Irregular growth of the thyroid gland is called goiter. The thyroid is a small butterfly-shaped organ located at the neck base below the Adam’s apple. While goiter may be an overall enlargement of the thyroid gland, it may result or irregular cell growth that often forms either one or more nodules (lumps). The goiter can be associated with no thyroid function changes or an increase or decrease in thyroid hormones.
One of the most common causes of goiter worldwide is a lack of iodine in the diet. That’s why in the U.S. the use of iodized salt is common and goiters usually occur due to other conditions or factors that negatively affect the thyroid.
The treatment depends on several factors. For example symptoms, the goiter cause, complications, and others. Small goiters commonly do not cause symptoms and do not require treatment.
Symptoms
While some people with goiter do not experience symptoms, others may experience other symptoms than a swelling at the neck base. Commonly, the goiters are small and found accidentally during a routine medical examination or an imaging test for other health problems. Other symptoms that may occur in people with this condition depend on the thyroid function changes, how fast it grows, and whether it obstructs breathing.
Hypothyroidism (underactive thyroid gland)
- Extreme tiredness (fatigue)
- Drowsiness
- Increased sensitivity to cold
- Dry skin
- Constipation
- Muscle weakness
- Difficulty concentrating and memory problems
Hyperthyroidism (overactive thyroid gland)
- Weight loss
- Increased heat sensitivity
- Excessive sweating
- Tremors
- Irritability and nervousness
- Muscle weakness
- Menstrual cycle changes
- Sleeping disturbances (insomnia)
- Hypertension (high blood pressure)
- Increased appetite
- Tachycardia (fast heartbeat)
- Frequent bowel movements
Check below some symptoms of hyperthyroidism in children:
- Behavioral changes
- Bone growth
- Fast growth in height
Obstructive Goiter
Obstruction of the airway and voice box may occur depending on the goiter’s size and position. Check below some symptoms:
- Cough
- Hoarseness
- Snoring
- Difficulty breathing with exertion
- Swallowing problems
Do not hesitate to see a doctor if you experience symptoms that bother you.
Causes
There are multiple factors that affect thyroid function and may result in goiter. Examples include:
- Iodine deficiency – An essential mineral that helps the thyroid gland produce hormones is iodine. When a person does not get enough dietary iodine, it may lead to reduced thyroid hormone production causing the pituitary gland to signal the thyroid to produce more hormones. As a result, the thyroid gland may grow. In the U.S. this is an uncommon cause of goiter because of iodine added to table salt.
- Hashimoto’s disease – This is an autoimmune condition in which the immune system attacks its own healthy cells. As a result, inflamed and damaged thyroid tissues start to produce fewer hormones but the pituitary gland identifies the decline and signals to the thyroid to make more hormones, which causes enlargement.
- Graves’ disease – This is another autoimmune disease that happens when the immune system produces a protein that mimics TSH. Therefore, it causes the thyroid gland to produce too many hormones causing its growth.
- Thyroid nodules – Irregular growth of thyroid cells are called nodules that form lumps. These nodules may appear as either one or more (multinodular goiter). Healthcare providers do not fully understand the exact cause of nodules but there may be several factors (including genetics, diet, lifestyle, and environment). In most cases, nodules are benign (noncancerous).
- Thyroid cancer – This cancer type occurs more often than others and generally it is treatable. Approximately 5% of people with thyroid nodules develop cancer.
- Pregnancy – Slightly enlargement of the thyroid gland and overproduction of thyroid hormones may occur during pregnancy due to a hormone called human chorionic gonadotropin (HCG).
- Inflammation – Inflammation of the thyroid caused by an autoimmune condition is called thyroiditis. However, this condition may also occur due to bacterial or viral infections or medicines. Sometimes, thyroiditis may cause hypo or hyperthyroidism.
How Does the Thyroid Gland Work?
This gland produces two hormones such as thyroxine (T-4) and triiodothyronine (T-3). These hormones play an important role in the following body functions. Examples include:
- Blood pressure
- Heart rate
- Body temperature
- Metabolism (conversion of the food into energy)
- Growth during childhood
- Other hormone interactions
In addition, the thyroid gland also makes Calcitonin, which is a hormone that regulates the calcium amount in the blood.
How the Thyroid Gland is Regulated?
The thyroid is controlled by the pituitary gland and hypothalamus. In other words, these two small glands tell the thyroid gland how many hormones are needed to produce and release. The hypothalamus is located at the brain’s base and it works as a thermostat to maintain different body systems. It also signals the pituitary gland to make a hormone called thyroid-stimulating hormone (TSH).
The pituitary gland is located below the hypothalamus and it releases a certain amount of TSH depending on the T-3 and T-4 levels in the blood. Thus, the thyroid gland regulates the T-3 and T-4 levels according to the TSH amount.
Risk Factors
Anyone can develop this condition and while some people are born with it, others develop it later in life. Check below the most common risk factors for goiters:
- Lack of dietary iodine – This mineral is mainly found in seawater and the soil in coastal areas. While it is a common cause of goiter in the developing world, in the U.S. goiter occurs rarely due to this cause.
- Women – Females are more likely to develop goiter or other thyroid conditions than males.
- Pregnancy and menopause – Commonly, thyroid problems happen during menopause and pregnancy.
- Age – The risk of developing goiter increases after 40 years old.
- Family history – If you have a family history of goiters or other thyroid conditions, the risk of developing one elevates.
- Medicines – There are some medicines that may elevate your risk of goiter. These include Lithium and a heart drug called Amiodarone.
- Radiation exposure – If you were exposed to radiation such as during radiation therapy used to treat cancer, your risk of developing goiter increases.
Complications
In most cases, goiter does not cause complications itself but some people may be troublesome due to the appearance of the thyroid gland. However, if it becomes too large, it may obstruct the airway and voice box. Thyroid hormone production changes may be associated with goiters. Thus, it may cause complications in multiple body systems.
Diagnosis
Commonly, a goiter is identified during a routine physical examination. Doctors usually check whether the thyroid gland is enlarged or not by touching the neck. Sometimes, goiter may be found during imaging tests for other health conditions. However, physicians may perform additional tests to measure the thyroid size, detect nodules, determine whether the thyroid is overactive or underactive, and goiter cause. Check below some tests:
- Thyroid function tests – This involves a blood test to measure the amount of TSH and the amount of T-3 and T-4 produced by the thyroid.
- Antibody test – Repeated blood tests may be performed after results of thyroid function test to check for autoimmune conditions (such as Hashimoto’s disease or Graves’ disease).
- Ultrasonography – This test uses sound waves to make pictures of the neck tissues.
- Radioactive iodine uptake – During this test doctors will give you a small amount of radioactive iodine and then will use a scanning device. This test can help doctors diagnose goiter.
- Biopsy – This is a procedure in which doctors get a small sample of thyroid tissue and send it to the laboratory for testing. A biopsy is usually performed when doctors suspect thyroid cancer.
Treatment
The treatment for this condition depends on the thyroid gland size, symptoms, age, and other factors. If the thyroid function is normal and the goiter is small, doctors may recommend waiting and having regular checkups.
Medications
Physicians often prescribe the following medicines for people with goiter. Examples include:
- Thyroid hormone replacement medicines – These include Levothyroxine, which replaces T-4, and Liothyronine for T-3 replacement. Previous medications may help reduce goiter size.
- Beta-blockers – Physicians usually prescribe this group of medicines to reduce symptoms of hyperthyroidism. For example Atenolol, Metoprolol, and others.
- Anti-thyroid medicines – These drugs are used for overactive thyroid gland. Doctors usually recommend Methimazole.
- Pain relievers – If you experience pain due to goiter, doctors may recommend some painkillers. For example Naproxen sodium, Aspirin, or Ibuprofen. For people with severe pain, physicians prescribe steroid medicines.
Surgery
Doctors recommend this procedure to remove either a part of all thyroid glands (partial or total thyroidectomy). Sometimes, surgery is recommended to treat the following complications of goiter. Examples include:
- Thyroid cancer
- Thyroid nodules
- Breathing problems
- Difficulty swallowing
Radioactive Iodine Treatment
It is usually recommended for people with an overactive thyroid gland (hyperthyroidism). The dose is taken orally. This treatment may reduce the goiter size and reduce hormone production.
Frequently Asked Questions
What are foods that contain iodine?
In normal circumstances, people get iodine from food and the recommended daily allowance is 150 micrograms. However, in a teaspoon of iodized salt, there are 250 micrograms of iodine. Check some foods that contain iodine:
- Saltwater fish and shellfish
- Seaweed
- Dairy and soy products
You should not get high iodine amounts because it may cause thyroid dysfunction.
Can goiter be cured?
Yes, especially if it is detected early. Sometimes, the goiter is small and goes away on its own without treatment. In any case, this is a treatable condition and there are different treatment options available.
What are the main symptoms of thyroid problems?
- Weak nails and thinning hair
- Sensitive skin
- More bowel movements
- Unusual weight loss
- Palpitations
- Increased sweating
- Nervousness
- Anxiousness
If you experience any of the previous symptoms, do not hesitate to visit a doctor. If you have additional questions, ask your healthcare professional.
