Definition & Overview

Goiter is a type of thyroid disorder that is characterized by an enlargement of the gland. The thyroid gland, which is part of the endocrine system, is responsible for producing thyroid hormones called thyroxine (T-4) and triiodothyronine (T-3), which help the body use energy efficiently and ensures that all the various organs are working properly. The gland also produces the calcitonin hormone that regulates the blood’s calcium content. The endocrine system, on the other hand, is a group of glands that are tasked to regulate body functions, such as sleeping, reproduction, mood, metabolism, and growth.

The thyroid gland has a butterfly shape and is located in front of the neck, just under the Adam’s apple. Enlargement of the gland, also referred to as goiter, causes the front portion of the neck to increase in size. However, the odd-looking shape of the neck is the least of the patient’s worries.

Goiter is known to result in a variety of complications, such as unintended weight loss or gain, irritability and mood swings, and sleeping problems. Additionally, if surgery is required to treat the condition, there will be other risks associated with the procedure.

However, not all goiter conditions require treatment particularly if it is significantly small and does not produce any undesirable effects, such as a change in voice or a large bulge in the neck. However, if the goiter is large and noticeable, treatment will be required and will be based on the exact cause.

Cause of Condition

In the past, the primary cause of goiter was iodine deficiency. Today, iodine deficiency rarely causes this condition in the United States due to the availability and widespread use of iodized salt. In under-developed countries, iodine deficiency is still a common cause.

Other causes of goiter are the following conditions:

  • Hypothyroidism - refers to a condition characterized by a low production of the thyroid hormone

  • Hyperthyroidism - occurs when there is an overproduction of the thyroid hormone

  • Hashimoto’s thyroiditis – this happens when an abnormality affects the immune system, and it begins to attack the thyroid gland.

  • Graves’ disease - is caused by an immune system disorder that forces the thyroid to overproduce hormones (hyperthyroidism)

  • Thyroid nodules – these are small growths on the thyroid gland. The majority of thyroid nodules aren’t serious, but some may result in goiter or even cancer.

  • Pregnancy – this results in the production of Human Chorionic Gonadotropin (HCG) hormone, which may cause a slight enlargement of the thyroid gland. In rare cases, genetic factors and benign or malignant tumours cause goiter.

Key Symptoms

Small goiters will not usually produce any signs, symptoms, or discomfort. However, large ones will not only be uncomfortable due to their size and visibility, but they can also cause coughs, voice changes (hoarseness), and breathing and swallowing difficulties.

Since the thyroid gland regulates some of the body’s functions, a person with a goiter may have sleep problems and difficulty in maintaining an ideal weight. Goiter usually causes unintended weight loss or gain.

Who to See & Types of Treatment Available

If you notice a lump in the neck area where the thyroid gland is located, or if you experience any of the above-mentioned symptoms, you should consult your primary care physician. A physical examination of your neck should be enough for the doctor to determine an enlarged thyroid gland. In some cases, even nodules can be felt during a physical exam.

The doctor may proceed with diagnosing your condition or refer you to an endocrinologist for further tests, diagnosis, and treatment.

Tests that are usually performed to diagnose goiters are:

  • Hormone tests – This blood test measures the amount of hormones produced by the thyroid glands.

  • Antibody test – This is another blood test that determines if an abnormal amount of antibodies in the blood is the primary cause of goiter.

  • Biopsy – Otherwise known as a fine-needle aspiration biopsy, it is performed to obtain a sample of tissue and test it for cancer.

  • Thyroid scan – If the doctor requires a clearer picture of your thyroid, a thyroid scan will be ordered. The scan involves injecting radioactive isotopes into the blood stream, which are then tracked by a special camera that produces a clear image on a computer monitor.

  • Ultrasonography – This is a common test used in diagnosing goiters and other thyroid disorders. The test is performed using an ultrasound device that transmits sound waves to the thyroid gland. The device captures the echo produced by the sound waves and relays the signal to a computer for processing, which then results in an image of the thyroid gland.

Once the doctor has determined the condition of the thyroid gland and goiter, a treatment plan will be laid out. However, in some cases that are deemed not serious, the doctor may simply opt to observe your condition for a while. This usually happens when the gland is still producing the ideal amount of hormones, which indicates that it is still functioning properly.

If the thyroid gland’s functions are impaired (hyperthyroidism/hypothyroidism), the doctor will prescribe medications, such as Levothroid and Synthroid to help reduce or replace the hormones. The doctor may also prescribe medication to reduce inflammation.

If the goiter is too large, the doctor may opt to perform surgery, which could be a total or partial thyroidectomy. This procedure involves removing a portion of the thyroid gland (partial thyroidectomy) or the entire gland (total thyroidectomy).

Overactive thyroid glands are sometimes treated using radioactive iodine. This type of medication destroys thyroid cells effectively, but there is a risk of destroying too many cells, which would then result in an underactive thyroid gland.

The main function of the thyroid gland is to produce hormones. If the gland fails to produce the hormones or if it is not producing the ideal amount, the doctor will resort to hormone replacement therapy.

After a successful treatment, you’ll need to make some lifestyle changes, which include increasing your intake of iodine, which is present in iodized salt, seaweeds, and some seafood.

References:

  • Kim M, Ladenson P. Thyroid. In: Goldman L, Schafer AI, eds. Goldman’s Cecil Medicine. 24th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 233.

  • Schlumberger MJ, Filetti S, Hay ID. Nontoxic diffuse and nodular goiter and thyroid neoplasia. In: Melmed S, Polonsky KS, et al., eds. Williams Textbook of Endocrinology. 12th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 14.

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