{{Short description|Neck swelling due to enlarged thyroid gland}} {{Use dmy dates|date=May 2023}} {{Infobox medical condition | name = Goitre | synonyms = Goiter | image = Thyroid, Diffuse Hyperplasia.jpg | caption = Diffuse hyperplasia of the thyroid | field = Endocrinology | symptoms = | complications = | onset = | duration = | types = | causes = Iodine deficiency, autoimmune disease, tumors, cyanide poisoning | risks = | diagnosis = | differential = | prevention = | treatment = | medication = | prognosis = | frequency = | deaths = }} A '''goitre''' (British English, spelled '''goiter''' in American English) is a swelling in the neck resulting from an enlarged thyroid gland.<ref name="BTF">{{cite web |work=British Thyroid Foundation |title=Thyroid Nodules and Swellings |date=11 September 2019 |url=http://www.btf-thyroid.org/information/leaflets/32-thyroid-nodules-and-swellings-guide |language=en-gb}}</ref><ref name="nhs">{{cite web |work=NHS Choices |title=Goitre - NHS Choices |url=http://www.nhs.uk/Conditions/Goitre/Pages/Introduction.aspx |language=en |date=2017-10-19 |access-date=3 July 2017 |archive-date=5 July 2017 |archive-url=https://web.archive.org/web/20170705140036/http://www.nhs.uk/Conditions/Goitre/Pages/Introduction.aspx |url-status=dead}}</ref> A goitre can be associated with a thyroid that is not functioning properly.
Worldwide, over 90% of goitre cases are caused by iodine deficiency.<ref name=Hoermann_2005>{{cite book |vauthors=Hörmann R |title=Schilddrüsenkrankheiten Leitfaden für Praxis und Klinik|trans-title=Thyroid Diseases: A Guide for Practic and Clinic |year=2005 |location=Berlin |isbn=3-936072-27-2 |edition=4., aktualisierte und erw. Aufl |pages=15–37 |publisher=ABW Wissenschaftsverlag |language=German}}</ref> The term is from the Latin ''gutturia'', meaning throat. Most goitres are not cancerous (i.e., benign), though they may be potentially harmful.
==Signs and symptoms== A goitre can present as a palpable or visible enlargement of the thyroid gland at the base of the neck. A goitre, if associated with hypothyroidism or hyperthyroidism, may be present with symptoms of the underlying disorder. For hyperthyroidism, the most common symptoms are associated with adrenergic stimulation: tachycardia (increased heart rate), palpitations, nervousness, tremor, increased blood pressure and heat intolerance. Clinical manifestations are often related to hypermetabolism (increased metabolism), excessive thyroid hormone, an increase in oxygen consumption, metabolic changes in protein metabolism, immunologic stimulation of diffuse goitre, and ocular changes (exophthalmos).<ref>{{cite book |last1=Porth |first1=Carol Mattson |last2=Gaspard |first2=Kathryn J |last3=Noble |first3=Kim A |title=Essentials of Pathophysiology: Concepts of Altered Health States |date=2011 |publisher=Lippincott Williams & Wilkins |isbn=978-1-58255-724-3}}{{pn|date=May 2025}}</ref> Hypothyroid people commonly have poor appetite, cold intolerance, constipation, lethargy and may undergo weight gain. However, these symptoms are often non-specific and make diagnosis difficult.{{citation needed|date=August 2020}}
According to the WHO classification of goitre by palpation, the severity of goitre is currently graded as grade 0, grade 1, grade 2.<ref>{{cite book |title=Goitre as a determinant of the prevalence and severity of iodine deficiency disorders in populations |date=2014 |publisher=World Health Organization |hdl=10665/133706 |hdl-access=free |last1=Organization |first1=World Health}}</ref>
<gallery widths="200" heights="200"> File:Struma 001.jpg|Goitre Class II, WHO grade 2 File:Kone med stor struma.jpg|Goitre Class III, WHO grade 2 </gallery>
==Causes== Worldwide, the most common cause for goitre is iodine deficiency, commonly seen in countries that scarcely use iodised salt. Selenium deficiency is also considered a contributing factor. In countries that use iodised salt, Hashimoto's thyroiditis is the most common cause.<ref name=Kumar>{{cite book |vauthors=Mitchell RS, Kumar V, Abbas AK, Fausto N |title=Robbins Basic Pathology |publisher=Saunders |location=Philadelphia |year=2007 |isbn=978-1-4160-2973-1 |edition=8th}}</ref> Goitre can also result from cyanide poisoning, which is particularly common in tropical countries where people eat the cyanide-rich cassava root as the staple food.<ref>{{cite web |url=http://www.atsdr.cdc.gov/toxprofiles/tp8-c2.pdf |archive-url=https://web.archive.org/web/20040728092929/http://www.atsdr.cdc.gov/toxprofiles/tp8-c2.pdf |archive-date=2004-07-28 |url-status=live |title=Toxicological Profile For Cyanide |website=Atsdr.cdc.gov |access-date=2017-03-16}}</ref> {{Clear}} {|class="wikitable sortable" |- ! Cause !! Pathophysiology !! Resultant thyroid activity !! Growth pattern !! Treatment !! Incidence and prevalence !! Prognosis |- | Iodine deficiency || Hyperplasia of thyroid to compensate for decreased efficacy || Can cause hypothyroidism || Diffuse ||Iodine|| Constitutes over 90% cases of goitre worldwide<ref name="Hoermann_2005"/> || Increased size of thyroid may be permanent if untreated for around five years |- | Congenital hypothyroidism || Inborn errors of thyroid hormone synthesis||Hypothyroidism || || || || |- | Goitrogen ingestion || || || || || || |- | Adverse drug reactions || || || || || || |- | Hashimoto's thyroiditis || Autoimmune disease in which the thyroid gland is gradually destroyed. Infiltration of lymphocytes. ||Hypothyroidism || Diffuse and lobulated<ref>{{cite journal |vauthors=Babademez MA, Tuncay KS, Zaim M, Acar B, Karaşen RM |title=Hashimoto thyroiditis and thyroid gland anomalies |journal=The Journal of Craniofacial Surgery |volume=21 |issue=6 |pages=1807–9 |date=November 2010 |pmid=21119426 |doi=10.1097/SCS.0b013e3181f43e32}}</ref> || Thyroid hormone replacement || Prevalence: 1 to 1.5 in a 1000 || Remission with treatment |- | Pituitary disease || Hypersecretion of thyroid stimulating hormone, almost always by a pituitary adenoma<ref name=Weiss2009>[http://www.uptodate.com/contents/thyrotropin-tsh-secreting-pituitary-adenomas Thyrotropin (TSH)-secreting pituitary adenomas.] By Roy E Weiss and Samuel Refetoff. Last literature review version 19.1: January 2011. This topic last updated: 2 July 2009</ref> || || Diffuse || Pituitary surgery || Very rare<ref name=Weiss2009/> || |- | Graves' disease—also called Basedow syndrome || Autoantibodies (TSHR-Ab) that activate the TSH-receptor (TSHR) || Hyperthyroidism || Diffuse || Antithyroid agents, radioiodine, surgery || Will develop in about 0.5% of males and 3% of females || Remission with treatment, but still lower quality of life for 14 to 21 years after treatment, with lower mood and lower vitality, regardless of the choice of treatment<ref name="pmid16356093">{{cite journal |vauthors=Abraham-Nordling M, Törring O, Hamberger B, Lundell G, Tallstedt L, Calissendorff J, Wallin G |title=Graves' disease: a long-term quality-of-life follow up of patients randomized to treatment with antithyroid drugs, radioiodine, or surgery |journal=Thyroid |volume=15 |issue=11 |pages=1279–86 |date=November 2005 |pmid=16356093 |doi=10.1089/thy.2005.15.1279}}</ref> |- | Thyroiditis || Acute or chronic inflammation || Can be hyperthyroidism initially, but progress to hypothyroidism || || || || |- | Thyroid cancer || || || Usually uninodular || || || Overall relative 5-year survival rate of 85% for females and 74% for males<ref name=european>Numbers from EUROCARE, from [https://books.google.com/books?id=u1aFpF-EcgwC&pg=PA10 Page 10] in: {{cite book |vauthors=Grünwald F, Biersack HJ |title=Thyroid cancer |publisher=Springer |location=Berlin |year=2005 |isbn=978-3-540-22309-2}}</ref> |- | Benign thyroid neoplasms || || Usually hyperthyroidism || Usually uninodular || || || Mostly harmless<ref>{{cite journal |vauthors=Bukvic BR, Zivaljevic VR, Sipetic SB, Diklic AD, Tausanovic KM, Paunovic IR |title=Improvement of quality of life in patients with benign goiter after surgical treatment |journal=Langenbeck's Archives of Surgery |volume=399 |issue=6 |pages=755–64 |date=August 2014 |pmid=25002182 |doi=10.1007/s00423-014-1221-7}}</ref> |- | Thyroid hormone insensitivity || || Secretional hyperthyroidism, <br> Symptomatic hypothyroidism || Diffuse || || || |} * Sarcoidosis * Amyloidosis * Hydatidiform mole * Cysts * Acromegaly * Pendred syndrome
==Diagnosis== [[File:Struma 004.jpg|thumb|Goitre with toxic adenoma]] Goitre may be diagnosed via a thyroid function test.<ref>{{cite web |title=Goitre |url=https://www.nhs.uk/conditions/goitre/ |website=nhs.uk |access-date=27 March 2019 |language=en |date=19 October 2017}}</ref>
===Types=== A goitre may be classified either as nodular or diffuse. Nodular goitres are either of one nodule (uninodular) or of multiple nodules (multinodular).<ref>{{cite book |doi=10.1016/B978-0-323-53114-6.00007-9 |chapter=Thyroid and Parathyroid Glands |title=Gnepp's Diagnostic Surgical Pathology of the Head and Neck |date=2021 |last1=Chernock |first1=Rebecca |last2=Williams |first2=Michelle D. |pages=606–688 |isbn=978-0-323-53114-6}}</ref> Multinodular goitre is the most common disorder of the thyroid gland.<ref>{{cite book |last1=Medeiros-Neto |first1=Geraldo |title=Endotext |date=2000 |publisher=MDText.com, Inc. |chapter-url=https://www.ncbi.nlm.nih.gov/books/NBK285569/ |chapter=Multinodular Goiter |pmid=25905424}}</ref>
;Growth pattern: * '''Uninodular goitre''': one thyroid nodule; can be either inactive, or active (toxic) – autonomously producing thyroid hormone. * '''Multinodular goitre''': multiple nodules;<ref>{{cite journal |vauthors=Frilling A, Liu C, Weber F |title=Benign multinodular goiter |journal=Scandinavian Journal of Surgery |volume=93 |issue=4 |pages=278–81 |year=2004 |pmid=15658668 |doi=10.1177/145749690409300405}}</ref> can likewise be inactive or toxic, the latter is called toxic multinodular goitre and associated with hyperthyroidism. These nodules grow up at varying rates and secrete thyroid hormone autonomously, thereby suppressing TSH-dependent growth and function in the rest of gland. Inactive nodules in the same goitre can be malignant.<ref name="BMJ">{{cite web |title=Toxic multinodular goitre - Symptoms, diagnosis and treatment {{!}} BMJ Best Practice |url=https://bestpractice.bmj.com/topics/en-gb/714 |website=bestpractice.bmj.com |language=en-us}}</ref> Thyroid cancer is identified in 13.7% of the patients operated for multinodular goitre.<ref>{{cite journal |vauthors=Gandolfi PP, Frisina A, Raffa M, Renda F, Rocchetti O, Ruggeri C, Tombolini A |title=The incidence of thyroid carcinoma in multinodular goiter: retrospective analysis |journal=Acta Bio-Medica |volume=75 |issue=2 |pages=114–7 |date=August 2004 |pmid=15481700}}</ref> * Diffuse goitre: the whole thyroid appearing to be enlarged due to hyperplasia.
;Size: * Class I: the goitre in normal posture of the head cannot be seen; it is only found by palpation. * Class II: the goitre is palpable and can be easily seen. * Class III: the goitre is very large and is retrosternal (partially or totally lying below the sternum), pressure results in compression marks.
==Treatment== Goitre is treated according to the cause. If the thyroid gland is producing an excess of thyroid hormones (T3 and T4), radioactive iodine is given to the patient to shrink the gland. If goitre is caused by iodine deficiency, small doses of iodide in the form of Lugol's iodine or KI solution are given. If the goitre is associated with an underactive thyroid, thyroid supplements are used as treatment. Sometimes a partial or complete thyroidectomy is required.<ref>{{cite news |url=http://health.nytimes.com/health/guides/disease/goiter/overview.html |work=The New York Times |title=Goiter – Simple}}</ref>
== Medical and scientific developments == The discovery of iodine's importance in thyroid function and its role in preventing goitre marked a significant medical breakthrough. The introduction of iodised salt in the early 20th century became a key public health initiative, effectively reducing the prevalence of goitre in previously affected regions. This measure was one of the earliest and most successful examples of mass preventive health campaigns.<ref>{{Cite book |last=Hetzel |first=Basil S. |chapter=The Iodine Deficiency Disorders |date=1993 |title=Iodine Deficiency in Europe |pages=25–31 |url=http://dx.doi.org/10.1007/978-1-4899-1245-9_3 |access-date=2024-08-06 |place=Boston, MA |publisher=Springer US |doi=10.1007/978-1-4899-1245-9_3 |isbn=978-1-4899-1247-3 |url-access=subscription}}</ref>
==Epidemiology== [[File:Iodine deficiency world map - DALY - WHO2002.svg|thumb|upright=1.15|Disability-adjusted life year for iodine deficiency per 100,000 inhabitants in 2002:<ref>{{cite web |url=https://www.who.int/entity/healthinfo/statistics/bodgbddeathdalyestimates.xls |title=Mortality and Burden of Disease Estimates for WHO Member States in 2002 |format=xls |work=World Health Organization |year=2002}}</ref>{{Div col|small=yes|colwidth=10em}} {{legend|#b3b3b3|No data}} {{legend|#ffff65|<50}} {{legend|#fff200|50–100}} {{legend|#ffdc00|100–150}} {{legend|#ffc600|150–200}} {{legend|#ffb000|200–250}} {{legend|#ff9a00|250–300}} {{legend|#ff8400|300–350}} {{legend|#ff6e00|350–400}} {{legend|#ff5800|400–450}} {{legend|#ff4200|450–500}} {{legend|#ff2c00|500–800}} {{legend|#cb0000|>800}} {{div col end}}]] Goitre is more common among women, but this includes the many types of goitre caused by autoimmune problems, and not only those caused by simple lack of iodine.
Iodine mainly accumulates in the sea and in the topsoil. Before iodine enrichment programs, goiters were common in areas with repeated flooding or glacial activities, which erodes the topsoil. It is endemic in populations where the intake of iodine is less than 10 μg per day.<ref>{{cite report |title=Goitre as a determinant of the prevalence and severity of iodine deficiency disorders in populations |date=2014 |url=https://apps.who.int/iris/bitstream/10665/133706/1/WHO_NMH_NHD_EPG_14.5_eng.pdf?ua=1 |work=Vitamin and Mineral Nutrition Information System |location=Geneva |publisher=World Health Organization |access-date=7 May 2026 |archive-url=https://web.archive.org/web/20210606021115/https://apps.who.int/iris/bitstream/handle/10665/133706/WHO_NMH_NHD_EPG_14.5_eng.pdf |archive-date=6 June 2021}}</ref>
Examples of such regions include the alpine regions of Southern Europe (such as Switzerland), the Himalayans, the Great Lakes basin, etc. As reported in 1923, all the domestic animals have goiter in some of the glacial valleys of Southern Alaska. It was so severe in Pemberton Meadows that it was difficult to raise young animals there.<ref>{{Cite journal |last=Kimball |first=O. P. |title=The Prevention of Simple Goiter |date=February 1923 |journal=American Journal of Public Health |volume=13 |issue=2 |pages=81–87 |doi=10.2105/ajph.13.2.81-a |pmid=18010882 |pmc=1354367}}</ref>
==History== [[File:Cretinnen aus Steiermark, 1819 gez. Loder, gest. Leopold Müller.jpg|thumb|left|Goitre and congenital iodine deficiency syndrome in Styria, copper engraving, 1815]] thumb|Woman in Miesbacher Tracht wearing a goitre choker Chinese physicians of the Tang dynasty (618–907) were the first to successfully treat patients with goitre by using the iodine-rich thyroid gland of animals such as sheep and pigs—in raw, pill, or powdered form.<ref name = "Temple_1986">{{cite book |vauthors=Temple R |date=1986 |title=The Genius of China: 3,000 Years of Science, Discovery, and Invention |location=New York |publisher=Simon and Schuster, Inc. |isbn=0-671-62028-2 |pages=134–5}}</ref> This was outlined in Zhen Quan's (d. 643 AD) book, as well as several others.<ref name = "Temple_1986" /> One Chinese book, ''The Pharmacopoeia of the Heavenly Husbandman'', asserted that iodine-rich sargassum was used to treat goitre patients by the 1st century BC, but this book was written much later.<ref name = "Temple_1986" />
In the 12th century, Zayn al-Din al-Jurjani, a Persian physician, provided the first description of Graves' disease after noting the association of goitre and a displacement of the eye known as exophthalmos in his ''Thesaurus of the Shah of Khwarazm'', the major medical dictionary of its time.<ref name=WNI>{{WhoNamedIt|synd|1517|Basedow's syndrome or disease}} – the history and naming of the disease</ref><ref>{{cite journal |vauthors=Ljunggren JG |title=[Who was the man behind the syndrome: Ismail al-Jurjani, Testa, Flagani, Parry, Graves or Basedow? Use the term hyperthyreosis instead] |journal=Läkartidningen |volume=80 |issue=32–33 |pages=2902 |date=August 1983 |pmid=6355710}}</ref> The disease was later named after Irish doctor Robert James Graves, who described a case of goitre with exophthalmos in 1835. The German Karl Adolph von Basedow also independently reported the same constellation of symptoms in 1840, while earlier reports of the disease were also published by the Italians Giuseppe Flajani and Antonio Giuseppe Testa, in 1802 and 1810 respectively,<ref>{{WhoNamedIt|doctor|1471|Giuseppe Flajani}}</ref> and by the English physician Caleb Hillier Parry (a friend of Edward Jenner) in the late 18th century.<ref>{{cite journal |vauthors=Hull G |title=Caleb Hillier Parry 1755-1822: a notable provincial physician |journal=Journal of the Royal Society of Medicine |volume=91 |issue=6 |pages=335–8 |date=June 1998 |pmid=9771526 |pmc=1296785 |doi=10.1177/014107689809100618}}</ref>
Paracelsus (1493–1541) was the first person to propose a relationship between goitre and minerals (particularly lead) in drinking water.<ref>[https://www.britannica.com/EBchecked/topic/442424/Paracelsus/5505/Assessment "Paracelsus"] Britannica</ref> Iodine was later discovered by Bernard Courtois in 1811 from seaweed ash.<ref>{{cite journal |title=VI. Some experiments and observations on a new substance which becomes a violet coloured gas by heat |journal=Philosophical Transactions of the Royal Society of London |date=31 December 1814 |volume=104 |pages=74–93 |doi=10.1098/rstl.1814.0007}}</ref>
Goitre was previously common in many areas that were deficient in iodine in the soil. For example, in the English Midlands, the condition was known as '''Derbyshire Neck'''. In the United States, goitre was found in the Appalachian,<ref>{{Cite web |url=https://www.thyroid.org/iodine-deficiency/ |title=Iodine Deficiency |access-date=27 February 2021 |archive-date=18 November 2022 |archive-url=https://web.archive.org/web/20221118193754/https://www.thyroid.org/iodine-deficiency/ |url-status=dead}}</ref><ref>{{Cite journal |url=https://jamanetwork.com/journals/jamapediatrics/article-abstract/507625 |doi=10.1001/archpedi.1977.02120210044010 |title=Kentucky Appalachian Goiter Without Iodine Deficiency |year=1977 |last1=Hollingsworth |first1=Dorothy R. |journal=American Journal of Diseases of Children |volume=131 |issue=8 |pages=866–869 |pmid=888801 |url-access=subscription}}</ref> Great Lakes, Midwest, and Intermountain regions. The condition is now practically absent in affluent nations, where table salt is supplemented with iodine. However, it is still prevalent in India, China,<ref>{{cite news |last1=McNeil |first1=Donald G. Jr |title=In Raising the World’s I.Q., the Secret’s in the Salt |url=https://www.nytimes.com/2006/12/16/health/in-raising-the-worlds-iq-the-secrets-in-the-salt.html |work=The New York Times |date=16 December 2006}}</ref> Central Asia, and Central Africa.
Goitre had been prevalent in the alpine countries for a long time. Switzerland reduced the condition by introducing iodised salt in 1922. The Bavarian tracht in the Miesbach and Salzburg regions, which appeared in the 19th century, includes a choker, dubbed ''Kropfband'' (struma band) which was used to hide either the goitre or the remnants of goitre surgery.<ref>{{cite web |url=http://www.planet-wissen.de/pw/Artikel,,,,,,,FC2D0E589CC11ACEE0340003BA5E0905,,,,,,,,,,,,,,,.html |title=Planet Wissen |first=Planet |last=Wissen |date=16 March 2017}}</ref>
In various regions around the world, particularly in mountainous areas, the prevalence of goitre was linked to iodine deficiency in the diet. For example, the Alps, the Himalayas, and the Andes had high rates of goitre due to the iodine-poor soil. In these regions, iodine deficiency led to widespread hormonal imbalances, particularly affecting thyroid function.<ref>{{Cite journal |last1=Dunn |first1=John T. |last2=Delange |first2=Francois |date=June 2001 |title=Damaged Reproduction: The Most Important Consequence of Iodine Deficiency |journal=The Journal of Clinical Endocrinology & Metabolism |volume=86 |issue=6 |pages=2360–2363 |doi=10.1210/jcem.86.6.7611 |pmid=11397823}}</ref>
==Society and culture== In the 1920s wearing bottles of iodine around the neck was believed to prevent goitre.<ref>{{cite web |url=http://www.nrc-cnrc.gc.ca/eng/dimensions/issue8/iodine.html |title=ARCHIVED – Why take iodine? |publisher=Nrc-cnrc.gc.ca |date=2011-09-30 |access-date=2012-11-01}}</ref>
===Notable cases=== * Former U.S. President George H. W. Bush and his wife Barbara Bush were both diagnosed with Graves' disease and goitres, within two years of each other. The disease caused hyperthyroidism and cardiac dysrhythmia.<ref>{{cite book |url=https://books.google.com/books?id=QLy42Bu3I6oC&q=George+H.+W.+Bush+Graves'+disease&pg=PT170 |title=Women and Autoimmune Disease |vauthors=Lahita RG, Yalof I |author-link1=Robert G. Lahita |page=158 |publisher=HarperCollins |isbn=978-0-06-008149-2 |date=2004-07-20}}</ref><ref>{{cite web |url=https://www.nytimes.com/1991/09/14/us/doctors-say-bush-is-in-good-health.html |vauthors=Altman LK |title=A White House Puzzle: Immunity Ailments |quote=Doctors Say Bush Is in Good Health |work=The New York Times |date=14 September 1991}}</ref> Scientists said that, absent an environmental cause, the odds of both a husband and wife having Graves' disease might be 1 in 100,000 or as low as 1 in 3,000,000.<ref>{{cite web |url=https://www.nytimes.com/1991/05/28/science/the-doctor-s-world-a-white-house-puzzle-immunity-ailments.html |vauthors=Altman LK |title=The Doctor's World; A White House Puzzle: Immunity Ailments |work=The New York Times |date=28 May 1991}}</ref>
===Heraldry=== The coat of arms and crest of Die Kröpfner, of Tyrol, showed a man "afflicted with a large goitre", an apparent pun on the German for the word ("Kropf").<ref name="Fox-Davies1904">{{cite book |vauthors=Fox-Davies AC |author-link=Arthur Charles Fox-Davies |title=The Art of Heraldry: An Encyclopædia of Armory |title-link=The Art of Heraldry: An Encyclopædia of Armory |year=1904 |publisher=Benjamin Blom, Inc. |location=New York and London |page=413}}</ref>
=== Social Impacts === In some historical contexts, goitres were so prevalent that they became normalized within the culture. For instance, in certain Alpine regions, large goitres were sometimes considered a sign of beauty. Conversely, in other areas, individuals with goitres faced social stigma, which could lead to marginalisation and discrimination.<ref>{{Cite journal |last=Norling |first=Bernard |date=October 1977 |title=Plagues and Peoples - William H. McNeill: Plagues and Peoples. (Garden City, New York: Anchor Press, Doubleday, 1976. Pp. 369. $10.00.) |journal=The Review of Politics |volume=39 |issue=4 |pages=557–560 |doi=10.1017/s0034670500025043}}</ref>
=== Art ===
Goitres have been discussed in art-historical and medical-historical literature as recurring features in painting and religious portraiture. A review by Accorona et al. described thyroid swelling as a phenomenon represented across multiple artistic periods, while other authors have examined its appearance in Renaissance art more specifically.<ref>{{cite journal |last1=Accorona |first1=Remo |last2=Huskens |first2=Inge |last3=Meulemans |first3=Jeroen |last4=Nicolai |first4=Piero |last5=Cappelli |first5=Carlo |last6=Lombardi |first6=Davide |title=Thyroid swelling: a common phenomenon in art? |journal=European Thyroid Journal |year=2018 |volume=7 |issue=5 |pages=272–278 |doi=10.1159/000488315|hdl=11379/511069 |hdl-access=free }}</ref><ref>{{cite journal |last1=Sterpetti |first1=Antonio V. |last2=De Toma |first2=Giorgio |last3=De Cesare |first3=Alessandro |title=Thyroid swellings in the art of the Italian Renaissance |journal=The American Journal of Surgery |year=2015 |volume=210 |issue=3 |pages=591–596 |doi=10.1016/j.amjsurg.2015.03.010|pmc=5578749 }}</ref><ref>{{cite journal |last1=Vescia |first1=F. G. |last2=Basso |first2=L. |title=Goiters in the Renaissance |journal=Vesalius |year=1997 |volume=3 |issue=1 |pages=23–32}}</ref> A review by Joselv Albano and Janelle Lara Mirhan specifically focused on the representation of goitre in the depictions of ''Susanna and the Elders''.<ref>{{cite journal |last1=Albano |first1=Joselv E. |last2=Mirhan |first2=Janelle Lara G. |title=The representation of goiter in the portraiture of Susanna and the Elders |journal=Gazzetta Medica Italiana - Archivio per le Scienze Mediche |year=2026 |volume=185 |issue=4 |pages=623–629 |doi=10.23736/S0393-3660.25.05989-3 |url=https://www.minervamedica.it/en/journals/gazzetta-medica-italiana/article.php?cod=R22Y2026N04A0623|url-access=subscription }}</ref>
== See also == * David Marine conducted substantial research on the treatment of goitre with iodine. * Endemic goitre * Struma ovarii—a kind of teratoma * Thyroid hormone receptor
== References == {{Reflist}}
== External links == * {{Wiktionary-inline}} * {{Commons-inline|Goiters}}
{{Medical resources | DiseasesDB = 5332 | ICD11 = {{ICD11|5A00.00}}, {{ICD11|5A00.1}}, {{ICD11|5A01}}, {{ICD11|5A02.0}} | ICD10 = {{ICD10|E01}}–{{ICD10|E05}} | ICD9 = {{ICD9|240.9}} | ICDO = | OMIM = | MedlinePlus = 001178 | eMedicineSubj = | eMedicineTopic = | MeshID = D006042 }} {{Thyroid disease}} {{Authority control}}
Category:Endocrine diseases Category:Thyroid Category:Thyroid disease