Goiter

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Goiter

Goiter is a condition where your thyroid gland gets abnormally enlarged. Your thyroid is a butterfly-shaped gland which is located at the base of the neck just below the Adam’s apple. Goiters are generally painless, but if it gets too large, it can make it hard for you to swallow or breathe.

Generally, lack of iodine is the most common cause of goiters. In places such as the United States, where the use of iodized salt is quite common, a goiter is mostly caused by over or underproduction of thyroid hormones.

Treatment can vary depending on the size of the goiter, the symptoms as well as the cause. Since small goiters are not noticeable and don’t cause problems, they generally don’t need any treatment.

Symptoms

The primary symptom of a goiter is generally a noticeable swelling in the neck. If you have nodules on your thyroid, they might range in size from very small to very large. The presence of nodules might also increase the appearance of swelling.

Some other symptoms include the following:

  • Difficulty in swallowing or breathing
  • Coughing
  • Dizziness when you raise your arm above the head
  • Hoarseness in your voice

Causes & risk factors

The most common cause of goiters is iodine deficiency. Iodine is important to help the thyroid produce thyroid hormones. When you don’t have enough iodine, the thyroid needs to work extra hard to make thyroid hormone, which can cause the gland to grow larger.

There might also be a few other causes which include:

  • Graves’ disease – Graves’ disease is a condition that occurs when your thyroid produces more thyroid hormone than normal. This is also known as hyperthyroidism. The excess production of hormones can make the thyroid increase in size.
  • Inflammation – Some people develop thyroiditis, an inflammation of the thyroid which can lead to a goiter.
  • Hashimoto’s thyroiditis – Hashimoto’s thyroiditis is a condition, which predisposes the thyroid not being able to produce enough thyroid hormone. This leads to hypothyroidism. The low thyroid hormone can cause the pituitary gland to create more thyroid-stimulating hormone, which can cause the thyroid to get enlarged.
  • Nodules – Solid or fluid-containing cysts can appear on the thyroid, causing it to swell. These nodules are generally noncancerous.
  • Thyroid cancer – Cancer can affect the thyroid, which can lead to swelling on one side of the gland. However, thyroid cancer is not as common as the formation of benign nodules.
  • Pregnancy – Sometimes pregnancy can also cause the thyroid to get larger.

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You are more likely to have a goiter if you:

  • Have a family history of thyroid cancer, nodules, and any such problems that affect the thyroid.
  • Have a condition that can decrease the iodine in your body.
  • Don’t get enough iodine in your diet.
  • Are female- Women generally a higher risk for this condition than men.
  • Are over 40 years of age- Aging can also affect the health of your thyroid.
  • Are pregnant or going through menopause- These risk factors are not understood easily, but pregnancy and menopause can trigger problems in the thyroid.
  • Have undergone radiation therapy in the neck or chest area. Radiation can change the way the thyroid is able to function.

Types of Goiters

Since there are many things that can cause your thyroid to swell, there are also multiple types of goiters. Some of them include:

  • Simple goiters – They occur when your thyroid gland is unable to make enough hormones. To make up for this, your thyroid can grow larger.
  • Endemic goiters – Also termed as colloid goiters, this is caused by a lack of iodine in your diet. Your thyroid uses iodine to create its hormones. In countries where iodine is added to table salt, lesser people get this kind of goiter.
  • Multinodular goiters – These occur when lumps called nodules grow in your thyroid.
  • Sporadic or nontoxic goiters – These types of goiters generally have no known cause. Certain drugs or medical conditions may trigger them.

 

When a goiter is linked to hyperthyroidism, it is described as toxic. This means that your thyroid makes too much thyroid hormone. A goiter which is non-toxic doesn’t lead to hyperthyroidism or hypothyroidism.

Diagnosis

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

Diagnosing a goiter can also involve:

A hormone test

Blood tests can help in determining the number of hormones produced by your thyroid and pituitary glands. However, if your thyroid is underactive, then the level of thyroid hormone is going to be low.

An antibody test

Some causes of goiter can involve the production of abnormal antibodies. A blood test should help in confirming the presence of these antibodies.

Ultrasonography

In this method, a wand-like device, known as a transducer, is held over your neck. Sound waves then bounce through your neck and back and form images on a computer screen. These images are able to reveal the size of your thyroid gland and whether it contains any nodules that your doctor might not have felt.

A thyroid scan

During this method, a radioactive isotope is injected into the vein on the inside of the elbow. While you lie on a table with your head stretched backward, a special camera is able to produce an image of your thyroid on a computer screen. The time required for the procedure generally varies, depending on how long it takes the isotope to reach the thyroid gland. Thyroid scans are able to provide information about the nature and size of your thyroid, but they are more invasive, time-consuming as well as expensive than ultrasound tests.

A biopsy

During a biopsy, an ultrasound is used to guide a needle into your thyroid to obtain a tissue or fluid sample, which is sent to the lab for testing.

Treatment

Depending on the cause of your goiter, and how serious it is, your doctor can suggest the following treatments:

Medication

If you are suffering from hypothyroidism, your doctor can prescribe a thyroid hormone replacement medication. For goiters caused by inflammation, you might take aspirin or corticosteroids.

Surgery

Surgery involves your surgeon removing all or part of your thyroid. Afterward, you might need to take thyroid hormone medications for the rest of your life.

Radioactive iodine

You can take this in a pill to treat an overactive thyroid. It helps by killing cells to shrink the thyroid. From then on, you will probably need to keep taking hormone drugs.

Complications

Although small goiters that don’t cause any physical or cosmetic problems are not a concern, large goiters can lead to multiple complications, such as difficulty in breathing or swallowing.

Goiters resulting 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 as well as trouble sleeping.

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