Goiter

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Goiter is an abnormal enlargement of your thyroid gland. Your thyroid is a butterfly-shaped gland located at the base of your neck just below your Adam’s apple. Although goiters are usually painless, a large goiter can cause a cough and make it difficult for you to swallow or breathe.

The most common cause of goiter worldwide is a lack of iodine in the diet

Symptoms

Not all goiters cause signs and symptoms. When signs and symptoms do occur they may include:

  • A visible swelling at the base of your neck
  • A tight feeling in your throat
  • Coughing
  • Hoarseness
  • Difficulty swallowing
  • Difficulty breathing

Causes

A number of factors can cause your thyroid gland to enlarge. Among the most common are:

  • Iodine deficiency. Iodine, which is essential for the production of thyroid hormones, is found primarily in seawater and in the soil in coastal areas.
  • Graves’ disease. Goiter can sometimes occur when your thyroid gland produces too much thyroid hormone (hyperthyroidism).
  • Hashimoto’s disease. Goiter can also result from an underactive thyroid (hypothyroidism)
  • Multinodular goiter. In this condition, several solid or fluid-filled lumps called nodules develop in both sides of your thyroid, resulting in overall enlargement of the gland.
  • Solitary thyroid nodules. In this case, a single nodule develops in one part of your thyroid gland.
  • Thyroid cancer. Thyroid cancer is far less common than benign thyroid nodules. Cancer of the thyroid often appears as an enlargement on one side of the thyroid.
  • Pregnancy. A hormone produced during pregnancy, human chorionic gonadotropin (HCG), may cause your thyroid gland to enlarge slightly.
  • Inflammation. Thyroiditis is an inflammatory condition that can cause pain and swelling in the thyroid.

Risk factors

Goiters can affect anyone. They may be present at birth and occur at any time throughout life, although they’re more common after age 40. Some common risk factors for goiter include:

  • A lack of dietary iodine. People living in areas where iodine is in short supply and who don’t have access to iodine supplements are at high risk of goiter.
  • Being female. Because women are more prone to thyroid disorders, they’re also more likely to develop goiters.
  • Your age. Your chances of developing a goiter increase with age.
  • Medical history. A personal or family history of autoimmune disease increases your risk.
  • Pregnancy and menopause. For reasons that aren’t entirely clear, thyroid problems are more likely to occur during pregnancy and menopause.
  • Certain medications. Some medical treatments, including immunosuppressants, antiretrovirals, the heart drug amiodarone and the psychiatric drug lithium increase your risk.
  • Radiation exposure. Your risk increases if you’ve had radiation treatments to your neck or chest area or you’ve been exposed to radiation in a nuclear facility, test or accident.

Complications

Small goiters that don’t cause physical or cosmetic problems aren’t a concern. But large goiters can make it hard to breathe or swallow and can cause a cough and hoarseness. Goiters that result from other conditions, such as hypothyroidism or hyperthyroidism, can be associated with a number of symptoms, ranging from fatigue and weight gain to unintended weight loss, irritability and trouble sleeping.

Tests and diagnosis

Your doctor may discover an enlarged thyroid gland simply by feeling your neck and having you swallow during a routine physical exam. In some cases, your doctor may also be able to feel the presence of nodules.

Diagnosing goiter may also involve:

  • A hormone test.
  • An antibody test.
  • Ultrasonography
  • A thyroid scan
  • biopsy.

Treatments and drugs

Goiter treatment depends on the size of the goiter, your signs and symptoms, and the underlying cause. Your doctor may recommend:

Observation

If your goiter is small and doesn’t cause problems, and your thyroid is functioning normally, your doctor may suggest a wait-and-see approach.

Medications

If you have hypothyroidism, thyroid hormone replacement with levothyroxine (Thyrox) will resolve the symptoms of hypothyroidism as well as slow the release of thyroid-stimulating hormone from your pituitary gland, often decreasing the size of the goiter. For inflammation of your thyroid gland, your doctor may suggest aspirin or a corticosteroid medication to treat the inflammation. For goiters associated with hyperthyroidism, you may need medications to normalize hormone levels.

Surgery

Removing all or part of your thyroid gland (total or partial thyroidectomy) is an option if you have a large goiter that is uncomfortable or causes difficulty breathing or swallowing, or in some cases, if you have nodular goiter causing hyperthyroidism. Surgery is also the treatment for thyroid cancer. You may need to take levothyroxine after surgery, depending on the amount of thyroid removed.

Radioactive iodine

In some cases, radioactive iodine is used to treat an overactive thyroid gland.

Lifestyle and home remedies

If your goiter is caused by your diet, these suggestions can help:

  • Get enough iodine. To ensure that you get enough iodine, use iodized salt or eat seafood or seaweed
  • Reduce iodine consumption. Although it’s uncommon, getting too much iodine sometimes leads to goiter. If excess iodine is a problem, avoid iodine-fortified salt, shellfish, seaweed and iodine supplements.

 

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