Goitre , an elastic swelling on the front and sides of the neck, arising from a hypertrophy of the thyroid gland; it is also called broncho-cele and Derbyshire neck. It is generally soft and yielding, and varies in size from that of a nut to a mass surrounding the greater part of the neck, sometimes descending far upon the chest; it is usually slow in its growth, and may increase in either lateral lobe or in the median isthmus; it is accompanied by neither tenderness nor discoloration of the skin, and is generally definitely circumscribed. When of small size it occasions no inconvenience; but when large its weight and pressure upon the trachea, oesophagus, vessels, and nerves cause headache, difficulty of breathing and swallowing, congestion of the brain, with dizziness, lividity of the face, protrusion of the eyes, alteration of the voice, dulness of hearing, obstinate cough, ending in pulmonary disease, and threatening even apoplexy and suffocation. The anatomical character of the disease is the enlargement of the cells of the gland, which are filled with a viscid fluid or with blood; in old cases the tumor may become hard and partly bony. All ages are subject to goitre, but young persons and the female sex are most liable to it; it is also hereditary.
Though occasionally sporadic, it is essentially an endemic disease in cold and damp countries, as in the deep valleys of the Alps, where the air is moist, cold, and stagnant; it is most common in mountain valleys of the Alps, the Pyrenees, the Himalaya chain in Asia, the Cordilleras in America, the high regions of Scotland, and the chalky districts of Derbyshire and Nottingham in England. Though often connected with cretinism, it does not appear to be a scrofulous disease; neither is it confined to persons living in poverty and uncleanliness, for it is the sad inheritance of many wealthy families. Various causes have been assigned for goitre, but none of them are entirely satisfactory; the most probable are the insufficient illumination by the sun, moisture, and stillness of deep valleys; deleterious emanations from clayey soils; the use of snow water, or that from springs, arising from calcareous formations; the deoxygenation of water from great elevation, or its contact with metallic and organic matters eagerly absorbing oxygen. It seems to be connected rather with the geological than with any other character of a region. Goitre may be distinguished from other tumors in the neck by its shape, consistence, and general development on both sides.
The prognosis in a person advanced in life is unfavorable, but in early life it may be cured. The chief remedy for this disease is iodine, both internally and externally, either alone or combined with potash and iron; the patient should be removed from the infected district to the seashore, and a tonic regimen be pursued. When suffocation is imminent from the pressure of the tumor, relief may be obtained for the time by puncture, the seton, ligatures of the supplying arteries, or by extirpation of the gland; the last three are dangerous to life, and have proved fatal, and the first three may fail even if the patient survive the operations. The usual treatment is simply palliative, iodine with tonics and narcotics. There is a form of goitre not uncommon in anaemic females in the United States and in England, with the symptoms of the Alpine disease, though milder, and relieved by the tonic treatment of anosmia.