Endemic goiter (DET) is one of the most common thyroid diseases that appears in population with predilection in mountainous regions. Under this condition, the thyroid gland changes both in morphological and functional levels.
In the etiology of this disease are involved both environmental and individual factors.
Among environmental factors, the primary role is the deficiency of iodine (iodine is essential for thyroid hormone biosynthesis). Other environmental factors involved in the etiology of endemic goiter are:
- substances that have been highlighted in peas, beans, cabbage, soybeans, lentils;
- water pollution;
- drugs: sulfonamides, phenylbutazone, cobalt salts, corticosteroids, prolonged iodine administration;
- some minerals like calcium, magnesium, fluorine, chlorine;
- unbalanced diet: high in fat and low in proteins;
Individual factors incriminated in the etiology of endemic goiter are represented by:
- sex, this condition is more common in women;
- hereditary factors;
- age: there are three peaks: one at puberty, the second from 20 to 30 years, and the third is the menopause;
- abnormal losses of iodine in some diseases like chronic diarrhea;
In terms of thyroid function, this condition can evolve with normal functioning of thyroid, with endocrine disorders (hypothyroidism or hyperthyroidism), or neuroendocrine disorders.
This evolution allows classification endemic goiter in three grades, as follows:
1. Grade I (fewer symptoms):
- is characterized by the presence of a goiter which evolves with euthyroidism (normal thyroid function);
- the goiter may be small, medium, large or giant with soft, parenchymal or hard consistency;
2. Grade II – goiter evolving with endocrine disorders (hypo – or hyperfunction). The symptoms are characteristic to the mode of evolution – hypothyroidism or hyperthyroidism;
3. Grade III (neuropathic form) – This form associates, in addition to earlier forms damage to the central nervous system (idiocy, cretinism, epilepsy, stammering);
Depending on the goiter volume, under this condition, there may appear compressions neighboring organs, giving characteristic symptoms, such as:
- compression on the trachea;
- compression of veins: cyanotic (blue coloration – purple skin), and swelling of the face;
- compression of the esophagus – dysphagia (difficulty in swallowing);
- compression of the recurrent nerve with paresis – hoarseness, voice on two tones, dysphonia.