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.
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, 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
Living in an area where people do not get enough iodine
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 large neck lump.
The swollen thyroid can put pressure on the windpipe and esophagus, which can lead to:
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
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
Support Groups:
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 .
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 Jan-Feb;12(1):63-102.
Ladenson P, Kim M. Thyroid. In: Goldman L and Ausiello D, eds. Goldman: Cecil Medicine. 23rd ed. Philadelphia, Pa:Saunders; 2007:chap 244.
Review Date: 6/17/2008 Reviewed By: Elizabeth H. Holt, MD, PhD, Assistant Professor of Medicine, Section of Endocrinology and Metabolism, Yale University. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
