Goiter

Goiter

What is goiter?

“Goiter” is the name used for an enlarged thyroid gland. The thyroid gland is a butterfly-shaped endocrine organ located in your neck. The thyroid gland makes thyroid hormones which then move through the blood stream to other tissues in the body. Thyroid hormones help with overall body health. Specifically, thyroid hormones help with growth, heart function, energy level, bowel movements, temperature regulation, and pubertal development. Thyroid hormones are especially important for brain development during infancy and early childhood. Patients with goiter may have normal, high, or low thyroid hormone levels when measured in a blood sample.

What are the symptoms of goiter?

Most individuals with goiter do not have symptoms due to the size of the goiter. However, when the thyroid gland is extremely large, it can cause swelling in the neck area. Sometimes a goiter can be noted by looking at the neck area. Typically, the enlarged thyroid (goiter) is painless. Rarely, symptoms related to pressure may be reported. These symptoms include:

• A feeling of fullness or tightness in the neck
• Trouble swallowing
• Breathing difficulty
• Hoarseness (scratchy voice)
• Coughing

What are the types of goiters?

Goiter can be classified as:

1. Simple (diffuse) goiter: The entire thyroid gland is enlarged and swollen smoothly.
2. Nodular goiter: This can happen if the thyroid gland grows irregularly and results in a single lump.
3. Multinodular goiter: This can happen if the thyroid gland grows irregularly and results in multiple lumps.

What are the common causes of goiter?

There are several causes of an enlarged thyroid (goiter). Worldwide, the most common cause of a goiter is lack of sufficient dietary iodine. The thyroid gland needs iodine to make the thyroid hormones. Iodine deficiency is uncommon in the United States. Eating seafood, dairy, eggs, seaweed and using iodized salt generally provides enough iodine.

The most common cause of goiter in the United States is Hashimoto disease, which is an autoimmune condition in which the immune system attacks cells in the thyroid leading to thyroid gland inflammation. Some individuals with Hashimoto disease develop hypothyroidism. Hypothyroidism described an underactive thyroid gland that does not produce enough of the active thyroid hormones. Another common cause of goiter is Graves’ disease which is also an autoimmune condition. In Graves’ disease, the immune system makes antibody proteins that cause the thyroid gland to produce more thyroid hormones than the body needs. This results in an “overactive thyroid gland”.  During puberty, the thyroid gland may temporarily grow larger than normal and is called an adolescent or colloid goiter; the thyroid still works normally in this situation.

How do you diagnose a goiter?

Goiter can be diagnosed usually with a physical exam. To determine the cause of the goiter, your healthcare provider may obtain thyroid hormone levels. Depending on the physical exam and test results, your healthcare provider may recommend additional testing, such as thyroid ultrasound. If the thyroid ultrasound shows a thyroid nodule or multiple nodules, a thyroid biopsy may be indicated depending on the size of the nodule(s) or the findings of the thyroid ultrasound. Also, in some instances, additional tests are done to help your provider determine the structure and function (radioiodine uptake) of the thyroid gland. Sometimes, your provider may recommend observation and re-evaluation in the future.

How do you treat goiter?

Treatment of a goiter depends on the underlying cause and severity of the related symptoms.  It is essential to consult your healthcare provider.

Common approaches include:

• Monitoring: Goiter without thyroid hormone issues may be monitored without any treatment.
• Hypothyroidism: If the goiter is caused by underactive thyroid disease, medications like levothyroxine may be prescribed by an endocrinologist to regulate thyroid hormone levels.
• Hyperthyroidism: If the goiter is caused by overactive thyroid disease, medications such as methimazole may be prescribed by an endocrinologist to regulate thyroid hormone levels. In some individuals, radioactive iodine ablation may be used to shrink the thyroid gland. In other cases, surgery may be advised by your endocrinologist as an alternative treatment option.
• Iodine Deficiency: Although it is rare in the US, if the underlying cause of goiter is not having enough iodine in the diet, iodine supplements or iodized salt may be recommended.
• Thyroid nodule(s): Most thyroid nodules in children are not cancerous. Small thyroid nodules can be monitored with a physical exam by your endocrinologist and thyroid imaging periodically. Your doctor may recommend a thyroid biopsy if there are suspicious or unusual features on thyroid ultrasound. If a biopsy shows thyroid cancer, your child should be evaluated and treated by doctors who are experienced with thyroid cancer in children.
• Surgery: In the rare instance that the goiter is extremely large and causing pressure symptoms such as breathing problems, swallowing difficulty, or change in voice, removing the entire or part of the thyroid gland may be considered.