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Today in Health & Wellness
HEALTH HINTS

The 411 on Goiter

By: Gwen Y. Reyes-Amurao, M.D.The 411 on Goiter

Goiter is an abnormal enlargement of the thyroid gland, which is a butterfly-shaped organ located at the base of your neck. According to the American Thyroid Association, the presence of goiter does not necessarily mean that the thyroid gland is malfunctioning. It can occur in a gland that is producing too much of the thyroid hormone, too little of it or even just the right amount of hormones, conditions that are respectively known as hyperthyroidism, hypothyroidism, and euthyroidism. A goiter simply means that there is a condition present which is causing the thyroid to grow abnormally.

Signs and Symptoms

Aside from having an enlarged thyroid, signs, and symptoms may or may not be present depending on the condition that may come along with it but may include:

  • A tight feeling in your throat
  • Coughing
  • Hoarseness
  • Difficulty swallowing
  • Difficulty breathing

Some of these symptoms may be experienced once the thyroid has enlarged greatly and deeper into the layers of the neck.

Causes

The American Thyroid Association mentions several underlying causes of goiter, the most common of which is iodine deficiency. Since the main purpose of the thyroid gland is to concentrate iodine from the blood to produce the thyroid hormone, not having enough iodine can lead to hypothyroidism. Consequently, the pituitary gland in the brain senses the low levels of the thyroid hormone level and sends a signal to the thyroid to produce more hormones. This signal is known as the Thyroid Stimulating Hormone or TSH. When the gland is constantly triggered to produce the hormone, it eventually grows in size and is thus termed goiter. Other common causes of goiter include:

  • Graves' disease. A goiter can sometimes occur when your thyroid gland produces too much thyroid hormone (hyperthyroidism). In Graves' disease, antibodies produced by your immune system mistakenly attack your thyroid gland, causing it to produce excess thyroxine. This overstimulation causes the thyroid to enlarge.
  • Hashimoto's disease is an autoimmune disorder. But instead of causing your thyroid to produce too much hormone, Hashimoto's damages your thyroid so that it produces too little.
  • Multinodular goiter is a condition wherein several solid or fluid-filled lumps called nodules develop in both sides of your thyroid, resulting in overall enlargement of the gland.
  • Solitary thyroid nodule happens when a single nodule develops in one part of your thyroid gland. Most nodules are noncancerous (benign) and don't lead to cancer.
  • Thyroid cancer is far less common than benign thyroid nodules. A biopsy of a thyroid nodule is very accurate in determining if it's cancerous.
  • Pregnancy. A hormone produced during pregnancy, human chorionic gonadotropin (HCG), may cause your thyroid gland to enlarge slightly.
  • Inflammation or Thyroiditis is an inflammatory condition that can cause pain and swelling in the thyroid and may also cause an over- or underproduction of thyroxine.

Risk factors

The following are important factors that can predispose a person to goiter

  • A lack of dietary iodine
  • Being female
  • Goiters are more common after age 40
  • A personal or family history of autoimmune disease increases your risk
  • Pregnancy and menopause
  • Certain medications such as amiodarone and lithium
  • Radiation exposure to the chest or neck area

Treatment

The Mayo Clinic stresses the following treatment plans, based on the underlying cause and the existing signs and symptoms of an individual:

  • Medications. If you have hypothyroidism, thyroid hormone replacement with levothyroxine can help resolve the symptoms of hypothyroidism as well as slow the release of thyroid-stimulating hormone from your pituitary gland, which can lead to a decrease in the size of the gland. For goiters associated with hyperthyroidism, medications to normalize hormone levels may be needed, while corticosteroids can be advised for those with inflammation.
  • Surgery. Removing all or part of your thyroid gland (total or partial thyroidectomy) is an option if you have a large goiter that is uncomfortable or causes difficulty breathing or swallowing, or in some cases, if you have a nodular goiter causing hyperthyroidism. Surgery is also the treatment for thyroid cancer.
  • Radioactive iodine. In some cases, radioactive iodine is used to treat an overactive thyroid gland. The radioactive iodine is taken orally and reaches your thyroid gland through your bloodstream, destroying thyroid cells. The treatment results in the diminished size of the goiter, but eventually may also cause an underactive thyroid gland.

On the other hand, a specialist may not recommend any form of treatment at all, especially if the enlargement is not that large or is not really causing any urgent symptoms that need to be addressed. If the thyroid is functioning normally, the doctor may suggest a wait-and-see approach with constant monitoring of the gland enlargement.

Before any form of treatment can be discussed, make sure to see your specialist if you feel you experience any of the above signs and symptoms, then have the necessary diagnostic procedures or thyroid function tests done in order to identify the cause of the enlargement. Once the cause is identified, treatment can immediately be done, and further progression and secondary prevention can be achieved later on. 

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