Goiter (Enlarged Thyroid): Types, Symptoms, Causes and Treatment

Overview

Goiter is a condition of the thyroid gland, a butterfly-shaped gland present below Adam’s apple. In goiter, the thyroid gland enlarges for numerous reasons and is usually painless. However, in certain rare cases, it can lead to difficulty in swallowing and breathing. 

This blog delves deep into various aspects of goiter, its causes, symptoms, diagnosis, and treatment. 

What is a goiter?

As mentioned above,  goiter is an enlargement of the thyroid gland. It can cause difficulty swallowing and breathing. 

The function of thyroid gland is to produce hormones that support metabolism and other vital physical functions like body temperature, heart rate and digestion.

A goiter can either be the result of irregular cell growth which forms one or more nodules (lumps) in the thyroid, or could be an overall enlargement of the thyroid gland. A goiter may not be connected to any change in the thyroid function or with a decrease or increase in the thyroid hormones.

What are the different types of goiters?

It can be categorized based on the way it grows and the levels of hormones produced by the thyroid glands. The different types are based on the size of the gland:

• Simple goiter: It occurs when the entire thyroid gland swells and is smooth to touch.
• Nodular goiter: When a nodule, a solid or fluid-filled lump, develops with the thyroid gland, it results in nodular goiter. It is lumpy to touch.
• Multinodular goiter: as the name suggests, this form of goiter may have multiple nodules present in the thyroid gland . These can either be visible or revealed through examination.

The following are a few forms of goiter based on the levels of hormones:

• Toxic goiter: It occurs when the thyroid gland enlarges and also produces abnormally high levels of hormones
• Nontoxic goiter: it is a condition when the enlarged thyroid gland  produces normal levels of hormones. Therefore, it is a nontoxic goiter. 

What are the causes of goiter?

• Iodine deficiency: Thyroid gland needs iodine to produce hormones. Iodine deficiency is the most prevalent cause of goiters worldwide
• Graves’ disease: It is a condition in which a person’s own  immune system attacks the thyroid gland, leading to the overproduction of hormones. Due to this, the thyroid gland may swell
• Thyroid cancer: Cancer of the thyroid gland can cause the organ to increase in size Hashimoto’s thyroiditis: It’s an autoimmune condition that causes the thyroid gland to generate insufficient hormones, leading to goiter
• Pregnancy: Hormones produced by women during pregnancy can cause the thyroid gland to enlarge
• Thyroiditis: This condition causes inflammation of the thyroid gland, which can lead to its enlargement

Who is at risk of developing goiter?

Everyone is at risk of developing goiter. However, women are four times more prone to developing goiter than men. Also, an individual is at risk if:

• Have family history of thyroid cancer, nodules and other health issues that affect the thyroid
• Iodine deficiency 
• Condition that reduces the iodine in the body
• Age over 40 years old individuals
• Pregnancy 
• Obesity
• Insulin resistance
• Metabolic syndrome
• Radiation exposure

What are the symptoms of goiter?

The position or size of a goiter can obstruct the voice box and airway. Symptoms may include:

1. Cough,
2. Difficulty breathing with exertion 
3. Difficulty swallowing
4. Snoring
5. Hoarseness
6. Swelling of neck vein
7. Swollen neck base 
8. Feeling dizzy when the arms are stretched over the head

In certain cases, the goiter may develop without causing any symptoms.

A goiter that causes an under active or overactive thyroid gland would lead to symptoms of hyper or hypothyroidism. These include:

Hyperthyroidism (Overactive thyroid)

Symptoms of hyperthyroidism include:

1. Tachycardia (Rapid heartbeat)
2. Tremors
3. Weight loss
4. Nervousness and irritability 
5. Increased sensitivity to heat
6. Excess sweating
7. Frequent bowel movements
8. Muscle weakness
9. Sleep difficulty
10. Changes in menstrual patterns
11. Increased appetite
12. High blood pressure

Hypothyroidism (Underactive thyroid)

Symptoms of hypothyroidism include:

1. Constipation 
2. Fatigue
3. Increased sleepiness 
4. Increased sensitivity to cold
5. Problems with memory or concentration
6. Dry skin
7. Muscle weakness

When to seek medical help?

A person should seek medical help if new symptoms develop.

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How is a goiter diagnosed?

The doctor may examine the patient’s neck and ask to swallow while observing the response to diagnose a goiter. Other methods for determining the presence of goiter include:

• Hormone test: A blood test helps measure the thyroid hormone levels and can give a clear picture of whether the thyroid gland of the patient is functioning normally. 
• Antibody test: If the patient has a genetic tendency to autoimmune thyroid disease, this blood test will detect these antibodies.
• Ultrasound: This imaging test allows the doctor to assess the size of the patient’s thyroid gland and notice the presence of any nodules if any .
• Thyroid scan: If the goiter is exceptionally large or has spread into the patient’s chest, then he/she may need an MRI or CT scan. 
• Biopsy: A needle is inserted into the patient’s thyroid gland to obtain a tissue or fluid sample, which is subsequently inspected under a microscope or submitted to additional tests.

What are the treatment options for goiter?

The doctor determines the treatment options based on the size, cause, and symptoms. Sometimes the goiter may not bother the patient, the doctor may recommend close monitoring to check if it develops or if there are any changes. If the patient does require therapy, the following are the options:

Medications

The doctor may recommend levothyroxine, a thyroid hormone replacement therapy, for an underactive thyroid. Other medications such as methimazole and propylthiouracil are recommended for overactive thyroid. A healthcare provider may also prescribe aspirin or a corticosteroid medication if the condition is due to inflammation.

Radioactive Iodine Treatment

This is used for an overactive thyroid gland. Patients are prescribed to take radioactive iodine orally to eliminate the thyroid cells, thus shrinking the gland. After the treatment, the patient may be on a lifelong thyroid hormone treatment.

Surgery

The healthcare provider may recommend surgery to remove all or a part of the thyroid gland, nodules, or cancer. Also, if  the goiter is larger and is causing breathing or swallowing issues, the doctor may advise surgery. After the procedure, the patient requires to be on hormone replacement therapy, for life. 

What are the preventive measures of goiter?

Only simple goiter, due to iodine deficiency, can be prevented. A patient with a simple goiter should include fish, dairy, and a healthy amount of iodised table salt to prevent simple goiter. It is vital to keep in mind to avoid iodine supplements as they do more harm than good.

Conclusion

The thyroid is a vital organ that is crucial for the proper functioning of the body. Goiter is treatable and sometimes reduces on its own. It is essential to diagnose the type of goiter.