Goiter: Symptoms, Causes, Diagnosis, Risk factors & Treatment

 

When your thyroid gland becomes enlarged, a goiter results. It may or may not be linked to abnormal thyroid hormone levels and has several potential causes. It is treatable.

The thyroid gland's atypical growth is called a goiter (GOI-tur). The thyroid is a butterfly-shaped gland situated directly beneath the Adam's apple at the base of the neck.

One or more lumps (nodules) in the thyroid may be the result of irregular cell growth, or a goiter may be an overall enlargement of the thyroid. Thyroid hormones can increase or decrease in response to a goiter, or thyroid function may remain unchanged.

Also Read: Hyperthyroidism (Overactive Thyroid)

What is a goiter?

Your thyroid gland enlarges when you have a goiter. One or more tiny lumps known as thyroid nodules may form on your thyroid, or your entire thyroid may enlarge.

The thyroid gland is a small, butterfly-shaped endocrine gland situated beneath the Adam's apple in your neck. The hormones triiodothyronine (also known as T3) and thyroxine (also known as T4) are produced by it. These hormones are involved in several body processes, such as:

•  Metabolism

• Body temperature

• Emotion and vigor

• Heart rate and pulse

• Digestion

Goiter can be linked to either normal thyroid hormone levels (euthyroidism) or an irregular amount of thyroid hormone in your body (hyperthyroidism or hypothyroidism).

There are numerous potential causes of goiter. Treatment might or might not be necessary, depending on the cause.

What types of goiter are there?

There are several ways to categorize goiter, such as how it develops and whether or not your thyroid hormone levels are abnormal.

According to how it enlarges, goiter can be categorized as follows:

• The whole thyroid gland swells and feels smooth to the touch when you have simple (diffuse) goiter.

• Nodular goiter: This type of goiter occurs when a lump, known as a nodule, forms inside your thyroid and causes it to feel lumpy.

• Multinodular goiter: This type of goiter occurs when your thyroid contains numerous lumps, or nodules. The nodules might be visible or only be found by scans or examination.

According to thyroid hormone levels, goiter can be categorized as follows:

• When your thyroid is enlarged and overproduces thyroid hormone, you get toxic goiter.

• Nontoxic goiter: This type of goiter occurs when your thyroid is enlarged but your thyroid function is normal (euthyroid). To put it another way, you do not have either hypothyroidism (an underactive thyroid) or hyperthyroidism in your body.

• When diagnosing specific types of goiter, medical professionals combine these descriptors. For instance, a toxic multinodular goiter occurs when your thyroid produces an excess of thyroid hormone from multiple nodules, usually several.

What symptoms of goiter are present?

A goiter can vary in size from very small and imperceptible to enormous. The majority of goiters don't hurt, but they can if you have thyroiditis, which is an inflammation of the thyroid gland.

Goiter's primary symptoms include:

• A lump directly beneath your Adam's apple at the front of your neck

• A constriction in the area of your throat

• Voice scratchiness or hoarseness

• Swelling of the neck veins

• Lifting your arms above your head can cause dizziness

Other, less typical symptoms consist of:

• Breathing problems (shortness of breath)

• Coughing

• Wheezing (caused by your windpipe being squeezed)

• swallowing difficulties brought on by esophageal constriction

Hyperthyroidism, or an overactive thyroid, can coexist with goiter in certain individuals. Hyperthyroidism symptoms include:

• Tachycardia, or a rapid heartbeat

• Inexplicable loss of weight

• Diarrhea

• Sweating occurs in the absence of physical activity or a warmer environment

• Shaking

• Agitation

Hypothyroidism, or an underactive thyroid, can also be present in some goiter patients.  Hypothyroidism symptoms include:

•  Fatigue (weariness)

•  Constipation

•  Dry skin

•  Weight gain that is not explained

What is the cause of goiter?

Goiter is the thyroid's cells' adaptive response to any process that prevents the production of thyroid hormones. Goiter can be caused by a variety of conditions, but iodine deficiency is the most common cause globally.

Among the causes of goiter are:

• Iodine deficiency: To produce thyroid hormone, your thyroid requires iodine. Your thyroid produces more cells (and grows) in an attempt to produce more thyroid hormone if you don't get enough iodine from your diet. Although this is the most frequent cause of goiter worldwide, it is uncommon in the US. Including seafood, dairy products, and iodized salt in your diet will help you reach the recommended daily intake of iodine. Iodine supplementation is not advised for the majority of Americans and may have unforeseen health consequences.

• Graves' disease: In Graves' disease, an autoimmune condition, your thyroid grows larger as a result of the immune system attacks. Hyperthyroidism is another complication of Graves' disease that needs to be treated.

• Hashimoto's disease: Your thyroid gland becomes inflamed when you have Hashimoto's disease, an autoimmune condition. A compensatory enlargement of the thyroid gland occurs in certain individuals with Hashimoto's disease. Over time, this type of goiter typically resolves on its own. Thyroid hormone treatment is necessary for certain Hashimoto's disease cases.

• Thyroid cancer: Thyroid cancer frequently causes the thyroid to enlarge.

• Pregnancy: The hormone human chorionic gonadotropin, which is produced during pregnancy, can cause a person's thyroid to enlarge.

• Thyroiditis: Your thyroid gland may enlarge as a result of inflammation of the thyroid gland itself. This may occur for a number of reasons.

Most of the time, the cause of sporadic goiters is unknown. This type of goiter can occasionally be brought on by specific medications. For instance, this type of goiter can be brought on by the medication lithium, which is used to treat several medical and mental health conditions.

Risk factors:

A goiter can appear on anyone. It can happen at any point in life or be present from birth. The following are some typical risk factors for goiters:

• Lacking dietary iodine. Seawater and coastal soil are the main sources of iodine. People who don't have access to iodine-supplemented food or enough iodine in their diets are more vulnerable, especially in the developing world. In the US, this is uncommon.

• Being a woman. Women are more likely to develop a goiter or other thyroid disorders.

• Menopause and pregnancy. Women are more likely to experience thyroid issues during pregnancy and menopause.

• Age. After the age of forty, goiters are more common.

• Medical history in the family. The risk of developing goiters is increased by a family medical history of goiters or other thyroid conditions. Additionally, scientists have discovered genetic variables that could be linked to a higher risk.

• Medications. Your risk is increased by certain medical treatments, such as the psychiatric medication lithium (Lithobid) and the heart medication amiodarone (Pacerone).

•  Radiation exposure. If you have received radiation therapy to the neck or chest, your risk is increased.

How does one diagnose goiter?

When your doctor examines you and determines that you have an enlarged thyroid, they typically diagnose goiter. On the other hand, a goiter is a sign that your thyroid gland is malfunctioning. They will have to identify the problem.

To diagnose and assess goiter, your healthcare provider may employ several tests, such as the following:

• Physical examination: By feeling for nodules and indications of tenderness in the neck region, your healthcare provider may be able to determine whether your thyroid gland is enlarged.

• Thyroid hormone levels are measured by this blood test, which indicates whether your thyroid is working properly.

• Blood test for antibodies: This test searches for specific antibodies that are generated in some types of goiter. White blood cells produce a protein called an antibody. Antibodies aid in protecting your body from invaders that can cause illness or infection, such as viruses.

• Thyroid ultrasound: High-frequency sound waves are sent through bodily tissues during an ultrasound procedure. The echoes are captured and converted into images or videos. Your doctor can "see" your thyroid to determine its size and whether any nodules are present.

• Biopsy: A biopsy involves taking a sample of tissue or cells for laboratory analysis. If your thyroid gland has big nodules, you might require a thyroid biopsy. The purpose of a biopsy is to rule out cancer.

• Thyroid uptake and scan: This imaging test tells you how big and how well your thyroid is working. This test creates an image of your thyroid on a computer screen by injecting a tiny quantity of radioactive material into a vein. Because this test is only helpful in specific situations, providers don't order it very often.

• A CT scan or MRI (Magnetic resonance imaging) is used to measure the size and spread of a goiter that is very large or has spread into your chest.

 Treatment:

Are goiters self-resolving?

A simple goiter may appear for a brief period of time and disappear without medical intervention.

Numerous goiters, including multinodular goiter, are linked to thyroid hormone levels that are within normal limits. Once diagnosed by your healthcare provider, these goiters typically don't require any special treatment. On the other hand, you might eventually be susceptible to either hyperthyroidism or hypothyroidism.

Even if you have an enlarged thyroid gland, you should still see your doctor because there are a number of potential causes for goiters, some of require treatment.

How does one treat goiter?

The size of your thyroid, its symptoms, and its cause will all affect how you are treated for goiter. Among the treatments are:

• No treatment/ "Wachful waiting": Your doctor may determine that there is no need to treat a small goiter if it is not bothering you. They will, however, keep a close eye on your thyroid to spot any changes.

• Medication: Levothyroxine is a thyroid hormone replacement medication (Levothroid®, Synthroid®). If hypothyroidism, or an underactive thyroid, is the cause of your goiter, your doctor will probably prescribe it. If an overactive thyroid (hyperthyroidism) is the cause of the goiter, additional medications are prescribed. Among these medications are propylthiouracil and methimazole (Tapazole®). If the goiter is due to inflammation, your doctor may prescribe a corticosteroid or aspirin.

• Taking radioactive iodine orally is known as radioactive iodine therapy, and it is used to treat overactive thyroid glands. Your thyroid gland shrinks as a result of the iodine's destruction of thyroid cells. You will probably require thyroid hormone replacement therapy for the remainder of your life following radioactive iodine treatment.

• Surgery: Your doctor might suggest a thyroidectomy, which is the removal of all or part of your thyroid gland. If the goiter is large and interferes with your ability to swallow and breathe, you may require surgery. Nodules can also occasionally be removed surgically. If there is cancer, surgery is required. You might require lifelong thyroid hormone replacement treatment, depending on the extent of thyroid gland removal.

Prevention:

How can I avoid getting a goiter?

The only type of goiter that is usually preventable is simple goiter, which is caused by an iodine deficiency. These types of goiters can be avoided by eating a diet high in dairy products, fish, and iodized table salt. Supplements containing iodine and other nutrients are typically not advised for other kinds and may cause more harm than good.

References:

• American Thyroid Association. Goiter (http://www.thyroid.org/what-is-a-goiter/). Accessed 6/6/2022.

• Goiter. Hormone Health Network. Endocrine Society. https://www.hormone.org/diseases-and-conditions/goiter. Accessed Oct. 4. 2021.

• MedlinePlus. Simple Goiter (https://medlineplus.gov/ency/article/001178.htm). Accessed 6/6/2022.

• Womenshealth.gov. Thyroid disease (http://womenshealth.gov/publications/our-publications/fact-sheet/thyroid-disease.html). Accessed 6/6/2022.

• Can AS, Rehman A. Goiter (https://www.ncbi.nlm.nih.gov/books/NBK562161/). [Updated 2021 Aug 30]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Accessed 6/6/2022.

• AskMayoExpert. Hyperthyroidism. Mayo Clinic; 2020.

• Ross DS. Treatment of nontoxic, nonobstructive goiter. https://www.uptodate.com/contents/search. Accessed Sept. 28, 2021.

• Ross DS. Clinical presentation and evalution of goiter in adults. https://www.uptodate.com/contents/search. Accessed Sept. 28, 2021.