Goitre (Fr.), or BRONCHOCELE, the name applied to any enlargement of the Thyroid Gland (q.v.) which is not either inflammatory or cancerous. The commonest and most interesting form of the disease is that which is endemic in certain districts, particularly in mountainous regions—e.g. among the Alps, the Himalayas (as at Darjeeling), and the Andes. In Britain it is most often met with in Derbyshire, and hence popularly called 'Derbyshire neck'; but even there it is not common. In some villages among the Alps all the inhabitants without exception are affected. Endemic goitre is often associated in the same districts and the same families with Cretinism (q.v.). Numerous theories have been advanced to account for it; it has been attributed to damp climate, snow-water, water with excess of lime or of magnesia, bad feeding, bad ventilation, and many other influences. But no one of these alleged causes is present in marked degree in all affected localities: it seems probable that various different combinations of causes are capable of producing a similar effect on the thyroid.
Sporadic cases of goitre, indistinguishable as regards the swelling from the endemic form, except that they do not attain such a large size, occur in all parts of the world. In either case, the enlargement may affect all the tissues of the gland equally, or may have its chief seat in the blood-vessels or the fibrous tissue, or may be much exaggerated by the formation of Cysts (q.v.) in the gland. In that form called Exophthalmic goitre, or Graves's disease, after its first describer, the thyroid enlargement is vascular and pulsating, and is associated with protrusion of the eyes, rapid action of the heart, &c., and is clearly only one symptom of a wide disturbance of the nervous system.
In other forms of goitre the tumour produces as a rule no obvious ill effects, except the inconvenience arising from its size, for it may be so large as to hang down upon the breast, or even to admit of being thrown over the shoulder. In some few cases, however, where it does not project so much forward, it is apt to press upon the windpipe, embarrassing the respiration, and may even cause death in this way.
Endemic goitre may usually be cured or checked by removal at an early stage of the malady to an unaffected district and more healthy surroundings. Where this is not practicable, and in sporadic cases, iodine is the favourite remedy, both applied locally and administered internally; but no method is uniformly or certainly successful in the reduction of the enlargement. In bad cases the gland has frequently been removed; but the evil results which are now known often to follow (see MYXODEMA) have made surgeons, during late years, most unwilling to undertake the operation, itself a serious one. Partial removal is not open to the same objection; nor is division of the tumour in the middle line without removal. Both these proceedings sometimes give great relief, and may be followed by shrinking of the remaining gland substance. See W. Robinson, Endemic Goitre or Thyroecle (1888).