An Overview of Goiters

A goiter is 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 (excess thyroid function) or hypothyroidism (low thyroid function) are the most common causes, though goiters sometimes occur for reasons unrelated to an underlying thyroid disorder.

An autoimmune attack on the thyroid can cause a goiter.

Symptoms

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.

Causes

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

• Graves' disease: This autoimmune disease causes your thyroid gland to swell and produce too much thyroid hormone. Graves' disease is the most common cause of hyperthyroidism.
• Hashimoto's thyroiditis: Hashimoto's thyroiditis is due to the inflammation of the thyroid. It is usually temporary and resolves once the inflammation resolves.
• 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, a thyroid hormone. 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.

Risk Factors

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

Diagnosis

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 levels of thyroid hormones will be low, and your thyroid-stimulating hormone (TSH) level will be elevated. If your thyroid is overactive, the level of thyroid hormone will be high. This suppresses TSH, so it will be found in low levels in your blood.
• An antibody test: Some goiters are due to the presence of abnormal antibodies.
• Imaging tests: Ultrasounds can reveal the size of your thyroid and whether the gland contains nodules. Based on those results, further imaging may be needed, such as computed tomography (CT) scans or magnetic resonance imaging (MRIs).
• A thyroid scan: For this test, you take a pill containing radioactive iodine. You then return a few hours later and a special camera produces an image of your thyroid on a computer screen. This test is indicated only if your TSH is suppressed.
• A biopsy: If the goiter has nodules, 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 to be tested for thyroid cancer.

Treatment

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 might 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 thyroid hormones and may slow or stop the gland's enlargement and shrink the goiter.
• Radioactive iodine treatment (RAI): If your TSH is suppressed, this indicates that the thyroid gland is overactive, and RAI may be indicated. 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 may 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.

A Word From Verywell

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.