Goiter

What is a goiter?

Goiter is a condition where your thyroid gland grows larger. Your entire thyroid can grow larger or it can develop one or more small lumps called thyroid nodules.

Your thyroid gland is a small, butterfly-shaped endocrine gland located in your neck, below your Adam's apple. It produces the hormones thyroxine (also called T4) and triiodothyronine (also called T3). These hormones play a role in certain bodily functions, including:

• Metabolism.
• Body temperature.
• Mood and excitability.
• Pulse and heart rate.
• Digestion.

Goiter may be associated with an irregular amount of thyroid hormone in your body (hyperthyroidism or hypothyroidism) or with normal levels of thyroid hormone (euthyroid).

Goiter has several possible causes. Depending on the cause, it may or may not require treatment.

What are the types of goiter?

Goiter can be classified in a few different ways, including the way by which it grows and if your thyroid hormone levels are irregular or not.

Classifications for goiter based on how it enlarges include:

• Simple (diffuse) goiter: This type of goiter happens when your entire thyroid gland swells and feels smooth to the touch.
• Nodular goiter: This type of goiter happens when a solid or fluid-filled lump called a nodule develops within your thyroid and makes it feel lumpy.
• Multinodular goiter: This type of goiter happens when there are many lumps (nodules) within your thyroid. The nodules may be visible or only discovered through examination or scans.

Classifications of goiter based on thyroid hormone levels include:

• Toxic goiter: This goiter happens when your thyroid is enlarged and produces too much thyroid hormone.
• Nontoxic goiter: If you have an enlarged thyroid but normal thyroid levels (euthyroid), it’s a nontoxic goiter. In other words, you don’t have hyperthyroidism (overactive thyroid) or hypothyroidism (underactive thyroid).

Healthcare providers combine these descriptors to classify certain types of goiter when diagnosing them. For example, a toxic multinodular goiter happens when there’s more than one nodule on your thyroid — usually several — producing an extra amount of thyroid hormone.

Who does goiter affect?

Anyone can have a goiter, but it’s about four times more likely to develop in people assigned female at birth compared to people assigned male at birth. Your risk of developing goiter also increases as you age. They’re more common after age 40.

People who have any of the following conditions may also be more likely to develop goiter:

• Obesity.
• Insulin resistance.
• Metabolic syndrome.

You’re also at greater risk for developing goiter if your head and neck have been exposed to radiation for medical treatments and/or if you have a family history of thyroid disease.

How common is goiter?

Goiters are relatively common. They affect about 5% of people in the United States.

The most common cause of goiters worldwide is iodine deficiency, which affects an estimated 2.2 billion people.

The more severe the iodine deficiency, the more likely someone is to have goiter:

• With mild iodine deficiency, the incidence of goiter is 5% to 20%.
• With a moderate iodine deficiency, the prevalence increases to 20% to 30%.
• With severe iodine deficiency, the incidence increases to greater than 30%.

What are the symptoms of goiter?

The size of a goiter can range from very small and barely noticeable to very large. Most goiters are painless, but if you have thyroiditis (an inflamed thyroid gland), it can be painful.

The main symptoms of goiter include:

• A lump in the front of your neck, just below your Adam's apple.
• A feeling of tightness in your throat area.
• Hoarseness (scratchy voice).
• Neck vein swelling.
• Dizziness when you raise your arms above your head.

Other, less common symptoms include:

• Difficulty breathing (shortness of breath).
• Coughing.
• Wheezing (due to squeezing of your windpipe).
• Difficulty swallowing (due to squeezing of your esophagus).

Some people who have a goiter may also have hyperthyroidism (overactive thyroid). Symptoms of hyperthyroidism include:

• Rapid heart rate (tachycardia).
• Unexplained weight loss.
• Diarrhea.
• Sweating without exercise or increased room temperature.
• Shaking.
• Agitation.

Some people with goiter may also have hypothyroidism (underactive thyroid). Symptoms of hypothyroidism include:

• Fatigue (feeling tired).
• Constipation.
• Dry skin.
• Unexplained weight gain.
• Abnormal menstruation (periods).

What causes goiter?

Goiter is an adaptive reaction of the cells in your thyroid to any process that blocks thyroid hormone production. While the most common cause of goiter worldwide is iodine deficiency, many conditions can cause it.

Causes of goiter include:

• Iodine deficiency: Your thyroid needs iodine to produce thyroid hormone. If you don’t get enough iodine in your diet, your thyroid makes more cells (and grows) to try to make more thyroid hormone. While this is the most common cause of goiter worldwide, it’s not common in the United States. You can get the recommended amount of iodine in your diet by including seafood, dairy products and iodized salt in your diet. Supplementation with iodine is not recommended for most people and may have unintended negative effects on your health.
• Graves' disease: Graves' disease is an autoimmune disease in which your immune system attacks your thyroid, causing it to grow larger. Graves’ disease also causes hyperthyroidism, which requires treatment.
• Hashimoto's disease: This is an autoimmune disease that causes inflammation of your thyroid gland. Some people with Hashimoto's disease develop a compensatory increase in the thyroid gland's size. This type of goiter usually gets better on its own over time. Some cases of Hashimoto’s disease require treatment with thyroid hormone.
• Thyroid cancer: Cancer of the thyroid gland often enlarges your thyroid.
• Pregnancy: Human chorionic gonadotropin, a hormone that a person produces during pregnancy, can cause their thyroid to grow.
• Thyroiditis: Inflammation of the thyroid gland itself can cause your thyroid gland to grow. This can happen for several reasons.

Sporadic goiters, in most cases, have no known cause. In some cases, certain drugs can cause this type of goiter. For example, the drug lithium, which is used to treat certain mental health conditions, as well as other medical conditions, can cause this type of goiter.

How is goiter diagnosed?

Your healthcare provider usually diagnoses goiter when they perform a physical examination and feel that you have an enlarged thyroid. However, the presence of a goiter indicates that there’s an issue with your thyroid gland. They’ll need to figure out what the issue is.

Your provider can use several tests to diagnose and evaluate goiter, including the following:

• Physical exam: Your provider may be able to tell if your thyroid gland is enlarged by feeling your neck area for nodules and signs of tenderness.
• Thyroid blood test: This blood test measures thyroid hormone levels, which reveal if your thyroid is working properly.
• Antibody test: This blood test looks for certain antibodies that are produced in some forms of goiter. An antibody is a protein made by white blood cells. Antibodies help defend against invaders (for example, viruses) that cause disease or infection in your body.
• Thyroid ultrasound: Ultrasound is a procedure that sends high-frequency sound waves through body tissues. The echoes are recorded and transformed into video or photos. Your provider can “see” your thyroid to check its size and if it has nodules.
• Biopsy: A biopsy is the removal of a sample of tissue or cells to be studied in a laboratory. You may need a thyroid biopsy if there are large nodules in your thyroid gland. A biopsy is taken to rule out cancer.
• Thyroid uptake and scan: This imaging test provides information on the size and function of your thyroid. In this test, a small amount of radioactive material is injected into a vein to produce an image of your thyroid on a computer screen. Providers don’t order this test very often, since it’s only useful in certain circumstances.
• CT scan or MRI (magnetic resonance imaging) of your thyroid: If the goiter is very large or spreads into your chest, a CT scan or MRI is used to measure the size and spread of the goiter.

Do goiters go away on their own?

A simple goiter may happen for only a short time and may go away on its own without treatment.

Many goiters, such as multinodular goiter, are associated with normal levels of thyroid hormone. These goiters usually don’t require any specific treatment after your healthcare provider has diagnosed it. However, you may be at risk of developing hypothyroidism or hyperthyroidism in the future.

If you have an enlarged thyroid gland, it’s still important to see your healthcare provider since goiters have multiple possible causes — some of which require treatment.

How is goiter treated?

Treatment for goiter depends on how large your thyroid has grown, symptoms and what caused it. Treatments include:

• No treatment/"watchful waiting": If the goiter is small and isn’t bothering you, your healthcare provider may decide that it doesn’t need to be treated. However, they’ll carefully monitor your thyroid for any changes.
• Medications: Levothyroxine (Levothroid®, Synthroid®) is a thyroid hormone replacement therapy. Your provider will likely prescribe it if the cause of the goiter is an underactive thyroid (hypothyroidism). Other medications are prescribed if the cause of the goiter is an overactive thyroid (hyperthyroidism). These drugs include methimazole (Tapazole®) and propylthiouracil. Your provider might prescribe aspirin or a corticosteroid medication if the goiter is caused by inflammation.
• Radioactive iodine treatment: This treatment, used in cases of an overactive thyroid gland, involves taking radioactive iodine orally. The iodine goes to your thyroid gland and kills thyroid cells, which shrinks the gland. After radioactive iodine treatment, you’ll likely need to take thyroid hormone replacement therapy for the rest of your life.
• Surgery: Your provider may recommend surgery to remove all or part of your thyroid gland (thyroidectomy). You may need surgery if the goiter is large and causes problems with breathing and swallowing. Surgery is also sometimes used to remove nodules. Surgery must be done if cancer is present. Depending on the amount of thyroid gland removed, you may need to take thyroid hormone replacement therapy for the rest of your life.

How can I prevent goiter?

A goiter caused by iodine deficiency (simple goiter) is generally the only type of goiter you can prevent. Consuming a diet that includes fish, dairy and a healthy amount of iodized table salt prevents these types of goiters. Iodine supplements and other supplements are generally not recommended and may do more harm than good.

What is the prognosis (outlook) for goiter?

The prognosis (outlook) for goiter depends on its type and what caused it.

Simple goiter has a good prognosis. If your thyroid continues to enlarge, it may compress the surrounding structures and may cause difficulty in breathing and swallowing and hoarseness.

If the goiter is a sign of another thyroid disease like Graves’ disease or Hashimoto’s disease, the prognosis depends on the underlying cause of thyroid enlargement.

When should I see my healthcare provider about goiter?

Regardless of the cause, it’s important to see your healthcare provider regularly (at least annually) if you’ve been diagnosed with goiter so they can monitor it.

If you develop new symptoms, talk to your healthcare provider.

A note from Cleveland Clinic

Your thyroid is an important gland in your endocrine system that affects many aspects of your body. If it becomes enlarged, it may be a sign of an underlying thyroid disease. The good news is that goiter is treatable and sometimes goes away on its own. If you notice a lump in the front of your neck, talk to your healthcare provider. They can determine if it’s goiter and the underlying cause.