Goiter

Goiter is an enlarged thyroid gland. The thyroid gland sits at the base of the front of the neck. The gland produces hormones that regulate mood, body temperature, pulse rate, and digestion. Most goiters are painless and are not a cause for serious concern. Goiters and conditions that cause goiters can be treated if necessary.

CAUSES

Common causes of goiter include:

  • Graves disease (causes too much hormone to be produced [hyperthyroidism]).

  • Hashimoto's disease (causes too little hormone to be produced [hypothyroidism]).

  • Thyroiditis (inflammation of the thyroid sometimes caused by virus or pregnancy).

  • Nodular goiter (small bumps form; sometimes called toxic nodular goiter).

  • Pregnancy.

  • Thyroid cancer (very few goiters with nodules are cancerous).

  • Certain medications.

  • Radiation exposure.

  • Iodine deficiency (more common in developing countries in inland populations).

RISK FACTORS

Risk factors for goiter include:

  • A family history of goiter.

  • Female gender.

  • Inadequate iodine in the diet.

  • Age older than 40 years.

SYMPTOMS

Many goiters do not cause symptoms. When symptoms do occur, they may include:

  • Swelling in the lower part of the neck. This swelling can range from a very small bump to a large lump.

  • A tight feeling in the throat.

  • A hoarse voice.

Less commonly, a goiter may result in:

  • Coughing.

  • Wheezing.

  • Difficulty swallowing.

  • Difficulty breathing.

  • Bulging neck veins.

  • Dizziness.

When a goiter is the result of hyperthyroidism, symptoms may include:

  • Rapid or irregular heart beat.

  • Sicknessin your stomach (nausea).

  • Vomiting.

  • Diarrhea.

  • Shaking.

  • Irritable feeling.

  • Bulging eyes.

  • Weight loss.

  • Heat sensitivity.

  • Anxiety.

When a goiter is the result of hypothyroidism, symptoms may include:

  • Tiredness.

  • Dry skin.

  • Constipation.

  • Weight gain.

  • Irregular menstrual cycle.

  • Depressed mood.

  • Sensitivity to cold.

DIAGNOSIS

Tests used to diagnose goiter include:

  • A physical exam.

  • Blood tests, including thyroid hormone levels and antibody testing.

  • Ultrasonography, computerized X-ray scan (computed tomography, CT) or computerized magnetic scan (magnetic resonance imaging, MRI).

  • Thyroid scan (imaging along with safe radioactive injection).

  • Tissue sample taken (biopsy) of nodules. This is sometimes done to confirm that the nodules are not cancerous.

TREATMENT

Treatment will depend on the cause of the goiter. Treatment may include:

  • Monitoring. In some cases, no treatment is necessary, and your doctor will monitor yourcondition at regular check ups.

  • Medications and supplements. Thyroid medication (thyroid hormone replacement) is available for hyperthroidism and hypothyroidism.

  • If inflammation is the cause, over-the-counter medication or steroid medication may be recommended.

  • Goiters caused by iodine deficiency can be treated with iodine supplements or changes in diet.

  • Radioactive iodine treatment. Radioactive iodine is injected into the blood. It travels to the thyroid gland, kills thyroid cells, and reduces the size of the gland. This is only used when the thyroid gland is overactive. Lifelong thyroid hormone medication is often necessary after this treatment.

  • Surgery. A procedure to remove all or part of the gland may be recommended in severe cases or when cancer is the cause. Hormones can be taken to replace the hormones normally produced by the thyroid.

HOME CARE INSTRUCTIONS

  • Take medications as directed.

  • Follow your caregiver's recommendations for any dietary changes.

  • Follow up with your caregiver for further examination and testing, as directed.

PREVENTION

  • If you have a family history of goiter, discuss screening with your doctor.

  • Make sure you are getting enough iodine in your diet.

  • Use of iodized table salt can help prevent iodine deficiency.