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Rare Causes of Thyroid Gland Enlargement

Uncommon Conditions that Cause Goiters

Aug 28, 2009 Jim Lowrance

The vast majority of enlarged thyroid glands occur due to common diseases or conditions but there are cases in which goiters do not have typical causes.

The most common cause of goiter worldwide is iodine deficiency with thyroid autoimmunity being the second major cause, the class of thyroid disease that presents with auto-antibodies attacking the thyroid gland. The two resulting autoimmune disorders that often present with goiters are Graves’ disease which results in hyperthyroidism and Hashimoto’s thyroiditis which results in hypothyroidism. There are less common causes of goiters as well and some of these will be addressed in the following subheadings.

Uncommon Sporadic Goiter

This type of primary goiter (a problem within the gland) is also sometimes placed in the “simple goiter” category, meaning there is enlargement without actual development of abnormal thyroid tissue and is commonly an inherited genetic condition. Some cases of sporadic goiters however, also include those in which diseased thyroid tissue grows outside of the normal boundaries of the gland. This can include thyroid autoimmunity diseases, thyroid nodules and a less common type of condition called Riedel's thyroiditis. This latter mentioned disease causes thyroid tissue to be replaced with fibrous tissue that can grow large enough to obstruct breathing and swallowing. This overgrowth of the thyroid gland can also occur with types of thyroid cancer, including papillary, follicular and sarcomatoid carcinomas.

Exophthalmic Goiter

This type of goiter that can be either primary or secondary (indirectly affecting the gland) manifests with severe hyperthyroidism and with a condition of protruding eyeballs or “proptosis” (a type of Thyroid Eye Disease). The term for this type goiter can also be synonymous with Grave’s disease (primary) but rarely the condition can be caused by a shortage of necessary enzymes in the thyroid that allows toxins to build within the gland. Some medical sources believe the condition may rarely also result from chronic alcohol abuse (secondary).

Severe and even life-threatening symptoms including hypertension, tachycardia (rapid heart rate) and other heart arrhythmias can occur with this condition. Some cases may be caused by brain lesions (secondary) that disrupt the manufacture of key thyroid enzymes. In this case it would not be caused by thyroid autoimmunity as Grave’s disease is. This rare, severe version of the disorder can be fatal if treatment with beta-blockers to regulate blood pressure and cardiac symptoms is not administered. Patients may also be referred for emergency thyroid removal (surgical thyroidectomy).

Congenital Goiter

If a baby is born with thyroid swelling, this term for the primary goiter is used. The goiter may be accompanied by hypothyroidism in the newborn as well, which is referred to as congenital hypothyroidism but some of them manifest without thyroid hormone imbalance or may occur with mild hypothyroidism. If thyroid nodules are also present, it is referred to as Congenital Nodular Goiter. Most cases of this type goiter are temporary and only require short-term treatment to resolve them.

Diagnosis and Treatment

Goiters, regardless of cause have treatments available for them, depending on the manifestations and the symptoms that may accompany them. If a person detects swelling or lumps in their thyroid gland, which is located at the front of the neck just below the adams apple area, they should report to their doctor for further evaluation. A doctor will often first palpate the gland, meaning to examine it by feel using the fingertips and may also order diagnostic imaging tests and/or tissue biopsy. Blood tests of thyroid hormone levels and/or to detect thyroid antibodies may also be ordered to help determine the cause and treatments that are needed for common goiters and for those that are less typical.

The copyright of the article Rare Causes of Thyroid Gland Enlargement in General Medicine is owned by Jim Lowrance. Permission to republish Rare Causes of Thyroid Gland Enlargement in print or online must be granted by the author in writing.

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