed further enlargement of the goitre during treatment.
. After mid 18th century people stop short and fail to continue the research to find the actual cause of goitre.
. They unanimously agree that protein bound iodine takes a major role in goitre.
. Therefore nobody knows the actual cause of goitre until now. If you know the actual cause of goitre, it is definitely sure that goitre would be wiped out of the human list of diseases in no time, effectively, economically and successfully and there won't be goitre in the world, because it is due to some deficiency and not bacterial in origin.
. Therefore surgery is the only procedure to remove the goitre and thus it is the only effective treatment for goitre and its complications.
Before - After
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