What Is Goiter?
Health ConditionsThyroid Disease

What Is Goiter?

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Updated on November 27, 2024
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A goiter is an enlarged thyroid gland and can occur for several reasons. It doesn’t always affect hormone levels, and treatment isn’t always necessary. But medications, iodine, and surgery can treat goiters effectively if you need it.

Overview

What Is Goiter?

A goiter is an abnormal enlargement of the thyroid gland. This butterfly-shaped organ at the base of your neck releases hormones that control how well your body turns food into energy as well as the speed at which your heart, muscles, brain, liver, and other organs work.

 The whole gland might grow if a goiter develops, or you might develop small lumps on the thyroid called nodules.

A goiter doesn't always mean your thyroid gland isn’t working properly. A goiter may grow if your thyroid gland is making too much of its hormones (hyperthyroidism), too little of them (hypothyroidism), or a normal amount (euthyroidism).

Types of Goiter

Doctors define goiters differently, depending on how they grow and whether they occur alongside irregular thyroid hormone levels.

The different types a doctor bases on growth patterns include:

  • Simple or diffuse goiter: The entire thyroid grows. This type of goiter feels smooth to touch.
  • Nodular goiter: This occurs when a lump or nodule grows in the thyroid, giving it a lumpy texture. The lump may be solid or contain fluid.
  • Multinodular goiter: A doctor diagnoses this type when several thyroid nodules grow. You might be able to see them, or they may only become obvious during a scan or doctor’s examination.

A diagnosis might also refer to whether a goiter is toxic or nontoxic. A toxic goiter occurs alongside high thyroid hormone levels, while a nontoxic goiter develops at the same time as normal thyroid hormone levels.

A goiter might fit more than one category, which may point to certain causes or conditions. For example, a goiter might be both diffuse and toxic, meaning the whole thyroid enlarges and thyroid hormone levels increase. This can be a sign of Graves’ disease, which is when the immune system attacks the thyroid gland and causes it to produce too much thyroid hormone.

Signs and Symptoms of a Goiter

Most people with a goiter don’t notice any symptoms other than swelling at the bottom of the neck.

 Often, a doctor finds a small goiter only while testing for another condition.

Other symptoms of a goiter may include:

  • A tight feeling in the throat
  • A swollen neck vein
  • Dizziness when raising the arms over the head
  • Hoarseness

Less often, a person with a goiter might experience:

  • Coughing
  • Difficulty breathing
  • Difficulty swallowing

Sometimes, a person with a goiter has an overactive or underactive thyroid, which causes its own symptoms. An underactive or overactive thyroid may not be occurring directly because of the goiter, but they can give doctors a clue as to the cause of it. Symptoms of hyperthyroidism include:

  • A very fast heart rate
  • Agitation
  • Diarrhea
  • Sweating
  • Shaking
  • Unexpected, unwanted, or unexplained weight loss

  • Heat intolerance
  • Insomnia

Hypothyroidism can lead to the following symptoms:

  • Constipation
  • Dry skin
  • Extreme tiredness
  • Irregular or abnormal periods
  • Unexpected, unwanted, or unexplained weight gain

  • Cold intolerance

Causes and Risk Factors of Goiter

A goiter is the way thyroid cells respond to bodily processes or diseases that disrupt thyroid hormone production.

Iodine deficiency is the most common cause of goiters worldwide. The thyroid needs the mineral iodine to produce thyroid hormones, and with insufficient dietary iodine intake, levels of this type of hormone start to drop. This drop causes levels of thyroid-stimulating hormones from the pituitary gland to rise, leading the thyroid to grow diffusely into a goiter.

Around 2.2 billion people don’t get enough iodine in their diet.

 But this problem isn’t as common in the United States, where manufacturers often add iodine to salt.

Other common causes of goiters include:

  • Graves’ Disease In Graves' disease, your immune system mistakenly attacks your thyroid gland.

     This causes the thyroid to produce too much of its hormones. Diffuse toxic goiters are the types of goiters usually caused by this disease.

  • Hashimoto’s Disease This autoimmune disease damages your thyroid, causing it to produce too little of its hormones.

     This can also result in a goiter that grows gradually.

     A goiter due to Hashimoto’s disease may shrink after a few years due to thyroid damage.

  • Thyroid Cancer Diffuse nontoxic goiters can develop into thyroid cancer. But thyroid cancer can also lead to an enlarged thyroid.

  • Pregnancy The thyroid might grow around 10 to 15 percent during pregnancy, according to the American Thyroid Association.

     But this is more common in parts of the world where people do not get enough iodine.

  • Thyroiditis This is inflammation of the thyroid gland, which can cause it to enlarge, potentially leading to pain around the thyroid area and a goiter. Hashimoto’s disease is a type of thyroiditis.

You have a higher risk of developing a goiter if you:

  • Are female

  • Have a family history of autoimmune diseases or goiters, as it can pass down in families

  • Are 40 years of age or older
  • Have ever received radiation therapy in your neck or chest area or underwent radiation therapy as a child
  • Are experiencing pregnancy or menopause
  • Take certain medicines, including the heart drug amiodarone (Cordarone or Pacerone), or the psychiatric drug lithium (Lithobid)

  • Eat a vegan diet, as eggs, seafood, milk, and dairy products are among the best dietary sources of iodine

How Is a Goiter Diagnosed?

To diagnose a goiter, your doctor may simply feel your neck and ask you to swallow while monitoring your response.

Other ways to diagnose a goiter include:

  • Ultrasound: This imaging test lets your doctor see the size of your thyroid gland and determine whether it contains any nodules.
  • Thyroid scan: This imaging test provides information about the size and function of your thyroid gland, as well as showing any nodules that may not be visible during physical examination.

Additional tests might be performed to assess the significance of the goiter, such as:

  • Thyroid hormone test: This is a blood test that, as the name implies, measures your thyroid’s hormone levels.
  • Antibody test: This blood test measures abnormal antibodies the immune system produces in relation to some types of goiters.
  • MRI or CT scan: These imaging tests may be used if your goiter is especially large or has spread into the chest.
  • Biopsy: This procedure involves inserting a needle into your thyroid gland to obtain a tissue or fluid sample. A lab technician examines this sample under a microscope or uses other tests to rule out thyroid cancer.

Goiter Treatment

Treatment for your goiter will depend on its size, its causes, and your symptoms.

Your doctor may decide not to treat your goiter if it's small and doesn't bother you.

 They refer to this as “watchful waiting.” Your doctor will closely monitor your condition in case the goiter grows or changes.

If you do need treatment, your options may include the following.

Medications

Your doctor may tell you to take aspirin or prescribe a corticosteroid if you have thyroiditis. If you have hypothyroidism (underactive thyroid), you may need to take thyroid medications like levothyroxine (Levothroid, Synthroid) to replace the hormones you're lacking.

If you have hyperthyroidism (an overactive thyroid), you may need to take drugs like methimazole (Tapazole) and propylthiouracil to return levels to normal.

Surgery

Your doctor may recommend thyroidectomy, a surgical procedure to remove all or part of your thyroid gland.

Surgery is often recommended if your goiter is very large, if it causes difficulty breathing or swallowing, if nodules are present, or if your thyroid is overactive. If a surgeon removes your thyroid, you’ll need to supplement your thyroid hormones for the rest of your life.

Radioactive Iodine

This treatment, which you take by mouth, can shrink the size of your goiter if you have an overactive thyroid. The thyroid directly absorbs the iodine, destroying thyroid cells and shrinking the gland. As with surgery, people who receive radioactive iodine might need to supplement their thyroid hormones long-term.

Prevention of Goiter

You can prevent goiters related to iodine deficiency. This is rarely a problem in the United States.

 Iodine-rich foods may prevent iodine deficiency. We’ve listed these in the Lifestyle Changes for Goiter section below.

Lifestyle Changes for Goiter

Depending on the condition, the following adjustments might help you manage symptoms that may develop alongside a goiter.

Make Changes to Your Diet and Nutrition Intake

According to the Office of Dietary Supplements, eating the following iodine-rich foods may help to prevent iodine deficiency, including:

  • White or whole-wheat bread enriched with iodate dough conditioner
  • Baked cod
  • Dried nori seaweed
  • Cooked oysters
  • Plain nonfat Greek yogurt
  • Nonfat milk
  • Iodized table salt
  • Cooked fish sticks
  • Hard-boiled egg
  • Enriched pasta boiled in iodized salt water
  • Chocolate ice cream
  • Cheddar cheese
  • Cooked beef liver
  • Cooked shrimp
  • Canned tuna in water
Excess iodine may increase levels by too much, contributing to rather than preventing goiters. The availability of iodized salt usually does a great job of reducing the risk, leading to lower rates in the United States than in countries where it is not available. Iodine intake from food is unlikely to provide more than 1,100 micrograms (mcg) of iodine, the safe upper limit of daily iodine intake.

Avoid adding extra iodine to the diet unless a doctor advises it. If you live in the United States, you probably get enough through your diet. Eating large amounts of foods like soy might interfere with how your body absorbs thyroid hormones, so if you have hypothyroidism, you may need to limit your intake.

Get Regular Exercise

If you have a goiter along with hypothyroidism or hyperthyroidism, you may need to adjust your approach to exercise. But it's also important to note that regular physical activity is still vital for health and may help you reduce the impact of some symptoms.

According to Cleveland Clinic, people living with hyperthyroidism should avoid exercise until medications are having an impact on their thyroid hormone levels. Making the body work too hard too soon after hyperthyroidism might risk dangerous overheating and heart failure. But once you have levels under control, you can safely exercise again, and it may also help to improve the symptoms you still get.

With hypothyroidism, fatigue, constipation, and weight gain are typical and may not improve after controlling levels using medication. Regular exercise like yoga may help you to control these symptoms and boost energy. Aim to get 150 to 300 minutes of moderate-intensity exercise or 75 to 150 minutes of vigorous exercise weekly.

Set and Stick to a Sleep Schedule

If you have a goiter due to thyroid issues, you might also find you experience disrupted sleep. Taking certain steps to manage your nighttime routine may help you get a more restful sleep.

For example, setting a comfortable bedroom temperature can help people with hyperthyroidism adapt to night sweats or those with hypothyroidism stay warm, as they may not tolerate the cold well. Practicing a restful bedtime routine can help to protect your sleep schedule, such as limiting phone use in the hour before bedtime, unwinding to chilled-out music, or taking part in some light stretching.

Goiter Prognosis

The outlook of a goiter depends on the underlying cause and its type.

 A simple goiter might grow but often gets better without treatment. Surgery may only be necessary if a doctor identifies a cancerous cause or if it keeps growing. Over time, goiters can reduce how much thyroid hormone the gland makes, leading to hypothyroidism. It might also start to directly make thyroid hormone by itself, which means it has become toxic. This can lead to hyperthyroidism.

If the goiter is a symptom of underlying health problems, like Graves’ disease or Hashimoto’s thyroiditis, the outlook depends on the condition that has caused the goiter and why that condition has developed.

Complications of Goiter

Many associated conditions of goiters, like hypothyroidism, hyperthyroidism, and nodule growth, aren’t technically complications. But a goiter may lead to the following health problems without treatment.

  • The goiter may grow large enough to press on the windpipe, causing breathing difficulties.
  • The Jod-Basedow phenomenon may develop, which is when a person with a goiter develops hyperthyroidism if they consume too much iodine.
  • Bleeding or tissue death might occur inside a nodule.

Research and Statistics: How Many People Have Goiters?

Goiters are common, with around 5 in every 100 people in the United States developing one.

 Worldwide, around 5 to 20 percent of people with mild iodine deficiency develop goiter. This increases to 20 to 30 percent in people with moderate iodine deficiency and over 30 percent in those with severe iodine deficiency.
Around four times as many females as males develop goiter.

Related Conditions to Goiter

As an overgrown thyroid, goiter has close links to both hyperthyroidism, often resulting from Graves’ disease, and hypothyroidism, which commonly results from Hashimoto’s thyroiditis. Thyroid cancer also has a close relationship with goiters.

Support for People With Goiter

While goiters might not cause symptoms for some people, its related conditions can severely impact people’s lives. Here are some support groups and resources for people with conditions linked to goiter.

Graves Disease & Thyroid Foundation

This nonprofit connects people with Graves’ disease and other thyroid disorders to resources and information about symptom recognition and treatment programs.

ThyCa: Thyroid Cancer Survivors’ Association

This volunteer-run nonprofit offers support and information to people who have lived through thyroid cancer, as well as their families. A medical advisory council of leading thyroid cancer specialists guides the organization.

The Takeaway

  • A goiter is an enlarged thyroid, and its impact on daily life depends on its underlying cause, what type of goiter it is, and how severe its symptoms are.
  • But a goiter is treatable, and it often gets better without any treatment at all.
  • If you have swelling at the base of your neck, chat with a healthcare professional about ruling out goiters and other thyroid problems.

Common Questions & Answers

What is the best treatment for a goiter?
The best treatment for a goiter depends on the cause. A goiter sometimes doesn’t need any treatment. If it occurs along with symptoms of an overactive or underactive thyroid, medications might be necessary to boost or suppress thyroid hormone levels. Particularly large goiters or those containing nodules or signs of cancer may need surgery to remove the goiter.
A goiter may get better without treatment. But the thyroid sometimes shrinks back down because of tissue damage, such as with Hashimoto’s disease. In these instances, thyroid hormone levels might become too low, and medication may be necessary to treat the goiter. A doctor may monitor a goiter with “watchful waiting” to see if it shrinks by itself or needs treatment.
Medications, radioactive iodine treatment, or surgical removal may stop a goiter from growing, depending on the cause.
A goiter is how thyroid cells respond to thyroid-hormone-disrupting processes. Iodine deficiency is the most common cause worldwide, but not in the United States. Graves’ disease, thyroid cancer, and Hashimoto’s disease are also linked to goiter development, as are hormone changes during pregnancy and thyroiditis.

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Anna L. Goldman, MD, is a board-certified endocrinologist. She teaches first year medical students at Harvard Medical School and practices general endocrinology in Boston.

Dr. Goldman attended college at Wesleyan University and then completed her residency at Icahn School of Medicine at Mount Sinai Hospital in New York City, where she was also a chief resident. She moved to Boston to do her fellowship in endocrinology at Brigham and Women's Hospital. She joined the faculty after graduation and served as the associate program director for the fellowship program for a number of years.

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