An Overview of Goiters

The term goiter is used to describe an abnormally enlarged thyroid gland. A normal thyroid gland is not visible from the outside. With goiter, the thyroid enlarges enough that you may have a visible lump or bulge in your neck. Conditions related to hyperthyroidism or hypothyroidism are the most common causes, though goiters sometimes occur for reasons unrelated to an underlying thyroid disorder.

In some cases, a goiter may not be visible and may cause no symptoms at all. When symptoms are present, they can include:

• A visible lump or swelling in the neck area
• A lump that is tender to the touch
• A feeling of fullness in the neck
• A feeling of pressure on your windpipe or esophagus
• Difficulty swallowing or a feeling that food is stuck in your throat
• Shortness of breath or difficulty breathing, especially at night
• Coughing
• Hoarseness
• Discomfort when wearing turtlenecks, ties, and scarves

Symptoms of hypothyroidism or hyperthyroidism may also accompany the goiter.

A goiter can occur for a number of reasons, including:

• Graves' disease: This autoimmune disease causes your thyroid gland to produce too much thyroid stimulating hormone (TSH), which makes the thyroid swell. Graves' disease is the most common cause of hyperthyroidism.
• Hashimoto's disease: Hashimoto's disease is an autoimmune disorder that causes your thyroid to produce too little thyroid hormone. In response, your pituitary gland produces more TSH to stimulate the thyroid, which then results in an enlarged gland.
• Thyroid nodules: Solid or fluid-filled lumps, called nodules, can develop in one or both sides of your thyroid gland, resulting in overall enlargement of the gland.
• Thyroid cancer: Certain types of thyroid cancer can cause generalized swelling of the gland. These include infiltrating papillary thyroid cancer, lymphoma, and anaplastic thyroid cancer.  
• Pregnancy: Human chorionic gonadotropin (HCG), a hormone produced during pregnancy, may cause your thyroid gland to enlarge slightly. This often resolves on its own once the baby is born.
• Thyroiditis: Thyroiditis is an inflammatory condition that can cause pain and swelling in the thyroid and over- or under-production of thyroxine (the hormone whose release is stimulated by TSH). Thyroiditis can occur in the postpartum period or as the result of a viral infection.
• Iodine deficiency: Iodine is essential for the production of thyroid hormones, and a lack of iodine in the diet can result in an enlarged thyroid. Iodine deficiency is often found in developing countries, but it's uncommon in the United States and other countries where iodine is routinely added to table salt and other foods.

Women are more prone to thyroid disorders than men and, therefore, more likely to develop a goiter. Goiters are also more common after age 40.

Your doctor may detect a goiter visually or manually during a clinical examination. Getting an accurate diagnosis may also require:

• Blood tests: These can determine the levels of hormones produced by your thyroid and pituitary glands. If your thyroid is underactive, the level of thyroid hormone will be low, while your TSH level will be elevated.
• An antibody test: Some causes of a goiter are due to the presence of abnormal antibodies.
• Imaging tests: Computed tomography (CT) scans, magnetic resonance imaging (MRIs), and ultrasounds can reveal the size of your thyroid and whether the gland contains nodules that your doctor may not have been able to feel.
• A thyroid scan: During a thyroid scan, a radioactive isotope is injected into the vein on the inside of your elbow. You then lie on a table with your head stretched backward while a special camera produces an image of your thyroid on a computer screen.
• A biopsy: If thyroid cancer is suspected, you may undergo a fine-needle aspiration biopsy. In this case, ultrasound is used to guide a needle into your thyroid to obtain a tissue or fluid sample for testing.

If you have a small goiter with no symptoms and no other underlying thyroid disease, your doctor may recommend periodic monitoring with no treatment. In most cases, however, treatment is necessary and tailored to the underlying cause of the goiter.

Treatments include:

• Thyroid hormone replacement drugs: If your goiter is associated with hypothyroidism, treatment with thyroid hormone replacement drugs such as Synthroid (levothyroxine) may slow or stop the growth of the gland. It may not, however, shrink your goiter.
• Antithyroid drugs: If your goiter is associated with hyperthyroidism due to Graves' disease, your doctor may prescribe propylthiouracil or Tapazole (methimazole). These medications stop the thyroid from producing T3 and T4 hormones and may slow or stop the gland's enlargement and shrink the goiter.
• Radioactive iodine treatment (RAI): With this treatment, you are given a dose of radioactive iodine, which shrinks the thyroid gland.
• Thyroidectomy: If your goiter continues to grow while on thyroid treatment, symptoms are debilitating, or you feel the goiter is cosmetically undesirable, your doctors will likely recommend surgery to remove part or all of the thyroid.
• Iodine replacement: If your goiter is due to an iodine deficiency, you will be given iodine supplementation. This will usually slow or stop growth, and it may reduce the size of the goiter somewhat, but often not completely.

While goiters can be uncomfortable and, in some cases, quite noticeable, they are rarely dangerous in and of themselves. However, because they are most often a sign of an underlying thyroid condition, it is important to call your doctor if you notice a swelling in the front of your neck so it can be promptly evaluated.