Goiter: Overview of Aetiopathogenesis and Therapy

*Dhananjaya Melkunte Shanthaiah, Piyush Gupta and Neeraj Kumar Agrawal*

### **Abstract**

The goiter was described in history for long time. Many luminaries suffered from it. The enlargement of thyroid is known as goiter, it can arise from various causes and each has separate aetiopathogenesis and treatment. As an overview for the book, this chapter delves into each aspect, whereas the details are in separate chapter.

**Keywords:** goiter, hypothyroidism, hyperthyroidism, thyroiditis, carcinoma thyroid

#### **1. Introduction**

Thyroid gland is a butterfly shaped organ lying in the anterior aspect of the neck. The major function of the gland is the production of thyroid hormones, namely Triiodothyronine and Tetraiodothyronine. These hormones are the major regulators of the various metabolic processes in the human body.

Various pathological processes affect the organ. One of the clinical manifestations of these pathological processes is enlargement of the gland. In general the abnormal enlargement of thyroid gland is defined as goiter by American thyroid association [1].

Historically goiter was mentioned in literature of various languages around the world. Ancient Indian physicians have described the condition called as Galaganda in detail in Ayurveda books written between fourteenth century BC and 400 A.D [2]. Many sculptures and paintings around the world have goiter being depicted suggest the prevalence of knowledge regarding goiter among the common people during those ages.

During 1600 BC Chinese used to treat the condition with the sea weed [3]. Even though ancient doctors use to treat the condition with sea weed, the exact pharmacological basis behind this treatment was understood only after the discovery of Iodine by Bernard Courtois in 1811 [4].

Association of iodine deficiency with goiter was first discovered during 19th century by various researchers like Lugol (1786–1851) and Coindet (1774–1834). But it was in the David Marine who proved requirement of iodine for normal thyroid function in a trial conducted between 1917 and 1922 in Ohio [5]. In 1835 Case of goiter with exophthalmos were described by Robert James Graves [6]. Thyroid hormone in pure form was extracted by Edward Kendall in 1914 at Mayo clinic [7].

Major progress occurred during twentieth century in management of Graves' disease with development of different treatment modalities like radioactive iodine and thionamides. Twenty-first century was marked with development of safer surgical practices and in depth understanding of the goiter pathology leading to better management of the condition.
