Goiter Introduction The thyroid gland is located at the base of your neck. If the gland becomes abnormally enlarged, it is called a goiter. Goiters usually do not cause pain. But a large goiter could cause a cough. It could make it hard for you to swallow or breathe. This reference summary explains goiters. It covers symptoms and causes of the condition, as well as treatment options. Anatomy of the Thyroid Gland The thyroid is a gland located at the front of your neck. It sits beneath your voice box, also called the larynx. The thyroid is above your collarbone and just below your Adam's apple. The thyroid has 2 parts and is shaped like a butterfly. These parts are called lobes. The thyroid gland makes several hormones that the body needs in order to be healthy, including thyroid hormone and calcitonin. Thyroid hormones affect: Heart rate. Blood pressure. Body temperature. Body weight. Calcitonin helps the body have a healthy level of calcium. The thyroid gland needs iodine to function normally. Iodine is an element that is not made by the body. It is found in various foods. A goiter is an enlarged thyroid. Thyroid Gland 1
Symptoms Not all goiters cause symptoms. When signs and symptoms of a goiter do happen, they may include: A visible swelling at the base of your neck. It usually takes several years for a goiter to become noticeable. A tight feeling in your throat. Other goiter symptoms include: Coughing. Hoarseness. Swallowing or breathing problems. Small goiters that don't cause physical or cosmetic problems aren't a concern. But large goiters can make it hard for you to breathe or swallow. They can cause a cough and hoarseness. Goiters that result from thyroid conditions can cause symptoms such as: Fatigue. Weight gain or weight loss. Irritability. Trouble sleeping. If you have symptoms of a goiter, contact your health care provider. Causes There are several possible causes of goiters. A goiter can happen without a known cause. The most common cause of goiters worldwide is a lack of iodine in peoples diets. Iodine is needed for the thyroid gland to make hormones. Iodine is mostly found in seawater and in the soil in coastal areas. Goiters may happen to people who live in places where the water and soil do not have enough iodine. In places where iodized salt is added to table salt and many food products, most people get enough iodine from their diet to prevent goiters. 2
In places where iodized salt is common, a goiter is usually caused by a thyroid disorder. Conditions that can affect the amount of hormones the thyroid gland makes include: Hyperthyroidism. Hypothyroidism. Hyperthyroidism is also called overactive thyroid. It happens when your thyroid gland produces too much thyroid hormone. Symptoms include: Anxiety. Bulging eyes. Chest pain. Diarrhea. Weight loss. Hypothyroidism is also called underactive thyroid. It happens when your thyroid gland doesn t produce enough thyroid hormone. Symptoms include: Constipation. Dry skin. Sensitivity to cold. Weight gain. Having a goiter doesn t always mean that your thyroid gland isn t working normally. Even when it is enlarged, it may make a normal amount of hormones. But a goiter may be a sign that your thyroid gland is making too many or too few hormones. Conditions that may cause an overactive or underactive thyroid gland include: Graves disease. Hashimoto s disease. 3
In Graves' disease, antibodies produced by your immune system mistakenly attack your thyroid gland. This causes the thyroid to swell and make too much thyroid hormone. Hashimoto's disease is an autoimmune disorder. It damages your thyroid so that it produces too little thyroid hormone. A single thyroid nodule may develop in one part of your thyroid gland. This can cause the gland to become larger. Most nodules are noncancerous, or benign, and do not lead to cancer. A nodule is a growth or lump. Multinodular goiter is a condition where several solid or fluid-filled lumps nodules develop in both sides of your thyroid. This causes the gland to become larger. Goiters may also be caused by: Certain medicines. Infections. Inflammation. Thyroid cancer. Smoking cigarettes. Certain foods may cause goiters. These include: Soy. Peanuts. Vegetables in the broccoli family. Risk Factors People with certain risk factors are more likely than others to develop a goiter. A risk factor is something that may increase the chance of developing a condition. Having one or more risk factors does not mean that a person will get a goiter. It is also possible to develop a goiter without any risk factors. Goiters can affect anyone. They may be present at birth, or they may happen at any time throughout life. But they are most common after age 40. Your chances of developing a goiter increase with age. Other common risk factors for goiter include: Being female. Because women are more prone to thyroid disorders, they're also more likely to develop goiters. Medical history. A personal or family history of an autoimmune disease increases your risk. 4
Pregnancy and menopause. For reasons that aren't entirely clear, thyroid problems are more likely to happen during pregnancy and menopause. Radiation exposure. Your risk increases if you've had radiation treatments to your neck or chest area or if you've been exposed to radiation in a nuclear test, nuclear accident or nuclear facility. Diagnosis Your health care provider will perform a physical exam. He or she will ask questions about your personal and family medical history. Your health care provider may discover an enlarged thyroid gland simply by feeling your neck and having you swallow during a routine physical exam. They may also be able to feel the presence of nodules. Diagnosing goiter may also involve: Blood tests. Hormone tests. Ultrasonography. A thyroid scan. A biopsy. During ultrasonography, a wand-like device is held over your neck. Sound waves bounce through your neck and back, forming images on a computer screen. The images reveal the size of your thyroid gland and whether the gland contains nodules. During a thyroid scan, a radioactive isotope is injected into a vein. A camera produces an image of your thyroid gland on a computer screen. A biopsy is the removal of a tissue or fluid sample for testing. Treatment Treatment for a goiter depends on: The size of the goiter. Your signs and symptoms. The underlying cause. 5
Treatment may not be needed if your goiter is small and if it doesn t cause problems. If your thyroid is functioning normally, your health care provider may suggest observation. This is also known as monitoring or watching and waiting. If you have hypothyroidism, thyroid hormone replacement therapy will help treat the symptoms of hypothyroidism. Often, the size of the goiter will also decrease. To treat inflammation of your thyroid gland, your health care provider may suggest aspirin or a corticosteroid medication. Aspirin is a drug that reduces pain, fever, inflammation and blood clotting. Corticosteroids are steroid hormones. They reduce inflammation and affect the immune system. For goiters caused by hyperthyroidism, you may need medications to normalize your hormone levels. Your health care provider may recommend surgery if: You have a large goiter that is uncomfortable. Your goiter causes breathing or swallowing problems. Your goiter is caused by nodules. Surgery is also the treatment for thyroid cancer. In some cases, radioactive iodine is used to treat an overactive thyroid gland. It is taken orally and reaches your thyroid gland through your bloodstream. This destroys extra thyroid cells. The treatment makes the goiter smaller. But it may also cause an underactive thyroid gland. Summary The thyroid gland is located at the base of your neck. If the gland becomes abnormally enlarged, it is called a goiter. Goiters usually do not cause pain. But a large goiter can cause a cough. It could make it hard for you to swallow or breathe. 6
Not all goiters cause symptoms. When signs and symptoms of a goiter do happen, they may include: A visible swelling at the base of your neck. A tight feeling in your throat. Coughing. Hoarseness. Swallowing or breathing problems. A goiter can happen without a known cause. It can happen if the thyroid gland doesn t make enough thyroid hormone. This can happen if there is not enough iodine in your diet. The thyroid gland grows larger to make up for the shortage of the hormone. The most common cause of goiters worldwide is a lack of iodine in peoples diets. Iodine is needed so that the thyroid gland can make hormones. In places where iodized salt is common, a goiter is more often caused by the production of too many or too few thyroid hormones. Goiters can affect anyone. They may be present at birth, or they may happen at any time throughout life. But they are most common after age 40. Your chances of developing a goiter increase with age. Treatment for a goiter depends on: The size of the goiter. Your signs and symptoms. The underlying cause. To treat inflammation of your thyroid gland, your health care provider may suggest aspirin or a corticosteroid medication. For goiters caused by hyperthyroidism or hypothyroidism, you may need medications to normalize your hormone levels. Your health care provider may recommend surgery if: You have a large goiter that is uncomfortable. Your goiter causes breathing or swallowing problems. Your goiter is caused by nodules. Surgery is also the treatment for thyroid cancer. Treatment may not be needed if your goiter is small and if it doesn t cause problems. Talk to your health care provider about what treatment is right for you. 7