GALAGANDA (GOITRE)

GALAGANDA (GOITRE)

ETIOPATHOGENESIS OF GALAGANDA (GOITRE)

• Galaganda (Goitre) is a disease characterized by swelling in the neck region due to enlargement of the thyroid gland.

• In Ayurveda, it is considered a type of Granthi (tumor/cyst) or Arbuda (benign swelling) caused by vitiation of Kapha and Meda along with aggravation of Vata leading to abnormal growth in the neck.

• Nidana (causative factors) include:

  • Mandagni (impaired digestion) leading to Ama (toxins) formation

  • Excessive intake of Kapha-Vata aggravating ahara and viharas (food and lifestyle)

  • Exposure to cold and excess physical strain

  • Genetic predisposition and iodine deficiency (modern concept)

• According to Charaka:
  "श्लेष्मा वातश्च मेदः सञ्जातः ग्रन्थिरिति चिन्त्यते"
  (Ch. Chi. 28/72)
  Meaning: Granthi (tumor) formation is due to vitiation of Kapha, Vata, and Meda.

• Modern etiopathogenesis:

  • Iodine deficiency causing decreased thyroid hormone synthesis leads to compensatory thyroid hyperplasia.

  • Autoimmune thyroiditis (Hashimoto’s thyroiditis) causes gland enlargement.

  • Genetic mutations, goitrogens, and environmental factors contribute.

CLINICAL FEATURES OF GALAGANDA (GOITRE)

• Visible swelling in the anterior neck region, usually around the thyroid cartilage.

• Swelling may be soft, firm, or nodular depending on chronicity.

• Associated symptoms:

  • Pressure symptoms like difficulty swallowing (dysphagia), hoarseness, and dyspnea in large goiters.

  • Symptoms of hypothyroidism or hyperthyroidism depending on functional status of thyroid.

  • Cosmetic deformity and discomfort.

• On examination:

  • Swelling moves with deglutition (swallowing).

  • Non-tender unless associated with inflammation.

• In Ayurveda, signs of Galaganda include:

  • Vriddhi (enlargement) in the kandara (neck region)

  • Gaurava (heaviness) and Shotha (swelling)

  • Possible pain and stiffness depending on vitiated Doshas.

INVESTIGATIONS

• Laboratory tests:

  • Thyroid function tests (T3, T4, TSH) to assess gland activity.

  • Anti-thyroid antibodies (Anti-TPO, Anti-thyroglobulin) for autoimmune thyroiditis.

  • Serum iodine levels (where applicable).

• Imaging:

  • Ultrasound neck for size, texture, and nodularity of thyroid gland.

  • Radioactive iodine uptake scan to assess functional status.

  • Fine needle aspiration cytology (FNAC) for suspicious nodules to rule out malignancy.

• Ayurvedic assessment:

  • Pulse diagnosis and thorough prakriti and dosha assessment to guide treatment.

DIFFERENTIAL DIAGNOSIS

• Thyroid cyst or adenoma

• Thyroid carcinoma

• Lymphadenopathy (infections, malignancy)

• Branchial cyst or thyroglossal cyst

• Submandibular or parotid gland enlargement

• Tuberculous lymphadenitis or abscess

• Other neck swellings like lipoma or sebaceous cyst

COMPLICATIONS

• Compression of trachea leading to respiratory distress

• Esophageal compression causing dysphagia

• Vocal cord paralysis due to recurrent laryngeal nerve involvement

• Thyroid storm in case of hyperfunctioning toxic goiter

• Malignant transformation in long-standing nodular goiter

• Hypothyroidism or hyperthyroidism complications

• Cosmetic deformity affecting quality of life

MANAGEMENT OF GALAGANDA (GOITRE)

Ayurvedic Management

• Shodhana (Purification therapies):

  • Vamana (therapeutic emesis) and Virechana (purgation) to eliminate aggravated Kapha and Pitta.

  • Nasya (nasal administration of medicated oils) to balance Doshas.

• Shamana (Pacifying therapies):

  • Use of Kapha-Vata shamaka herbs such as Yashtimadhu (Glycyrrhiza glabra), Shunthi (Zingiber officinale), and Haridra (Curcuma longa).

  • Administration of Triphala and Chitrakadi Vati for improving digestion and metabolism.

  • Use of Medohara formulations to reduce Meda and swelling.

• Local therapies:

  • Application of medicated oils and pastes like Aragwadha or Kumari Taila externally on the neck.

  • Therapeutic massage to improve circulation and reduce swelling.

• Diet and lifestyle:

  • Avoidance of cold, heavy, and Kapha aggravating foods.

  • Encouragement of moderate exercise and avoidance of daytime sleep.

• Sanskrit sloka from Sushruta Samhita:
  "श्लेष्मं च मेदं च संजायते ग्रन्थिर्यथा तदा।
  निःशुल्कं हि व्याधेर्नाशं विना तस्यैव हान्यते॥"
  (Su. Nid. 5/23)
  Meaning: The Granthi (tumor) arises due to vitiation of Kapha and Meda; without proper management, it cannot be cured easily.

Modern Medical Management

• Medical treatment:

  • Iodine supplementation in endemic iodine deficiency areas.

  • Thyroid hormone replacement therapy in hypothyroid goiter.

  • Antithyroid drugs in hyperthyroid states.

• Surgical treatment:

  • Indicated in large compressive goiters, suspected malignancy, or cosmetic reasons.

  • Partial or total thyroidectomy depending on extent.

• Radioiodine therapy:

  • Used for toxic multinodular goiters or Graves’ disease.

• Regular follow-up:

  • Monitoring thyroid function and ultrasound to detect changes or malignancy.