Guide To Goiters: Causes, Symptoms And Treatment

Thyroid Goiter Pictures




What Is A Goiter?
What Are The Symptoms?
What Causes Goiters?
How Is It Diagnosed?
How Are Goiters Treated?

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Thyroid Disease Guide

What Is A Goiter?

A goiter is an umbrella term that refers to any swelling or enlargement of the thyroid gland in the neck. Although some goiters are caused by thyroid problems like hyperthyroidism or hypothyroidism (these are called toxic goiters), others occur in people with normal thyroids (these are called diffuse goiters). People with toxic goiters develop small lumps on the thyroid called thyroid nodules (picture). The swelling is normally limited to the area of the nodule. Toxic goiters are medically defined by how many nodules there are, a person can one or lots. People with diffuse goiters on the other hand develop a large smooth, uniformly shaped swelling at the base of their neck. It is more of a cosmetic problem than a medical one, unless it starts to cause difficulties with swallowing or breathing. In general most goiters will not interfere with a person's health, but diagnosing the cause is important as it can indicate an underlying thyroid problem or even thyroid cancer.

What Are The Symptoms?

Not all goiters are large enough to be instantly noticeable or cause symptoms. If signs do occur they can include:

• A swelling at the base of your neck.
• A tightness in your throat.
• Difficulties swallowing or breathing.
• Hoarseness.
• Coughing.
If you are also showing symptoms of thyroid disease, such as protruding eyes (picture) and unexplained weight loss or weight gain, contact your doctor immediately.

What Causes Goiters?

Iodine Deficiency: Before the introduction of iodized table salt into America, goiter was epidemic. Today, goiters caused by iodine deficiency are only prevalent in poor countries (see causes of thyroid disease).
Drugs: Certain drugs such as lithium can cause goiter (10 percent of patients who take lithium suffer). Other problem drugs include amiodarone and interferon alfa.
Inflammation: Inflammation of the thyroid gland can cause a swelling (diffuse goiter). This is common in people with Hashimoto's disease as well as Graves disease.
Childbirth: Some women develop symptoms of thyroid disease within months of childbirth, including goiter. This is known as postpartum thyroiditis. It normally resolves itself without treatment within a few months. Read about thyroid disease and pregnancy.
Virus: The thyroid can become painfully enlarged as a result of a virus. This condition is known as subacute thyroiditis.
Cancer: Goiter can be caused by the growth of a malignant tumor, in other words, thyroid cancer.
Unknown: It is estimated that 5 to 7 percent of women will develop sporadic goiter for unknown reasons. In most cases the swelling is small enough to go unnoticed.

How Is It Diagnosed?

The first thing a doctor will do is carry out a physical examination. The 3 key questions he will want answered are:

1. Is the gland so swollen or enlarged that it is pressing on nearby structures?
A swollen thyroid can cause tightness around the neck. If the goiter or nodule is large enough it can press on the windpipe and cause shortness of breath and coughing. Or if it presses down on the esophagus it can cause swallowing difficulties. If it is due to cancer, the tumor might grow into nearby structures causing pain and hoarseness if the voice box is infected. Or it can cause the patient to cough up blood if the windpipe is invaded.

2. Is the gland behaving normally or is it under- or overactive?
The doctor will need to order blood tests to determine this. These tests are discussed in our article on thyroid tests.

3. Is the goiter due to cancer?
Fortunately in the vast amount of cases, goiters and thyroid nodules are not due to cancer. While some doctors think that all goiter and nodule cases should be screened for cancer, others don't think it necessary, particularly if the patient is diagnosed with hyperthyroid Graves disease or they have a nodule smaller than 1 to 1.5 cm in diameter. These tests are also discussed in our article on thyroid tests.

When assessing the cause of your goiter, your doctor will take the following into account:

Gender and Age
Nodules and goiters are more common in women and the elderly but nodules in men and young people are more likely to be cancerous

Neck Symptoms
Is there swelling or pain in the front of the neck?
Is there hoarseness that is new and persistent?
Is there a new and persistent cough?
Do you cough up blood?
Are you short of breath?

Do They Have Risk Factors for Cancer?
Have you ever had radiation to the neck area?
Is there a family history of thyroid cancer?
Is there a family history of polyps?
Is there a family history adrenal tumors or parathyroid?

If It's Cancer
The following are signs that it has spread:
Bone pain in one area that won't go away.
Numbness or weakness in an arm or leg that persists.

Hyperthyroidism Symptoms
Does the patient display any of the following symptoms, especially if they are new or persistent:
Weight loss.
Heat intolerance.
Hand tremors.
Sleep apnea.
Feeling anxious all the time.
Diarrhea or increased bowel movement.

Hypothyroidism Symptoms
Does the patient display any of the following symptoms, especially if they are new or persistent:
Weight gain
Feels cold easily.
Dry skin and puffy face.
Muscle cramps.

Once the appropriate tests have been carried out, and cancer ruled out, your doctor will propose a treatment plan.

How Are Goiters Treated?

The treatment will depend on the cause of the goiter. Options include:

1. Wait and See Approach: If you have noncancerous nodules or a small diffuse goiter and your thyroid is functioning normally, then you may need no treatment at all. It may clear of it's own accord. Treatment is only considered if the goiter is large enough to cause difficulties swallowing. Younger people however may be given treatment straight away because they have a longer life expectancy and doctors will not want to risk the goiter causing a mechanical problem in the throat long-term.

2. Surgery: If the goiter is so large that it is causing breathing or swallowing difficulties, or if it is really unsightly, doctors may surgically remove part of or the entire gland (thyroidectomy). This is also the treatment for thyroid cancer. Or they may chemically destroy part or all of it using radioactive iodine. If the entire thyroid is removed, you will no longer produce thyroid hormones, so you will become hypothyroid. This means you will need to take hormone replacement medications for the rest of your life (levothyroxine).

3. Hyperthyroidism: If the goiter is related to a condition causing hyperthyroidism, such as Graves disease, radioactive iodine may be used to control the over activity of the gland and to reduce its size. One of the risks with this, is that it may decrease activity so much that you become hypothyroid.

4. Hypothyroidism: If the thyroid gland is swollen due to an autoimmune disease like Hashimoto, then starting medication for treating hypothyroidism will be suggested (levothyroxine). If you take this medication your doctor should check your blood TSH levels to make sure that you do not develop subclinical (early stage) hyperthyroidism. This can happen as a result from over treatment of a goiter - it could also increase your risk factors for osteoporosis. Expect to wait up to 6 months for the goiter to respond to treatment and it may take several years for it to disappear altogether.

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