A goiter is an enlargement of the thyroid gland that causes a swelling on the front of the neck. It is usually not related to a tumor, but a doctor determines the cause of the enlargement.
What a goiter is and what it looks like
The thyroid gland is a small organ in the front of the neck, just above the point where the collarbones meet. It produces the hormones T4 and T3, which control metabolism, mood, weight, and energy levels. A goiter appears when the gland enlarges: the swelling is located in the lower part of the neck and is usually painless, may feel smooth or lumpy to the touch, and is sometimes visible on only one side. A simple goiter is simply an enlargement of the gland; as a rule, it is not a tumor and not cancer.
Key point: a goiter is an enlargement of the thyroid gland.
Types of thyroid goiter
A simple, or nontoxic, goiter is an enlargement of the gland without an excess of hormones. The tissue may contain one or several growths — nodules; nodules can be benign (harmless). Toxic nodular goiter is an enlarged gland with nodules that produce too much thyroid hormone.
Separately, goiter is distinguished in the setting of increased or decreased gland function, thyroiditis, and autoimmune conditions such as Graves' disease. Rarely, the cause is thyroid cancer.
Key point: the type of goiter is clarified by hormone tests, ultrasound, and, if needed, biopsy.
Endemic goiter: the role of iodine deficiency
Iodine is needed to produce thyroid hormones. If there is not enough iodine in the diet, the gland enlarges: in this way it tries to capture more iodine and produce the required amount of hormone, so a goiter can be a sign that the gland is not coping. Iodine deficiency is the most common cause of goiter; goiter associated with iodine deficiency in a region is called endemic. Most simple goiters are prevented by iodized salt.
Other causes: autoimmune processes, certain medications (lithium, amiodarone), smoking, very large amounts of soy, peanuts, and cruciferous vegetables, infections (rarely).
Key point: with iodine deficiency, the gland grows in order to obtain more of it.
Why goiter is more common in women
Goiter is more common in women. Among the causes of gland enlargement are hormonal changes during puberty, pregnancy, and menopause. Gland enlargement is more often found in people over 40, in those whose relatives had a goiter, and in people born and raised in regions with iodine deficiency.
Key point: goiter is more common in women, especially after 40 and with a family history.
Symptoms and complications of goiter
The main sign is enlargement of the gland: from a small nodule to a large growth in the neck. Some people with a simple goiter have signs of decreased gland function. With very large goiters, the gland presses on the windpipe and esophagus, and then the following appear:
- difficulty breathing, especially when lying on the back or with the arms raised above the head;
- cough and a whistling sound when breathing;
- hoarseness, voice change;
- a feeling as if something is stuck in the throat;
- difficulty swallowing, especially solid food, pain in the area of the gland.
Over time, a simple goiter may shrink on its own or grow; sometimes the gland stops producing enough hormone (hypothyroidism), and sometimes it starts producing too much (hyperthyroidism).
Key point: goiters differ in their causes, so a doctor determines the cause.
How goiter is diagnosed and when to see a doctor
The doctor examines the neck and palpates the gland while you swallow. With a very large goiter, the doctor may ask you to raise your arms above your head: due to compression of the neck veins, dizziness occurs at that moment. Next, blood tests for TSH and free T4, thyroid ultrasound, and, if necessary, scanning and fine-needle biopsy are usually ordered if nodules are found on ultrasound.
You should see a family doctor if you notice a swelling on the front of the neck. A goiter is usually not serious, but it is better to see a doctor; the decision on observation or consultation with a surgeon for difficulty breathing and swallowing is made by the doctor.
A goiter by itself is not a reason to call an ambulance. Call 103 or 112 if it is hard to breathe or a whistling sound is heard when breathing.
This material is for reference: it helps to understand what is being discussed, but does not replace a doctor's consultation.
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This content is for reference and does not replace a doctor's consultation. Medical disclaimer