Goiter

Condition

What is a goiter?

A goiter is an enlarged thyroid gland. The thyroid gland is a butterfly-shaped gland that is normally located in the lower front of your neck, makes thyroid hormones that are essential for good health and energy. When your thyroid gland is enlarged, it can produce too much (overactive), too little (underactive), or just enough thyroid hormone. Several factors can lead to the enlargement of the thyroid gland. The most common cause of goiter outside of the United States is a lack of iodine in the diet. Iodine is a substance in food (iodized salt and seafood) that the thyroid uses to make thyroid hormones. However, a lack of iodine is not common in the United States because iodine is added to salt and many foods.

What do thyroid hormones do?Thyroid gland

Thyroid hormones travel from your thyroid gland through the blood to all parts of your body. They control how your body uses food for energy, and help all your organs work well. Thyroid hormones affect your metabolism rate, which means how fast or slow your brain, heart, muscles, liver, and other parts of your body work.

If your metabolism is too fast or too slow, you won't feel well. For example, if you don't have enough thyroid hormone and your metabolism slows down, you might feel tired and cold. You may not burn off calories as quickly and you can gain weight. On the contrary, if you have too much thyroid hormone, it can accelerate your body’s metabolism causing weight loss without trying, making you feel tired, upset, or having a fast heartbeat and/or frequent bowel movements.  

What are the symptoms of a goiter?

You can have a goiter but have no symptoms at all, other than having some swelling at the lower part of your neck. Due to the swelling, some people also may have:

  • Tightness in the throat
  • Coughing
  • Hoarseness
  • Trouble swallowing
  • Trouble breathing

If your goiter is making your thyroid underactive or overactive, you may also have a wide range of symptoms, from fatigue and weight gain to involuntary weight loss, irritability, and sleep disorders. 

What causes a goiter?

In the United States, the most common causes of an enlarged thyroid gland (goiter) are:

Less common causes include a hormone made during pregnancy that increases thyroid hormone production, inflammation of the thyroid, or thyroid cancer. A goiter also can be present in a newborn if his or her thyroid gland doesn't work properly before birth.

What factors increase the risk of a goiter?

Risk factors include:

  • Being a woman (four times more often in women than in men) 
  • Being over 40 years old 
  • Being pregnant or in menopause
  • Having a family history of autoimmune disease or goiter
  • Having been exposed to radiation as a child or having had radiation treatment to your neck or chest
  • Having a diet low in iodine
  • Some medicines also increase the risk of goiter. [e.g. amiodarone (heart drug) and lithium (psychiatric drug)]

How is a goiter diagnosed?

Everyone can get a goiter at any time in their lives. A goiter is often found during a physical exam when your doctor feels swelling in your neck. Your doctor also may use other tests to find the cause of the goiter and to see how troublesome it is, such as:

  • Hormone tests to show whether your thyroid gland is underactive (too little hormone) or overactive (too much hormone) 
  • Antibody tests for Hashimoto disease and Graves' disease (conditions in which your immune system attacks your thyroid) 
  • Ultrasound to see the size of your thyroid and whether there are nodules
  • A thyroid scan with a radioactive substance to take a picture of your thyroid, especially if your thyroid is overactive (not safe if you are pregnant or breastfeeding) 
  • Other scans (CT or MRI) of the neck to check your windpipe
  • A biopsy (using an ultrasound and a needle to get a sample of your thyroid for testing) 

If you notice a lump or swelling on your neck, schedule an appointment with your endocrinologist to evaluate your thyroid gland.

What is the treatment for a goiter?

Treatment depends on the cause of the goiter, its size, and your symptoms. The goal of treatment is to normalize the level of thyroid hormones in the blood (if abnormal), reduce the size of your thyroid, relieve pressure symptoms, or reduce the risk of thyroid cancer. If your goiter is small and your thyroid is making normal amounts of thyroid hormone, your doctor might observe the goiter over time instead of starting treatment right away.

Possible treatments include:
  • Medicines to normalize thyroid hormone levels in the blood if you are making too little (underactive thyroid) or too much (overactive thyroid)
  • Radioactive iodine for overactive thyroid. If you are pregnant, planning to become pregnant in the near future, or breastfeeding, this is not the right treatment for you.
  • Surgery is rarely used. However, removal of all or part of the thyroid gland might be recommended for a large goiter, for one causing breathing or swallowing problems, for a hyperactive thyroid, for nodules, or for thyroid cancer.

Questions to ask your doctor

  • What is causing my goiter?
  • What are my options for treatment?
  • What are the risks and benefits of each treatment option?
  • How long will I need treatment?

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