Goiter

Goiter is a condition where your thyroid gland grows larger. Your entire thyroid can get larger, or you may develop one or more small lumps called thyroid nodules.

Your thyroid gland is a small, butterfly-shaped organ in your neck just below your Adam’s apple. It produces the hormones thyroxine (T4) and triiodothyronine (T3). These hormones play a role in your:

• Metabolism
• Body temperature
• Blood pressure
• Pulse and heart rate

A goiter can occur when your thyroid makes too much hormone (hyperthyroidism), too little hormone (hypothyroidism) or a normal amount of hormone. Because thyroid hormones affect many parts of your body, issues with your thyroid can lead to health problems.

Goiter has several causes, but iodine deficiency is the most common cause. You may or may not need treatment for goiter depending on its cause, size and if it causes symptoms.

Types of thyroid goiter

Goiter can be classified based on how they grow and if thyroid hormone levels are high, low or normal.

Types of goiters based on how the thyroid enlarges include:

• Simple (diffuse) goiter: This type happens when your entire thyroid gland swells and feels smooth to the touch.
• Nodular goiter: This type happens when a solid or fluid-filled lump called a nodule forms within your thyroid and makes it feel lumpy.
• Multinodular goiter: This type happens when there are many lumps (nodules) within your thyroid.

Types of goiter based on thyroid hormone levels include:

• Toxic goiter: Your thyroid is enlarged and produces too much thyroid hormone.
• Nontoxic goiter: The enlarged thyroid makes normal amounts of thyroid hormone.

Healthcare providers may combine these descriptions to name specific types of goiters. For example, a toxic multinodular goiter occurs when you have multiple thyroid nodules that produce too much thyroid hormone.

Symptoms of goiter

The size of a goiter can be very small and barely noticeable. It can also grow large and cause symptoms due to pressing on your airway or voice box.

The symptoms of goiter include:

• A lump in the front of your neck
• A feeling of tightness in your throat area
• Coughing
• Hoarseness
• Difficulty swallowing
• Wheezing

Most thyroid goiters are painless, but if you have an inflamed thyroid gland, it can be painful.

Goiter causes

The most common cause of goiter worldwide is 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 larger as it tries to produce enough thyroid hormone. Having a goiter due to iodine deficiency isn’t common in the U.S. because many people put iodized salt in their food.

Your thyroid may grow larger when something affects how it works. It may enlarge as it tries to make more hormones, responds to inflammation or changes because of abnormal cell growth.

Other causes of goiter include:

• Hashimoto’s disease: This is an autoimmune disease that causes inflammation of your thyroid gland. Over time, the inflammation can cause your thyroid to grow larger and form a goiter.
• Graves’ disease: Graves’ disease is an autoimmune disease where your immune system attacks your thyroid, causing it to grow larger. Graves’ disease also causes you to have high thyroid hormone levels.
• Thyroid cancer: Cancer of the thyroid gland often enlarges your thyroid.
• Pregnancy: Human chorionic gonadotropin, a hormone you make during pregnancy, can cause your thyroid to grow.
• Thyroiditis: Inflammation of the thyroid gland itself can cause your thyroid gland to grow. This condition can happen for several reasons.

Risk factors

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

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

Taking medications like amiodarone and lithium can also increase your risk.

A goiter caused by iodine deficiency is generally the only type of goiter you can prevent. A diet that includes fish, dairy and a healthy amount of iodized table salt can help prevent these types of goiters.

Complications

Goiter doesn’t usually cause serious problems. You may feel self-conscious if the swelling in your neck is noticeable. A large goiter can make it hard to breathe, swallow or talk. Changes in thyroid hormone levels can also cause problems, such as an irregular heartbeat, weak bones or other health complications.

How doctors diagnose this condition

Your healthcare provider can usually diagnose a goiter during a physical exam by feeling your neck for an enlarged thyroid. A goiter is a sign that something is affecting your thyroid. They’ll need to figure out what the issue is.

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

• Thyroid blood test: This blood test measures thyroid-stimulating hormone (TSH) levels, which tell your thyroid how much hormone to make.
• Antibody test: This blood test looks for certain antibodies that are produced in some forms of goiter. Antibodies help defend against invaders that cause disease or infection in your body.
• Thyroid ultrasound: Ultrasound helps your provider see your thyroid’s size and if it has nodules.
• Biopsy: A biopsy removes a small sample of tissue or cells to be examined under a microscope. Your healthcare provider may recommend a thyroid biopsy to check a thyroid nodule. A biopsy can also check for 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.
• CT scan or MRI: 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.

How is it 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 not bothering you, your healthcare provider may decide that it doesn’t need to be treated. They’ll 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 is hypothyroidism. Other medications are prescribed if the cause is hyperthyroidism. These drugs include methimazole (Tapazole®) and propylthiouracil. Your provider might prescribe a corticosteroid medication if inflammation causes the goiter.
• Radioactive iodine therapy: This treatment 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. It 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.

Can thyroid goiters go away?

Some may shrink or go away depending on the cause. For example, a goiter due to thyroid inflammation may get smaller as the inflammation improves. A goiter caused by iodine deficiency may improve after getting enough iodine. Talk to your healthcare provider about the chances of it going away — they know your situation best.

What can I expect if I have this condition?

What you can expect depends on the type of goiter and what is causing it. Talk to your healthcare provider about what you can expect based on your specific condition.

Many simple goiters have a good outlook and may not cause problems. But if your thyroid continues to grow, it can put pressure on nearby areas and make it harder to breathe or swallow.

If the goiter is a sign of another thyroid disease, like Graves’ disease or Hashimoto’s disease, what you can expect depends on treating the underlying cause of the enlarged thyroid.

It’s important to see your healthcare provider regularly so they can monitor your thyroid. Talk to your healthcare provider if you notice new symptoms.