A goiter (GOI-tur) is an abnormal enlargement of your thyroid gland. Your thyroid is a butterfly-shaped gland located at the base of your neck just below your Adam's apple. Although goiters are usually painless, a large goiter can cause a cough and make it difficult for you to swallow or breathe.
The most common cause of goiters worldwide is a lack of iodine in the diet. In the United States, where the use of iodized salt is common, a goiter is more often due to the over- or underproduction of thyroid hormones or to nodules that develop in the gland itself.
Not all goiters cause signs and symptoms. When signs and symptoms do occur they may include:
A visible swelling at the base of your neck that may be particularly obvious when you shave or put on makeup
A tight feeling in your throat
Your thyroid gland produces two main hormones — thyroxine (T-4) 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 helps regulate the amount of calcium in your blood.
Your pituitary gland and hypothalamus control the rate at which these hormones are produced and released.
A number of factors can cause your thyroid gland to enlarge. Among the most common are:
Iodine deficiency. Iodine, which is essential for the production of thyroid hormones, is found primarily in seawater and in the soil in coastal areas. In the developing world, people who live inland or at high elevations are often iodine deficient and can develop goiters when the thyroid enlarges in an effort to obtain more iodine. The initial iodine deficiency may be made even worse by a diet high in hormone-inhibiting foods, such as cabbage, broccoli and cauliflower.
Graves' disease. A goiter can sometimes occur when your thyroid gland produces too much thyroid hormone (hyperthyroidism). In Graves' disease, antibodies produced by your immune system mistakenly attack your thyroid gland, causing it to produce excess thyroxine. This overstimulation causes the thyroid to swell.
Hashimoto's disease. A goiter can also result from an underactive thyroid (hypothyroidism). Like Graves' disease, Hashimoto's disease is an autoimmune disorder. But instead of causing your thyroid to produce too much hormone, Hashimoto's damages your thyroid so that it produces too little.
Multinodular goiter. In this condition, several solid or fluid-filled lumps called nodules develop in both sides of your thyroid, resulting in overall enlargement of the gland.
Solitary thyroid nodules. In this case, a single nodule develops in one part of your thyroid gland. Most nodules are noncancerous (benign) and don't lead to cancer.
Thyroid cancer. Thyroid cancer is far less common than benign thyroid nodules. A biopsy of a thyroid nodule is very accurate in determining if it's cancerous.
Pregnancy. A hormone produced during pregnancy, human chorionic gonadotropin (HCG), may cause your thyroid gland to enlarge slightly.
Inflammation. Thyroiditis is an inflammatory condition that can cause pain and swelling in the thyroid. It may also cause an over- or underproduction of thyroxine
Goiters can affect anyone. They may be present at birth and occur at any time throughout life. Some common risk factors for goiters include:
A lack of dietary iodine. People living in areas where iodine is in short supply and who don't have access to iodine supplements are at high risk of goiters.
Being female. Because women are more prone to thyroid disorders, they're also more likely to develop goiters.
Your age. Goiters are more common after age 40.
Medical history. A personal or family history of autoimmune disease increases your risk.
Pregnancy and menopause. For reasons that aren't entirely clear, thyroid problems are more likely to occur during pregnancy and menopause.
Certain medications. Some medical treatments, including the heart drug amiodarone (Cordarone, Pacerone, others) and the psychiatric drug lithium (Lithobid, others), increase your risk.
Radiation exposure. Your risk increases if you've had radiation treatments to your neck or chest area or you've been exposed to radiation in a nuclear facility, test or accident.
Small goiters that don't cause physical or cosmetic problems aren't a concern. But large goiters can make it hard to breathe or swallow and can cause a cough and hoarseness.
Goiters that result from other conditions, such as hypothyroidism or hyperthyroidism, can be associated with a number of symptoms, ranging from fatigue and weight gain to unintended weight loss, irritability and trouble sleeping.
Goiter treatment depends on the size of the goiter, your signs and symptoms, and the underlying cause. Your doctor may recommend:
Observation. If your goiter is small and doesn't cause problems, 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 (Levoxyl, Synthroid, Tirosint) 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.
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 a nodular goiter causing hyperthyroidism.
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.
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