A goiter (Latin, struma; also called a bronchocele), is a swelling in the neck (just below the Adam’s apple or larynx) due to an enlarged thyroid gland. The term goiter refers to enlargement of the thyroid not associated with overproduction of thyroid hormone or malignancy. The thyroid can become very large so that it can easily be seen as a mass in the neck. There are a number of factors that may cause the thyroid to become enlarged.

Treatment of Goiters

The treatment depends upon the cause of the goiter. If the goiter was due to a deficiency of iodine in the diet (not common in the United States), then you will be given iodine supplementation by mouth. This will lead to a reduction in the size of the goiter, but often the goiter will not completely resolve.

• If the goiter is due to Hashimoto’s Thyroiditis, and you are hypothyroid, you will be given thyroid hormone supplement as a daily pill. This treatment will restore your thyroid hormone levels to normal, but does not usually make the goiter go completely away. While the goiter may get smaller, sometimes there is too much scar tissue in the gland to allow it to get much smaller. However, thyroid hormone treatment will usually prevent it from getting any larger.
• If the goiter is due to hyperthyroidism, the treatment will depend upon the cause of the condition. For some causes of hyperthyroidism, the treatment may lead to a disappearance of the goiter. For example, treatment of Graves’ disease with radioactive iodine usually leads to a decrease or disappearance of the goiter.



• Most small- to moderate-sized goiters can be treated by providing thyroid hormone in the form of a pill. By supplying thyroid hormone in this fashion, the pituitary will make less TSH, which should result in stabilization in size of the gland. This technique often will not cause the size of the goiter to decrease but will usually keep it from growing any larger, just like the other methods. Patients who do not respond to thyroid hormone therapy are often referred for surgery if it continues to grow.
• A more common indication for surgical removal of an enlarged thyroid (goiter) is to remove glands that are enlarged enough to cause compression on other structures in the neck such as the trachea and esophagus. These patients will typically complain of a cough, a slight change in voice, or nighttime choking episodes because of the way the gland compresses the trachea while sleeping.



• Many goiters, such as the multinodular goiter, are associated with normal levels of thyroid hormone in the blood. These goiters usually do not require any specific treatment after the appropriate diagnosis is made. If no specific treatment is suggested, you may be warned that you are at risk for becoming hypothyroid or hyperthyroid in the future. However, if there are problems associated with the size of the thyroid per se, such as the goiter getting so large that it constricts your breathing (airways), your doctor may suggest that the goiter be treated by surgical removal.
• As always, suspicion of malignancy in an enlarged thyroid is an indication for removal of the thyroid. There is often a dominant nodule within a multinodular goiter that can cause concern for cancer. It should be remembered that the incidence of malignancy within a multinodular goiter is usually significantly less than 5%. If the nodule is cold on thyroid scanning, then it may be slightly higher than this. For the vast majority of patients, surgical removal of a goiter for fear of cancer is unwarranted.



• Another reason (although not a very common one) to remove a goiter is for cosmetic reasons. Often a goiter gets large enough that it can be seen as a mass in the neck. When other people begin to notice the mass, it is usually big enough to begin causing compression of other vital neck structures…but not always.
• Treatment for goiter may not be necessary if the goiter is small. Hypothyroidism should be treated, and this treatment often leads to a substantial reduction in the size of the goiter. Although removal of the goiter may be necessary if it causes difficulty with breathing or swallowing, there is now an alternative to surgery in large goiters.
• Radioiodine therapy with or without the pre-injection of a synthetic thyroid stimulating hormone, TSH, can relieve obstruction and reduce the size of the goiter by 30-65%. But removal of a goiter requires removing the thyroid. The complete removal of the thyroid gland removes the body’s ability to produce thyroid hormone. In this case, oral thyroxine supplements are necessary to avoid harm from hypothyroidism.

Symptoms of Goiters

Goiter symptoms may include:

• Enlargement of your thyroid gland, resulting in swelling of your neck.
• A tight feeling in your throat.
• Coughing.
• Difficulty swallowing.
• Difficulty breathing.

You may experience other signs and symptoms depending on the underlying cause of the goiter.

Causes of Goiters

One of the most common causes of goiter formation worldwide is iodine deficiency. While this was a very frequent cause of goiter in the United States many years ago, it is no longer commonly observed.

The primary activity of the thyroid gland is to concentrate iodine from the blood to make thyroid hormone. The gland cannot make enough thyroid hormone if it does not have enough iodine.

Iodine is necessary for the synthesis of the thyroid hormones triiodothyronine and thyroxine (T3 and T4). In conditions producing endemic goiter, when iodine is not available, these hormones cannot be made.

In response to low thyroid hormones, the pituitary gland releases thyroid stimulating hormone (TSH). Thyroid stimulating hormone acts to increase synthesis of T3 and T4, but it also causes the thyroid gland to grow in size by increasing cell division.

Therefore, with iodine deficiency, the individual will become hypothyroid. Consequently, the pituitary gland in the brain senses the thyroid hormone level is too low and sends a signal to the thyroid. This signal is called thyroid stimulating hormone (TSH).

The following is a list of causes or underlying conditions (both common and uncommon) that could possibly trigger goiter:

• Iodine deficiency.
• Hypothyroidism and hyperthyroidism (goiters can arise from both increased and reduced thyroid hormones).
• Autoimmune thyroid disease.
• Graves’ disease.
• Hashimoto’s thyroiditis.
• Thyroiditis.
• Thyroid cyst.
• Thyroid cancer.
• Puberty; can cause simple goiter.
• Pregnancy; can cause simple goiter.
• Certain foods; e.g., turnips.

Goiter is more common among women, but this includes the many types of goiter caused by autoimmune problems, and not only those caused by simple lack of iodine. In any case, now that you know most everything there is to know about goiters, your health will be safe once again. Just remember to make use of these tips and information before it’s too late.