What Is Goiter?
The term goiter refers to any situation where your thyroid gland has become abnormally enlarged. A normal thyroid thyroid gland weighs about an ounce and is not visible externally.
But with goiter, the thyroid enlarges enough so that the change is detectable by ultrasound or x- rays, and in some cases, your neck may show a visible lump or bulge.
Goiter can occur in a number of situations:
- when your thyroid gland is producing too much thyroid hormone (hyperthyroidism)
- when your thyroid is not producing enough thyroid hormone (hypothyroidism)
- when you have an autoimmune thyroid disease—Graves’ disease or Hashimoto’s disease—that is causing an inflammatory reaction in your thyroid
- when you have a single or multiple thyroid nodules
- when you have underlying thyroid cancer
- when you are iodine deficient
Common Signs & Symptoms of Goiter
Signs of goiter include:
- neck enlargement
- visible lump or swelling in the neck area
Symptoms of goiter include:
- tenderness to the touch
- a feeling of fullness in the neck
- a feeling of pressure on your windpipe or your esophagus
- difficulty swallowing, or a feeling that food is stuk in your throat
- shortness of breath or difficulty breathing, especially at night
- coughing
- hoarseness
- discomfort with turtlenecks, ties, and scarves
Tests and Procedures to Diagnose Goiter
Detection of goiter is most often done visually or manually during a clinical examination by your physician. In some cases, goiter may be detected during imaging tests.
When goiter is detected, the next step is to evaluate the cause and determine what thyroid abnormality has triggered the enlargement. This evaluation will typically include key thyroid tests, including the TSH, Free T4, Free T3, and thyroid antibodies tests to look for Hashimoto’s (thyroid peroxidase antibodies/TPO) and Graves’ disease (thyroid stimulating immunoglobulins/TSI). Iodine levels may also be evaluated to check for iodine deficiency.
Your doctor may also order imaging tests such as ultrasound, MRI, CT scan, or a thyroid uptake scan, to evaluate the extent of goiter, to see whether it is affecting your breathing or swallowing, and determine if you have nodules.
Goiter Treatments
Treatment for goiter depends on the cause and the symptoms.
- If you have a small goiter with no symptoms and no other underlying thyroid disease, your doctor may recommend periodic monitoring with no treatment.
- If your goiter is due to an iodine deficiency, you will be given iodine supplementation. This will usually slow or stop growth, and may reduce the size of the goiter somewhat, but often not completely.
- If your goiter is associated with hypothyroidism, treatment with thyroid hormone replacement drugs may slow or stop the growth of the gland. It may not, however, shrink your goiter.
- If your goiter is associated with hyperthyroidism due to Graves’ disease, treatment—including radioactive iodine, or antithyroid drugs—may slow or stop the gland’s enlargement, and may shrink the goiter.
- If your goiter continues to grow while on thyroid treatment, symptoms are debilitating, or the goiter is cosmetically unsightly, your doctors will likely recommend surgery, known as thyroidectomy.
What Are Thyroid Nodules?
Thyroid nodules are swellings or lumps in your thyroid gland. Nodules can be solid, or liquid-filled cysts. Thyroid nodules are extremely common, and it’s estimated that half the population has at least one nodule, although most are not aware of it. Thyroid nodules are also more common as you age, and it’s estimated that by age 70 as many as 70 percent of people have at least one thyroid nodule.
Nodules can occur for a number of reasons:
- Thyroid cancer. This is the least common cause of thyroid nodules, and approximately 95 percent of all thyroid nodules are non-cancerous.
- Autoimmune thyroid conditions, such as Hashimoto’s and Graves’ disease, that cause inflammation of the gland and result in nodules.
- Overgrowth of your normal thyroid tissue. This is known as a thyroid adenoma, and is usually not cancerous or considered serious unless the nodule is causing symptoms due to its size.
- Iodine deficiency. This can trigger nodule development, along with goiter.
- Multinodular goiter, also known as toxic adenoma, where you have a number of nodules. Typically, these nodules produce thyroid hormone and can result in hyperthyroidism.
Common Signs and Symptoms of Thyroid Nodules
In some cases, if you have a very large nodule, or it is close to the surface of your skin, it may be visible externally or able to be felt by your practitioner’s manual evaluation. Many nodules, however, are not visible or palpable, and can only be detected by imaging tests.
In many cases, nodules cause no obvious symptoms. But when thyroid nodules do cause symptoms, some common ones include:
- palpitations
- insomnia
- weight loss or weight gain
- anxiety
- tremors
- fatigue
- depression
- sensitivity in the neck
- difficulty swallowing
- a feeling of fullness or tenderness in the neck
- hoarseness