Have you ever seen people who have a lump right below Adam’s apple? The lump may be as small as a ping-pong ball or as big as several inches and may give a pouch-like appearance to the throat with one or more sections. Such a growth at the throat is known as thyromegaly, more commonly known as goiter.
What is it?
The thyroid gland is located just around the base region of the throat and consists of two lobes connected by an isthmus. Thyromegaly is caused by the enlargement of the thyroid gland, the occurrence of which can be contributed to a number of factors. The swelling may easily be treated with medication, therapy, and homemade antidotes, but in some cases may need surgery.
Medically goiter can be categorized into different types according to various factors.
1. Thyroid Function
The way the thyroid gland functions when a person is suffering from goiter is quite varied. Accordingly, the goiter is classified into 3 different types:
- Hypothyroid Goiter – when the gland secretes extremely low or no amount of thyroid hormones
- Hyperthyroid Goiter – when the production of the thyroid hormones increases significantly
- Euthyroid Goiter – when the gland secretes hormones normally
2. Growth Pattern
The way a goiter grows also helps in the classification. The categorization is done in the following way:
(i) Nodular Goiter: when one or more nodules growth around and with the thyroid gland, the goiter is known to be nodular. Nodular goiter can be further classified into –
- Non-toxic and toxic goiter
- Multinodular and uninodular
(ii) Diffuse Goiter: when instead of nodules, the goiter forms all throughout the gland, it is named as diffuse goiter.
3. Size and Visibility
The size of the swelling as well as the visibility factor helps in classifying the goiter into 3 types:
(i) Class I goiter
These are known to as palpation goiter. As such, they can be seen only when there is palpation and not when the person is in the normal position.
(ii) Class II goiter
The swelling of the throat is usually visible but may sometimes be palpable as well.
(iii) Class III goiter
These goiters are quite big and may create compression marks.
Goiter can also be classified based on the causal factor.
- Endemic Goiter – when goiter occurs due to a natural lack of iodine in the daily diet.
- Sporadic Goiter – when factors like age, heredity, etc. cause goiter.
What Causes Thyromegaly?
The enlargement of the thyroid gland can be traced to various causes, the most important of them being the following:
1. Iodine Deficiency:
The deficiency of iodine in the regular diet has a direct impact on the thyroid gland. Due to iodine insufficiency, the gland fails to produce sufficient amount of T3 and T4. This deficiency of the thyroid hormones in the blood level triggers the pituitary gland to secrete more of TSH or thyroid stimulating hormone that helps in the tissue expansion of the thyroid gland, thus causing swollen glands or thyromegaly.
Iodine deficiency generally occurs in areas where iodized salt is not commonly consumed by the people as a part of their regular diet. Thus, states and countries where people get enough iodine from their regular diets do not see iodine deficiency as the main or major cause of thyromegaly.
2. Genetic Factors:
Your genes may also play a significant role in causing goiter. If you have a family history of goiters being caused commonly, then it is quite possible that you will have goiter as well. Such people are more prone to the problem and may have ailment even if other factors aren’t at play.
3. Hashimoto’s Disease:
Countries where people usually receive sufficient iodine in their diets see Hashimoto’s disease as one of the major causes of goiter. Also known as Hashimoto’s thyroiditis, this autoimmune disease is seen as a severe case of hypothyroidism where insufficient production of the thyroid hormones is caused due to the fact that the disease severely damages the thyroid gland so that the production of the hormones is at its minimal. This condition makes the pituitary gland to secrete excess TSH which leads to the excessive increase in the girth of the thyroid gland, thus resulting in thyromegaly.
4. Graves’ Disease:
This is another autoimmune disease where the body itself makes the thyroid gland to work overtime, thus causing hyperthyroidism or excess production of the thyroid hormones. The swelling of the gland occurs due to a stimulant known as the TSI. Thyroid Stimulating Immunoglobin is a protein which works to induce an increase in the size of the gland, thus causing a swollen gland.
5. Multinodular Goiter:
This type of goiter or thyromegaly occurs due to the formation of multiple nodules on either side of the gland which gradually increases in size and thus, gives the swollen appearance to the throat.
Thyromegaly may also be caused in people who suffer from thyroiditis. The thyroid gland in such cases gets inflamed due to a bacterial or viral infection.
If you are taking medicines that contain lithium and cobalt in significant proportions, then the consumption of such medicines for a long time can lead to thyromegaly.
Major changes in the hormonal levels is caused during pregnancy. If the signals sent by the pituitary are misinterpreted by the thyroid gland, it may react differently than it is supposed to and thus, produce less or more hormones which may eventually lead to goiter.
9. Other Factors:
Several other factors like cancer in the thyroid gland, pituitary diseases, congenital hypothyroidism, etc. may also be a contributing factor towards the formation of goiter or thyromegaly.
Who are at Risk?
Though thyromegaly can occur to anyone due to one or more of the factors mentioned above, some people are more prone to developing the ailment than others and include:
- Those who do not take sufficient amount of iodine in their daily diets
- Those who consume too much of cabbage, spinach, peaches or peanuts.
- Those who have a family history or carry hereditary factors contributing to goiter
- Those who belong to the age group 40 and above.
Though the above-mentioned factors enhance the chances of the occurrence of thyromegaly, yet others may suffer from the disease as well. Women, in general, are seen to be prone to the disease than men. Also, the disease may also occur in younger people as well as those who lift too much weight regularly.
Common Sign and Symptoms of Thyromegaly
The most common and visible symptom of thyromegaly is, obviously, the enlarged thyroid gland which becomes visible in the form of a swollen lump at the lower portion of the throat. Other than this very obvious symptom or sign, people suffering from goiter usually have the following indicative symptoms:
- Breathing problem
- Problem during swallowing food
- Problem in speaking clearly/raspy voice
- Intermittent coughing due to pressure on the esophagus
- Bad breath
- Fever (in case the swelling occurs due to infection/thyroiditis)
Apart from the symptoms mentioned above, other symptoms may also be seen depending on whether the person is suffering from hypothyroidism or hyperthyroidism. If your thyroid glands are producing too much of the thyroid hormones, then you may see additional symptoms like chest pain, heat intolerance, nervousness, high blood pressure, etc. However, if you happen to have less thyroid hormones in your bloodstream, you may see symptoms like lethargy, intolerance to cold, constipation, weight gain, etc.
It must also be noted that the swelling of the throat may or may not always be visible, especially when the disease is in its early stages and the glands haven’t swelled too much to become conspicuous. Also, the problems in breathing, swallowing and speaking may not be that prominent and thus, may not be considered significant. As such, one may not think about the occurrence of thyromegaly. In such situations, the associated symptoms must be carefully observed to identify the problem.
Diagnosis of Thyromegaly
Once you start experiencing the various symptoms of thyromegaly, however insignificant they may be, it would be wise to consult a physician immediately. Even though you may not have the tell-a-tale swelling that occurs due to goiter, the doctor will be able to carry out various tests that will confirm whether you have goiter or not. Diagnosing the disease at an early stage makes it easy to completely cure it without any impairing the windpipe and causing any associated injuries.
The first phase of diagnosis is usually done via a thorough physical examination after going through the symptoms or problems that you may be facing. The doctor usually determines the present condition of the gland by checking the area for tenderness, firmness, and mobility.
Once the physical test is complete, the doctor usually recommends a complete clinical checkup that will ensure whether you are actually suffering from thyromegaly or not. The clinical checkup procedure generally includes:
1. Blood Tests
Blood tests are suggested by the doctor to determine the levels of TSH, T4, and T3 in the blood. If the TSH levels are too high and T4 and T3 levels are very low, then you may be suffering from goiter.
The clinical checkup will also include an ultrasound of the throat so as to find out the exact shape and size of the gland and tissues that surround the gland. If the ultrasound images show that the tissues and the gland have started increasing in size, thyromegaly is imminent.
3. Radioactive Iodine Uptake
For this test, a fixed quantity of radioactive iodine is usually injected into the person. Once this is done, imaging is done to find out whether the nodule that has started growing becomes hot or becomes cold. This reaction can be used to determine whether these nodules are hyper or hypoactive. Hypoactive nodules become cold whereas the hyperactive nodules become hot due to the fast absorption of iodine. A cold nodule may be benign or malignant.
4. MRI or CT Scan
Clinical tests for thyromegaly also include CT scans or MRIs. A CT scan helps determine the iodine level in the blood and an MRI is used to determine whether the growing mass is malignant or not.
Fine needle aspiration cytology is carried out when the thyroid gland appears swollen, but the hormone levels are at normal. An FNAC actually involves implies a thyroid tissue biopsy which helps determine the level and type of the tumor and nodule.
Once it has been determined that thyromegaly is the cause of the swelling of the throat, action needs to be taken. The course of action generally depends on the size of the swelling, the causal factor and the malignancy of the tumor or nodule, if any exists. Commonly, the following techniques are used to treat goiter:
1. Hormone Replacement Therapy
Since in most cases goiter occurs due to insufficiency or excess of the thyroid hormones, the problem can be easily treated by replacing the hormones as per necessity. The replacement can be done either via surgery or radiation.
2. Levothyroxine Suppressive Therapy
Patients suffering from benign nodular goiter can be prescribed this therapy. It must be remembered that the procedure is a lengthy and gradual one and patients must follow the treatment plan systematically to benefit from the program.
3. Sufficient iodine intake
Since scarcity of iodine in the daily diet can lead to goiter, it is suggested that patients of thyromegaly ensure that their daily iodine intake is optimal so that the thyroid glands can function normally.
The level of the involved hormones can be lowered and controlled by medicines like PTU and methimazole. Since the hormone levels are kept optimum, the gland doesn’t tend to swell.
5. Ethanol Infusion
Thyromegaly can also be treated by infusing ethanol. This method works well if you have non-cancerous growths around the gland. Though the procedure is meant to gradually make the lump smaller, in certain cases the size may increase. In such cases, it would be prudent to contact a doctor.
If the swelling of the glands is too much and is causing major discomfort and pain to the patient, one may even opt to go for a surgery. Surgery is also suggested to those who have cancerous growths around the gland. Though a surgery is usually suggested as a last resort when all other techniques have failed, yet one may take up the option at the very first. The surgery is referred to as thyroidectomy and is usually classified into 3 types, depending on the portion of the gland that is removed.
(i) Total thyroidectomy – If the entire gland is removed for the treatment of thyromegaly, then it is referred to as total thyroidectomy and is carried out only in severe cases.
(ii) Near-total thyroidectomy – When both lobes of the gland are surgically removed to eliminate the swelling, leaving only a small portion of the thyroid tissue, the procedure is known as near-total thyroidectomy.
(iii) Subtotal thyroidectomy – In this procedure, a small portion of the tissue (about 3-5 g) is left on the lobe that’s less affected.
Risks of Thyroidectomy
Thyroidectomy has its own share of problems and risks, such as:
- Recurrent nerve palsy may occur after the surgery. This happens when the nerve becomes traumatized during the surgical procedures.
- There may be a change in the voice of a person who undergoes surgery.
- In case the patient’s parathyroid glands get affected or removed while performing thyroidectomy, then the calcium levels in the blood will drop significantly and the person will experience symptoms like numbness, muscle cramps, tingling, etc. Extreme low levels of calcium can also cause problems like seizures or throat spasms.
As such, it is quite important that the surgery is carried out using endoscopic techniques that extremely less invasive. Using such techniques also ensure that the scars are practically invisible.
Home Remedies that can Cure Thyromegaly
If the doctor determines that the swelling is non-cancerous as well as quite small, he may also suggest a variety of home remedies that will help to treat the swelling. In such cases, clinical and medical treatment of thyromegaly may not be indeed. Here is a list of some home remedies that are known to be effective in treating goiter
1. Eat food Rich in Iodine
If your doctor determines that the cause of thyromegaly is the lack of iodine in your diet, then you can introduce it into your diet as a cure to the problem. Some of the common items that you can add to your diet are iodized salt, kale, cabbage, cranberries, natural yogurt, milk, eggs, tuna, codfish, seafood, etc.
2. Take Optimum Amount of Selenium
Another reason behind the malfunction of the thyroid gland is the lack of optimum selenium in the diet. Thus, adding food items like poultry, meats, fatty fish, shellfish, eggs, barley, onions, sunflower seeds, etc. that are rich sources of selenium in the daily diet can help cure goiter.
Garlic assists glutathione production in the human body. Glutathione helps the thyroid gland to function normally. Taking 3-4 garlic cloves early in the morning can help in curing the problem.
4. Green Tea
Green tea not only helps cure thyromegaly, but also helps prevent it. Moreover, the presence of natural fluorides in the tea promotes healthy functioning of the thyroid gland.
5. Lemon Balm
Available as a tincture, Lemon balm has properties that can help slow down the pituitary gland’s activities, thereby reducing TSH levels. It can be taken in the form of a tea.
The high iodine content of kelp makes it an excellent home remedy for thyromegaly. It can be consumed as a pickle or in the powdered form.
Another seaweed that is a rich source of iodine. Can be taken in the form tea or as capsules after drying.
Lycopus virginicus, commonly known as bugleweed, can inhibit the activity of TSH, thus reducing the chances of hyperthyroidism which may lead to goiter. Bugleweed must be taken only when prescribed by the doctor.
9. Self Heal
Prunella vulgaris, popularly known as Self Heal, has excellent anti-inflammatory properties. Easily available in the form of a tincture, it can effectively reduce the swelling and treat thyromegaly.
Flaxseeds have anti-inflammatory properties. Thus, applying a paste of ground flaxseeds around the area can help in reducing the swelling.
11. Dandelion leaves
The swelling can be reduced with the help of dandelion leaves. Application of a lukewarm mixture of clarified butter and paste of dandelion leaves on the goiter regularly for atleast 2 weeks will minimize the swelling significantly.
12. Bauhinia Variegate
Indigenously known as Kachnar, the powder of the bark of this herb is known to be an effective cure for thyromegaly. Drinking a concoction of the boiled powder and ginger twice daily can treat the swelling.
Applying watercress leaves as a paste on the swelling or drinking a diluted juice extracted from the leaves can supply the body with several essential nutrients, including iodine, thus enhancing the curing process.
14. Sorrel leaves
Much like dandelion leaves and flaxseeds, the paste of these leaves, too, can be applied on the swollen area to reduce the lump.
15. Bentonite Clay
Applying a paste of bentonite clay can help suck the toxins out of the lump, thus helping treat goiter. The paste must be allowed to dry off before removal.
16. Oak bark
A paste made of dried oak bark in water when applied over the lump and allowed to stay overnight can minimize the swelling and alleviate symptoms as well.
Taking pineapple can help add important minerals and nutrients to the diet that can mainly alleviate the coughing that occurs due to goiter.
Motherwort helps relieve symptoms like fast heartbeat, palpitations, etc. that occur due to hyperthyroidism. Moreover, being rich in alkaloids, tannins, and flavonoids, Motherwort can help the swelling to gradually decrease in size.
19. Cold Shower
Taking cold showers daily can help improve the activity of the thyroid gland, thus reducing swelling if the cause of goiter has been the improper functioning of the thyroid glands.
Food that You Need to Avoid
While there are several food items that can help in curing goiter, there are others that can make matters worse if you have goiter. So, you must ensure that none of the following goitrogenic food items make way into your daily diet:
- Mustard greens
- Brussels sprouts
- Sweet potatoes
Even if you cannot totally keep these food items out of your daily diet, it would be preferable that you eat only limited amounts of these items and that too, after cooking them thoroughly.
Exercises that help in Treating Thyromegaly
Whether you are taking medications and undergoing therapies or have opted for home remedies for curing thyromegaly, exercises play an important role in the treatment procedure. Practicing a few simple, yet effective exercises daily can offer relief from the various symptoms and also assist the healing procedure. A list of these exercises is given below:
Yoga is an all-round healer and various yogic poses as well as breathing practices help in relieving severe symptoms like coughing, breathing and speech problems, etc. that occur due to thyromegaly.
2. Shoulder Shrugs
Shrugging your shoulders in a backward rotating motion while standing straight with arms by the side can help in enhancing blood circulation in the muscles that surround the gland, thus offering relief as well as cure.
3. Neck Rotation
Neck rotations can be done either while sitting or standing straight. Do it in sets of 5 in both left and right directions. However, if the lump is quite big and heavy, do avoid doing this exercise.
4. Chin Extension
This is a simple yet effective way to help the curing process. Place your hands behind your head while keeping the fingers crossed. Now, gradually bring your chin down while moving it towards your right side. Hold this position for about 15 secs and come back to the original posture. Repeat in the left direction, making sets of 5 in each direction.
Thyromegaly and Cancer
As already mentioned, thyromegaly may be caused due to tumors growing around the thyroid gland. If these tumors are malignant, they can cause cancer and thus, need to be treated as early as possible. If the malignancy is detected at a very early stage, the cancerous cells can be removed quite easily without harming the thyroid glands. But if the tumors grow to an advanced stage, it may become necessary to remove the thyroid glands entirely and cancer may spread to other areas of the body as well.
A small lump in your throat may not look much significant, but when allowed to grow unchecked without any treatment, the lump may assume huge proportions and may pose a danger to the thyroid gland as well to the general well-being of the person. So, it is important that thyromegaly is detected at the very start and the problem is nipped in the bud. Even if you have the slightest indications and feel uneasiness at the throat, make sure that you set up an appointment with the doc.
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