Goiter - simple

Thyroid enlargement - scintiscan — This image shows enlargement of the thyroid gland and extension down behind the breastbone (retrosternal space). The image, called a scintiscan, was generated using a radioactive isotope.

Also known as: Simple goiter

Definition

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

Causes, incidence, and risk factors

There are different kinds of goiters. A simple goiter can occur for no known reason, or when the thyroid gland is not able to produce enough thyroid hormone to meet the body's needs. The thyroid gland makes up for this by becoming larger.

There are two types of simple goiter:

Endemic (colloid) goiter
Sporadic (nontoxic) goiter

Colloid goiters occur in groups of people who live in areas with iodine-poor soil. These regions are usually away from the sea coast. People in these communities might not get enough iodine in their diet (iodine is needed to produce thyroid hormone).

The use of iodized table salt in the United States today prevents iodine deficiency. However, the Great Lakes, Midwest, and inner mountain areas of the United States were once called the "goiter belt," because a high number of goiter cases occurred there. A lack of enough iodine is still common in central Asia, the Andes region of South America, and central Africa.

In most cases of sporadic goiter the cause is unknown. Occasionally, certain medications such as lithium or aminoglutethimide can cause a nontoxic goiter.

Inherited factors may cause goiters. Risk factors include:

Age over 40 years
Family history of goiter
Female gender
Not getting enough iodine in the diet

Symptoms

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

The swollen thyroid can put pressure on the windpipe and esophagus, which can lead to:

Breathing difficulties (may rarely occur with very large goiters)
Cough
Hoarseness
Swallowing difficulties

There may be neck vein swelling and dizziness when the arms are raised above the head.

Signs and tests

The doctor will feel your neck as you swallow. The doctor may be able to feel swelling in the area.

Tests that may be done include:

Free thyroxine (T4)
Thyroid scan and uptake
Thyroid stimulating hormone (TSH)
Ultrasound of thyroid

If nodules are found on ultrasound, a biopsy should be done to check for thyroid cancer.

Treatment

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

Treatments for an enlarged thyroid include:

Radioactive iodine to shrink the gland, particularly if the thyroid is producing too much thyroid hormone
Surgery (thyroidectomy) to remove all or part of the gland
Small doses of Lugol's iodine or potassium iodine solution if the goiter is due to iodine deficiency
Treatment with thyroid hormone supplements if the goiter is due to underactive thyroid

Expectations (prognosis)

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

Occasionally, a goiter may become toxic and produce thyroid hormone on its own. This can cause high levels of thyroid hormone, a condition called hyperthyroidism.

Complications

Difficulty swallowing or breathing
Hypothyroidism
Hyperthyroidism
Thyroid cancer
Toxic nodular goiter

Calling your health care provider

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

Prevention

The use of iodized table salt prevents endemic colloid goiter.

References

Vanderpas J. Nutritional epidemiology and thyroid hormone metabolism. Ann Rev Nutr. 2006; 26:293-322.

AACE/AME. American Association of Clinical Endocrinologists and Associazione Medici Endocrinologi medical guidelines for clinical practice for the diagnosis and management of thyroid nodules. Endocr Pract. 2006;12(1):63-102.

Ladenson P, Kim M. Thyroid. In: Goldman L and Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders; 2007:chap 244.

Schlumberger MJ, Filetti S, Hay ID. Nontoxic diffuse and nodular goiter and thyroid neoplasia. In: Kronenberg HM, Melmed S, Polonsky KS, Larsen PR, eds. Williams Textbook of Endocrinology. 11th ed. Philadelphia, Pa: Saunders Elsevier;2008:chap 13.

Review date:: May 10, 2010
Reviewed by:: Ari S. Eckman, MD, Division of Endocrinology and Metabolism, Johns Hopkins School of Medicine, Baltimore, MD. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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