The difference between toxic and nontoxic goiter Top Article All Articles 1 of 1 by rags-gvr Created on: September

16, 2007 Last Updated: November 06, 2008 Toxic and Non-Toxic Goiter Goiter is an enlargement of the thyroid gland. It is termed as toxic or non-toxic depending on the resultant changes in thyroxine (T3) and triidothyronine (T4) hormone levels. Non-toxic goiter is a simple enlargement of the thyroid gland without any increased secretion of thyroid hormone. It can be endemic or sporadic. Endemic goiter is mainly seen in areas like mountainous regions, flood planes which lacks iodine in the soil, hence in the food. Though the aetiology of sporadic goiter is not clearly known, possible reasons could be pregnancy, physiological stress, enzyme deficiencies, some drugs, and goitrogens like cabbage.

In contrast, toxic goiter mainly occurs as a result of a hypersensitivity reaction to an auto-antibody of IgG type class that acts on surface receptors for TSH (Thyroid Stimulating Hormone) on thyroid epithelium. In these patients, a remarkable rise occurs in both T3 and T4 concentrations. The increase in thyroid hormone levels results in reduced TSH release, whereas in non-toxic goiter TSH levels rise in an attempt to enhance the production of thyroid hormones (T3 & T4). Non-toxic goiter can be either parenchymatous (epithelial overgrowth) or colloid. In the first type, the epithelial hyperplasia leads to enlargement of the gland, which is often mild and symptomless. In later stages, it can turn into nodular form with formation of fibrous tracts in the gland. Colloid goiter is due to an increase in the stored protein substance of the gland, and is generally seen in pregnants. Whatever the form and aetiology are, nontoxic goiter is usually symptom-free, except in larger cases where pressure symptoms like dysphasia, dyspnoea and hoarseness of voice can be observed due to compression of the trachea by the enlarged mass. In short, non-toxic goiter simply results from an attempt of the body to enhance the thyroid hormones production to normal levels by increasing the release of the thyroid-stimulating hormone.

On the other hand, toxic goiter occurs in three forms, namely Grave's disease, toxic adenoma, toxic nodular goiter. Grave's disease mostly affects females and is commonly seen in families with a history of autoimmune diseases like thyroiditis, pernicious anaemia. Exophthalmos (abnormal protrusion of the eye) is a prominent feature in this disease. Toxic adenoma develops from only 1% of normal adenomas. A nodular goiter can become toxic, generally in older patients, when a portion of the gland starts releasing high levels of T3 and T4. The rise in T3 and T4 concentrations results in increased basal metabolic rate (BMR). This shows clinical manifestations such as weakness, hyperkinesia and emotional instability. Patients suffer from loss of weight. Glucose tolerance is diminished resulting in glycosuria. Skin becomes warm and sweaty (heat intolerance). Cardiac arrhythmias are common in elderly patients suffering from toxic goiter. The enlargement of the gland is clearly recognizable in most cases. Management also differs for these two varieties. Non-toxic goiter usually regresses with the elimination of the aetiology. Endemic goiter can be controlled with the use of iodized salt in food. Simple goiter in pregnants mostly subsides after delivery. However, toxic goiter needs prompt treatment with anti thyroid drugs, partial thyroidectomy and/or radioactive iodine (I131) depending on patient's age and clinical status of the gland. Symptomatic treatment is also necessary for toxic goiter.