Goiter

Definition
Goiter is an enlargement of your thyroid gland — a small, butterfly-shaped gland
weighing less than an ounce, located just below your Adam's apple. Hormones
produced by your thyroid gland regulate all aspects of your metabolism, from the rate
at which your heart beats to the speed at which you burn calories.

Although generally not uncomfortable, goiter can interfere with swallowing or

breathing. Goiters are more common in women and older adults.

The possible causes are numerous. In the past, the most common cause of goiter was a
shortage of iodine in the diet in areas where the soil was deficient in iodine. Without
enough dietary iodine, your thyroid can't make and release enough of the two
essential iodine-containing hormones. Goiter became rare in the United States after
iodized salt was introduced. In some parts of the world, however, goiter is still
common because of iodine deficiency.

Treatment for goiter depends on the size of the enlargement, signs and symptoms, and
the underlying cause.

Symptoms

Goiter symptoms may include:

 Enlargement of your thyroid gland, resulting in swelling of your neck

 A tight feeling in your throat
 Coughing
 Difficulty swallowing
 Difficulty breathing

You may experience other signs and symptoms depending on the underlying cause of
the goiter.
Causes
Normally, your thyroid gland produces two main hormones — thyroxine and
triiodothyronine (T-3). These hormones circulate in your bloodstream and help
regulate your metabolism. They maintain the rate at which your body uses fats and
carbohydrates, help control your body temperature, influence your heart rate and help
regulate the production of proteins. Your thyroid gland also produces calcitonin — a
hormone that regulates the amount of calcium in your blood.

Your pituitary gland and hypothalamus control the rate at which these hormones are
produced and released. The process begins when the hypothalamus — an area at the
base of your brain that acts as a thermostat for your whole system — signals your
pituitary gland to make a hormone known as thyroid-stimulating hormone (TSH).
Your pituitary gland — also located at the base of your brain — releases a certain
amount of TSH, depending on how much thyroxine and T-3 are in your blood. Your
thyroid gland, in turn, regulates its production of hormones based on the amount of
TSH it receives from the pituitary gland.

Hormone level could be high, low or normal

Goiter doesn't necessarily mean your thyroid gland isn't producing hormones
normally. Even when enlarged, your thyroid may produce below-normal, normal or
above-normal amounts of hormones.

Enlargement of the gland can be uniform (diffuse goiter), or the gland may be
enlarged due to one or more nodules (nodular goiter). Nodules are lumps within an
otherwise normal thyroid gland.

One cause of goiter is iodine deficiency. In this situation, your thyroid can't make and
release enough thyroxine and T-3 — both of which contain iodine — and it enlarges
in response to excess stimulation from the pituitary.

Many causes of thyroid enlargement exist other than iodine deficiency. Some of the
causes are serious, others not. Other causes of goiter include:

 Graves' disease. This disease, an autoimmune disorder, is the most common

cause of an overactive thyroid (hyperthyroidism). In Graves' disease,
antibodies produced by your immune system stimulate the thyroid to produce
too much thyroxine. Normally, your immune system uses antibodies to help
protect against viruses, bacteria and other foreign substances that invade the
body. In Graves' disease, antibodies mistakenly attack your thyroid gland and
occasionally the tissue behind your eyes and the skin of your lower legs. The
overstimulation of your thyroid in Graves' disease results in uniform and
nonpainful swelling of the gland.
 Hashimoto's disease. This disease, also called chronic lymphocytic
thyroiditis, is a common cause of an underactive thyroid (hypothyroidism).
Hashimoto's disease also is an autoimmune disorder and causes inflammation,
which impairs your thyroid's ability to produce hormones. Then, your pituitary
gland attempts to stimulate your thyroid gland to produce more thyroid
hormones, causing your thyroid gland to enlarge.
  Multinodular goiter. In this condition, several nodules develop in both sides
of your thyroid, resulting in overall enlargement of the gland. Multinodular
goiter may occur with normal, low or excessive thyroid hormone production.
 Solitary thyroid nodules. A solitary nodule describes a single nodule that can
occur in any part of your thyroid gland. Most nodules are noncancerous
(benign) and don't lead to cancer.
 Thyroid cancer. Thyroid cancer is 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 slight uniform enlargement of your thyroid
gland.
 Inflammation. Thyroiditis is an inflammatory condition of the thyroid.
Various types of thyroiditis can result in an enlargement of your thyroid gland.
Some may cause thyroid pain, often aggravated by swallowing or pressure.
Some types of thyroiditis are associated with hyperthyroidism, while others
are associated with hypothyroidism.

When to seek medical advice

If you have had persistent widespread swelling of the front of your neck, above and
between your collarbones, your thyroid gland may be enlarged. See your doctor, who
can determine whether your thyroid is causing your neck to be swollen and what the
reason might be.

Tests and diagnosis

Goiter may cause your neck to appear swollen. By examining your neck, your doctor
can determine the degree of gland enlargement and the areas of tenderness. In some
cases, your doctor may be able to feel the presence of nodules.

Diagnosing goiter may also involve:

 A hormone test. Blood tests can determine the amount of hormones produced
by your thyroid and pituitary glands. If your thyroid is underactive, the level
of thyroid hormone will be low. At the same time, the level of thyroid-
stimulating hormone (TSH) will be elevated because your pituitary gland tries
to stimulate your thyroid gland to produce more thyroid hormone. Goiter
associated with an overactive thyroid usually involves a high level of thyroid
hormone in the blood and a lower than normal TSH level.
 An antibody test. Some causes of goiter involve production of abnormal
antibodies. A blood test may confirm the presence of antibodies.
 Ultrasonography. A wand-like device (transducer) 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 that your doctor may not have been able to
feel.
 A thyroid scan. During a thyroid scan, you'll have a radioactive isotope
injected into the vein on the inside of your elbow. You then lie on a table with
 your head stretched backward while a special camera produces an image of
your thyroid on a computer screen. The time needed for the procedure may
vary, depending on how long it takes the isotope to reach your thyroid gland.
Thyroid scans generate information about the nature of the thyroid
enlargement and the function of the gland.

Treatments and drugs

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

 Observation. If your goiter is small and doesn't cause you much of a problem,
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 (Levothroid, Synthroid) 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 an
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. The radioactive iodine is taken orally and reaches
your thyroid gland through your bloodstream, destroying thyroid cells. The
treatment results in diminished size of the goiter but eventually may also cause
an underactive thyroid gland. Hormone replacement with the synthetic thyroid
hormone levothyroxine then becomes necessary, usually for life.