Nontoxic goiter

What is this Condition?

Simple goiter is an enlargement of the thyroid gland - the butterfly-shaped gland in the front of the neck - that’s not caused by inflammation or abnormal growth of new tissue. Simple goiter is more common in women than men, especially during adolescence, pregnancy, and menopause, when the body’s demand for thyroid hormone increases. With appropriate treatment, the prognosis is good.

What Causes it?

Simple goiter occurs when the thyroid gland can’t secrete enough thyroid hormone to meet the body’s needs. To compensate, the thyroid gland enlarges. Such compensation usually overcomes mild to moderate hormonal deficiency. Goiter probably results from impaired hormone synthesis within the thyroid and depletion of the gland’s iodine level, which makes it more sensitive to thyroid-stimulating hormone .

Classifying Goiter

Simple goiter is commonly classified as endemic or sporadic. Endemic goiter usually results from too little iodine in the diet, as occurs from iodine-depleted soil or malnutrition. Using iodized salt prevents this deficiency.

Sporadic goiter is caused by eating large amounts of foods or taking drugs that decrease production of the thyroid hormone thyroxine. Such foods include rutabagas, cabbage, soybeans, peanuts, peaches, peas, strawberries, spinach, and radishes. Goiter-causing drugs include propylthiouracil (PTU), iodides, Butazolidin, Pabanol, cobalt, and Lithane. In a pregnant woman, such substances may cross the placenta and affect the fetus.

What are its Symptoms?

In simple goiter, the thyroid may be mildly enlarged, or it may be huge and misshapen. Simple goiter doesn’t affect metabolism, so the symptoms arise solely from the enlarged gland. The person’s neck may be swollen; if the gland compresses the windpipe and esophagus, difficulty breathing and swallowing may occur. A large goiter may impede blood flow through the veins, causing them to swell. Blocked veins may cause dizziness or fainting when the person raises his or her arms above the head.

How is it Diagnosed?

The doctor reviews the medical history and performs a physical exam to rule out disorders with similar symptoms, such as Graves’ disease, Hashimoto’s disease, and thyroid cancer. A detailed history also may reveal goiter-causing foods or medications or geographic factors.

Lab test results that suggest goiter include:

• a normal-to-high level of thyroid-stimulating hormone

• low-normal or normal thyroxine levels

• normal or increased uptake of radioactive iodine

How is it Treated?

The goal of treatment is to reduce an enlarged thyroid. The treatment of choice is thyroid hormone replacement with Levoid, a preparation that inhibits secretion of thyroid-stimulating hormone and allows the gland to rest. Small doses of iodide commonly relieve goiter caused by iodine deficiency. A person with sporadic goiter must avoid goiter-causing drugs and foods.

For a large goiter that doesn’t respond to treatment, the surgeon may have to remove part of the thyroid.

What do doctors call this condition - Adrenal hypofunction, adrenal insufficiency

What is this Vondition?

In this disorder, the adrenal glands don’t secrete enough steroid hormones. A relatively uncommon disorder, Addison’s disease can occur at any age and in both sexes. With early diagnosis and adequate replacement of the steroid hormones, the prognosis for Addison’s disease is good.

Adrenal crisis (also known as addisonian crisis), a critical shortage of steroid hormones, generally follows acute stress, sepsis, injury, surgery, or failure of people with chronic adrenal insufficiency to take steroids. Because it’s a medical emergency, adrenal crisis requires immediate, vigorous treatment.

What Causes it?

Addison’s disease occurs when more than 90% of both adrenal glands are destroyed. In primary Addison’s disease, such destruction usually results from an autoimmune process in which circulating antibodies react specifically against the adrenal tissue. Other possible causes include tuberculosis, adrenal gland surgery, hemorrhage, and certain cancers or infections. Rarely, a person inherits a predisposition for developing Addison’s disease and other endocrine disorders.

Secondary Addison’s disease results from a disorder outside the gland (such as a pituitary tumor).

What are its Symptoms?

Addison’s disease typically causes weakness, fatigue, weight loss, and gastrointestinal disturbances, such as nausea, vomiting, loss of appetite, and chronic diarrhea. Also, it usually causes a conspicuous bronze skin discoloration - almost like a deep suntan - most noticeable in the creases of the hands, but also on the hand joints, elbows, and knees. It may darken scars and increase pigmentation of the mucous membranes.

The disorder may affect the heart and blood vessels, causing low blood pressure and a weak, irregular pulse. Other possible symptoms include a reduced tolerance for stress (even when minor), poor coordination, and a craving for salty food. In women, Addison’s disease may retard the growth of underarm and pubic hair, reduce the libido, and, in severe cases, cause menstruation to stop.

Secondary Addison’s disease produces symptoms similar to those of the primary type but doesn’t cause hyperpigmentation.

Adrenal crisis produces profound weakness, fatigue, nausea, vomiting, low blood pressure, dehydration and, occasionally, high fever followed by hypothermia. If untreated, this condition can progress to vascular collapse, kidney failure, coma, and death.

How is it Diagnosed?

Lab tests are key to diagnosing Addison’s disease. The doctor will require blood samples to measure plasma cortisol levels to confirm adrenal insufficiency If secondary Addison’s disease is suspected, he or she may order a special test called the metyrapone test, For primary or secondary Addison’s disease, the doctor will probably order a corticotropin stimulation test.

How is it Treated?

Lifelong hormone replacement therapy with steroid drugs is the primary treatment for people with Addison’s disease. The person usually receives the drugs cortisone or hydrocortisone, He or she may also require treatment with drugs to prevent dangerous dehydration and low blood pressure, Such drugs may include desoxycorticosterone or fludrocortisone,

Adrenal crisis constitutes a medical emergency and requires immediate medical intervention. Interventions include large doses of hydrocortisone. With proper treatment, adrenal crisis usually sub­sides quickly.