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Goiter - simple

A simple goiter is an enlargement of the thyroid gland. It is usually not cancer.

Causes

There are different kinds of goiters:

  • A simple goiter can occur without a known reason. It can occur when the thyroid gland is not able to make enough thyroid hormone to meet the body's needs.  This can be due to a lack of iodine in a person's diet. To make up for the shortage of thyroid hormone, the thyroid gland grows larger.
  • Toxic nodular goiter is an enlarged thyroid gland that has a small, rounded growth or many growths called nodules. One or more of these nodules produce too much thyroid hormone.

The body needs iodine to produce thyroid hormone:

  • Simple goiters may occur in people who live in areas where the soil and water do not have enough iodine. People in these areas might not get enough iodine in their diet.
  • The use of iodized salt in many food products in the United States prevents a lack of iodine in the diet.

In many cases of simple goiter, the cause is unknown. Other than a lack of iodine, other factors that may lead to the condition include:

  • Certain medicines (lithium, amiodarone)
  • Infections
  • Cigarette smoking
  • Certain foods (soy, peanuts, vegetables in the broccoli and cabbage family)

Simple goiters are also more common in:

  • Persons over age 40
  • People with a family history of goiter
  • Women

Symptoms

The main symptom is an enlarged thyroid gland. The size may range from a single small nodule to a large neck lump.

Some people with a simple goiter may have symptoms of an underactive thyroid gland.

In rare cases, an enlarged  thyroid can put pressure on the windpipe (trachea) and food tube (esophagus). This can lead to:

  • Breathing difficulties (with very large goiters), especially when lying on the back
  • Cough
  • Hoarseness
  • Swallowing difficulties, especially with solid food

Exams and Tests

The doctor will do a physical exam. This involves feeling your neck as you swallow. Swelling in the area of the thyroid may be felt.

If you have a very large goiter, you may have swelling in your neck vein. As a result, when the doctor asks you to raise your arms above your head, you may feel dizzy.

Blood tests may be ordered to measure thyroid function:

  • Free thyroxine (T4)
  • Thyroid stimulating hormone (TSH)

Tests to look for abnormal and possibly cancerous areas in the thyroid gland include:

If nodules are found on an ultrasound, a biopsy may be needed to check for thyroid cancer.

Treatment

A goiter only needs to be treated if it is causing symptoms.

Treatments for an enlarged thyroid include:

  • Thyroid hormone replacement pills, if the goiter is due to an underactive thyroid
  • Small doses of Lugol's iodine or potassium iodine solution if the goiter is due to a lack of iodine
  • Radioactive iodine to shrink the gland, especially if the thyroid is producing too much thyroid hormone
  • Surgery (thyroidectomy) to remove all or part of the gland

Outlook (Prognosis)

A simple goiter may disappear on its own, or may become larger. Over time, the thyroid gland may stop making enough thyroid hormone. This condition is called hypothyroidism.

In some cases, a goiter becomes toxic and produces thyroid hormone on its own. This can cause high levels of thyroid hormone, a condition called hyperthyroidism.

When to Contact a Medical Professional

Call your health care provider if you experience any swelling in the front of your neck or any other symptoms of goiter.

Prevention

Using iodized table salt prevents most simple goiters.

Alternative Names

Simple goiter; Endemic goiter; Colloidal goiter; Nontoxic goiter; Toxic nodular goiter

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.

Update Date: 5/10/2014

Updated by: Brent Wisse, MD, Associate Professor of Medicine, Division of Metabolism, Endocrinology & Nutrition, University of Washington School of Medicine, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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