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Page Contents:
 
1. What is a goiter?
2. Causes
3. How the thyroid is regulated
4. symptoms of goiter
5. When should I see my doctor?
6. How common is goitre?
7. Is goitre inherited
8. Diagnosis
9. Treatment
10. How common is goiter?
11. Sources and references
A goitre is a lump or swelling at the front of the neck caused by a swollen thyroid. The thyroid is a small gland in your neck that makes hormones. Goitres are not usually serious but should be checked by a Doctor.

What is a goiter?

A goiter is an enlarged thyroid gland.
 
The thyroid is a butterfly shaped gland situated in front of the windpipe. It is responsible for producing and secreting hormones that regulate growth and metabolism.
 
Most cases of a goiter are categorized as “simple” goiters. These do not involve inflammation or any detriment to thyroid function, produce no symptoms, and often have no obvious cause.
 
Some people experience a small amount of swelling. Others can have considerable swelling that constricts the trachea and causes breathing problems.
 
An enlarged thyroid does not necessarily mean that the thyroid gland is working incorrectly. A person with a goiter may have a thyroid gland that is:
 
*creating too much hormone, known as hyperthyroidism
*creating too little hormone, known as hypothyroidism
*creating the typical amount of hormone, known as euthyroidism

Goiters are more commonTrusted Source in females than males, especially after menopause. Goiters and thyroid disease are generally more common after the age of 40.

Causes

There are a range of possible causes of a goiter, including:
 
_Iodine deficiency
 
The most common cause of goiters outside the United States is a lack of iodine in the diet. The thyroid needs iodine to create thyroid hormones, which regulate metabolism. A lack of iodine is uncommon in the U.S., as manufacturers add iodine to salt and other foods.
 
As iodine is less commonly found in plants, vegan diets may lack sufficient iodine. This is less of a problem for vegans who live in countries where manufacturers add iodine to salt.
 
Dietary iodine is found in:
 
*seafood
*plant foods grown in iodine-rich soil
*cow’s milk
 
In some parts of the world, the prevalence of goiters can be as high as 80%. This includes remote mountainous areas of Southeast Asia, Latin America, and central Africa.
 
_Hypothyroidism
 
Hypothyroidism is the result of an underactive thyroid gland. When the gland produces too little thyroid hormone, it is stimulated to produce more, leading to swelling.
 
This usually results from Hashimoto’s thyroiditis, a condition in which the body’s immune system attacks its own tissue and causes inflammation of the thyroid gland.
 
_Hyperthyroidism
 
Hyperthyroidism, or an overactive thyroid gland, is another cause of goiters. In people with this condition, the thyroid produces too much thyroid hormone.
 
This usually happens as a result of Graves’ disease, an autoimmune disorder where the body’s immunity turns on itself and attacks the thyroid gland, causing it to swell.
 
_Other causes
Less common causes of goiters include the following:
 
*Smoking: Thiocyanate in tobacco smoke interferes with iodine absorption and can cause enlargement of the thyroid gland.
*Hormonal changes: Pregnancy, puberty, and menopause can affect thyroid function.
*Thyroiditis: Inflammation caused by infection, for example, can lead to goiter.
*Lithium: This psychiatric drug can interfere with thyroid function.
*Too much iodine: This can trigger a swollen thyroid.
*Radiation therapy: This also can trigger a swollen thyroid, particularly when administered to the neck.
*Thyroid cancer: This is more common Trusted Source in females.
 
People over the age of 40 are at greater risk of goiters, as are people with a family history of the condition.

How the thyroid is regulated

The pituitary gland and hypothalamus control the rate at which T-4 and T-3 are produced and released.
 
The hypothalamus is a specialized region at the base of the brain. It acts as a thermostat for maintaining balance in multiple body systems. The hypothalamus signals the pituitary gland to make a hormone known as thyroid-stimulating hormone (TSH).
 
The pituitary gland — located below the hypothalamus — releases a certain amount of thyroid-stimulating hormone (TSH), depending on how much T-4 and T-3 are in the blood. The thyroid gland, in turn, regulates its production of hormones based on the amount of TSH it receives from the pituitary gland.

What are the symptoms of goiter?

The size of a goiter can range from very small and barely noticeable to very large. Most goiters are painless, but if you have thyroiditis (an inflamed thyroid gland), it can be painful.
 
The main symptoms of goiter include:
 
*A lump in the front of your neck, just below your Adam’s apple.
*A feeling of tightness in your throat area.
*Hoarseness (scratchy voice).
*Neck vein swelling.
*Dizziness when you raise your arms above your head.

Other, less common symptoms include:
 
*Difficulty breathing (shortness of breath).
*Coughing.
*Wheezing (due to squeezing of your windpipe).
*Difficulty swallowing (due to squeezing of your esophagus).

Some people who have a goiter may also have hyperthyroidism (overactive thyroid). Symptoms of hyperthyroidism include:
 
*Rapid heart rate (tachycardia).
*Unexplained weight loss.
*Diarrhea.
*Sweating without exercise or increased room temperature.
*Shaking.
*Agitation.

Some people with goiter may also have hypothyroidism (underactive thyroid). Symptoms of hypothyroidism include:
 
*Fatigue (feeling tired).
*Constipation.
*Dry skin.
*Unexplained weight gain.
*Abnormal menstruation (periods).

When should I see my doctor?

See a doctor if you see or feel a lump at the base of your neck, or if you have any of the other symptoms of goitre.

How common is goitre?

Worldwide, goitre is estimated by the World Health Organization to affect around 12% of people, although the rate of goitre in Europe as a whole is slightly lower. Goitre affecting a particular area (endemic) occurs in areas where there is iodine deficiency and is defined when more than 1 in 10 people have goitre.

Is goitre inherited?

Some forms of goitre can be inherited. There is some evidence that the presence of goitre in one family member increases the chances of other family members having goitre.

Diagnosing a goitre

Examination by a doctor

This is done to determine if a neck swelling arises from the thyroid, or from another structure in the neck.
 
 

Blood tests

When you have a goitre, a doctor will usually do some blood tests to check if you are making too much or too little thyroxine (T4) or triiodothyronine (T3). Blood tests may also help to find out the cause of some goitres. See the separate leaflet called Thyroid function tests.
 
 

Ultrasound scan

An ultrasound scan of the thyroid. This is the best test for thyroid swellings. An ultrasound scan is a safe and painless test which uses sound waves to create images of organs and structures inside your body. It can tell if a nodule is a cyst or a solid lump. See the separate leaflet called Thyroid Scans and Uptake Tests.
 
 

Biopsy

A small piece of tissue (a biopsy) may be taken from a nodule to look at under the microscope. The biopsy is done by inserting a thin needle into the nodule. It is a simple and safe procedure. The specialist doing the biopsy can see where they are inserting the needle by doing an ultrasound scan at the same time.
 

Other tests

Occasionally other specialist blood tests are needed to help establish the cause. Occasionally a computerised tomography (CT) scan or a magnetic resonance imaging (MRI) scan is needed.

Treatment of goitre

Most simple goiters are preventable through adequate intake of iodine, which is added to table salt in many countries. A range of iodine supplements are also available in health stores.
 
Medical professionals reserve active treatment of goiters for cases that cause symptoms. If the goiter is small and thyroid function is normal, people do not typically need treatment.
 
 

Hypothyroidism

In cases caused by an underactive thyroid, or hypothyroidism, treatment is a synthetic replacement of thyroid hormone.
 
A doctor will gradually increase the dosage of synthetic thyroxine (T4) until their measurements indicate that the person’s normal thyroid function has been restored.
 

Hyperthyroidism

In goiters caused by an overactive thyroid, or hyperthyroidism, treatment aims to counter the excess hormone production.
 
For instance, antithyroid drugs, such as thionamide drugs, gradually reduce excessive hormone levels.
 
Another option is radioactive iodine to decrease thyroid function and stop hormone production.
 

Goiter surgery

Doctors will reserve surgery to reduce the size of the swelling for cases where the goiter is causing troublesome symptoms, such as difficulty breathing or swallowing.
 
Surgeons will usually perform thyroidectomies, the removal of part or all of the thyroid gland, when the person is under general anesthetic.

How common is goiter?

Goiters are relatively common. They affect about 5% of people in the United States.
 
The most common cause of goiters worldwide is iodine deficiency, which affects an estimated 2.2 billion people.
 
The more severe the iodine deficiency, the more likely someone is to have goiter:
 
_With mild iodine deficiency, the incidence of goiter is 5% to 20%.
_With a moderate iodine deficiency, the prevalence increases to 20% to 30%.
_With severe iodine deficiency, the incidence increases to greater than 30%.
Sources and references
 
https://www.nhs.uk/conditions/goitre/
https://my.clevelandclinic.org/health/diseases/12625-goiter
https://www.ncbi.nlm.nih.gov/books/NBK562161/
https://www.yourhormones.info/endocrine-conditions/goitre/
https://www.medicalnewstoday.com/articles/167559#treatment
https://www.healthdirect.gov.au/goitre
Estecharat/2MDOpinion

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