Goiter

Goiter is a condition where the butterfly-shaped thyroid gland located in the neck region enlarges. This could be in the form of growth of the whole gland or it may be the result of irregular cell growth that forms one or more nodules.

Last Updated: February 26, 2024

The thyroid gland swells as an adaptation in response to underproduction or overproduction of thyroid hormones. Some common causes of goiter include:

  • Iodine deficiency 
    • Lack of iodine in the diet is the most common cause of goiter since iodine is the material needed by the thyroid gland to produce its hormones
  • Hypothyroidism
    • This condition describes an underactive thyroid gland
    • Since the gland does not produce enough hormones for the body, it is overstimulated to produce more which leads to swelling
    • This could be caused by Hashimoto’s thyroiditis wherein the immune system attacks its own tissue and causes the gland to swell
  • Hyperthyroidism
    • This condition describes an overactive thyroid gland
    • Goiter can also occur when the body produces too much thyroid hormones
    • Hyperthyroidism can be caused by Grave’s disease 

Less common causes of goiters include the following:

  • Smoking (interferes with iodine absorption)
  • Hormonal changes (puberty, pregnancy, menopause)
  • Thyroiditis (inflammation caused by infection)
  • Thyroid cancer

Most people with goiter only experience swelling at the base of the neck where the thyroid gland lies. If the goiter is small enough, it may not be noticeable to the naked eye but may only be discovered during a routine medical exam or an imaging test.

 

Excessive swelling in some cases can cause throat tightness, cough, voice hoarseness, trouble swallowing, and difficulty breathing.

 

Hyperthyroidism associated with goiter can result to metabolic changes such as:

  • Heat hypersensitivity
  • Palpitations
  • Hyperactivity
  • Increased sweating
  • Fatigue
  • Increased appetite
  • Hair loss
  • Weight loss

 

Hypothyroidism, on the other hand, causes the following:

  • Intolerance to cold
  • Constipation
  • Forgetfulness
  • Hair loss
  • Weight gain

Severe cases of goiter can be diagnosed just by looking at the swelling at the patient’s neck but other procedures can be done for milder cases. Doctors can evaluate an enlarged thyroid gland by feeling your neck area for any nodules or tenderness. Thyroid blood tests are done to measure the amount of thyroid hormones your body has to determine if the gland is working properly. 

 

Different imaging modalities can also be done to look at the thyroid gland:

  • Ultrasounds are done to “see” your thyroid and check for its size and presence of nodules
  • Thyroid uptake and scan uses radioactive iodine to evaluate the gland’s function and ability to absorb
  • CT Scan or MRIs are also done if the goiter is very large since it can also check if the goiter has spread to other parts of the body

 

For treatment, simple cases of goiter can go away on their own without much intervention. In hypothyroidism cases, medications such as levothyroxine are given as replacement to thyroid hormone. In hyperthyroidism cases, methimazole and propylthiouracil are examples of drugs that are usually prescribed by physicians. If the goiter is caused by inflammation, noninflammatory drugs are given.

 

Other forms of treatment for goiter are radioactive iodine treatment which involves taking a drug orally to kill thyroid cells to shrink the gland. Thyroidectomy is also a surgical option if the goiter is very large.

Since the most common cause of goiter is the lack of iodine in the diet, it would be best to include iodine-rich foods in the diet such as fish, dairy, eggs, or seaweed. Some table salts are also marketed as “iodized salt” which means they have extra iodine and these are actually developed to prevent iodine deficiency. 

 

References

https://www.medicalnewstoday.com/articles/167559#causes 

https://my.clevelandclinic.org/health/diseases/12625-goiter

https://www.mayoclinic.org/diseases-conditions/goiter/symptoms-causes/syc-20351829 

https://www.hopkinsmedicine.org/health/conditions-and-diseases/goiter 

Last Updated: February 26, 2024