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Goiter - simple
Simple goiter; Endemic goiter; Colloidal goiter; Nontoxic goiter
A simple goiter is an enlargement of the thyroid gland. It is usually not a tumor or cancer.
Causes
The thyroid gland is an important organ of the endocrine system . It is located at the front of the neck just above where your collarbones meet. The gland makes the hormones that control the way every cell in the body uses energy. This process is called metabolism .
Endocrine system
Endocrine glands release (secrete) hormones into the bloodstream. The endocrine glands include:AdrenalHypothalamusIslets of Langerhans in the pancrea...
Metabolism
Metabolism refers to all the physical and chemical processes in the body that convert or use energy, such as:BreathingCirculating bloodControlling bo...
Iodine deficiency is the most common cause of goiter. The body needs iodine to produce thyroid hormone. If you do not have enough iodine in your diet, the thyroid gets larger to try and capture all the iodine it can, so it can make the right amount of thyroid hormone. So, a goiter can be a sign the thyroid is not able to make enough thyroid hormone. The use of iodized salt in the United States prevents a lack of iodine in the diet.
Other causes of goiter include:
-
The body's immune system attacking the thyroid gland (
autoimmune problem
)
Autoimmune problem
An autoimmune disorder occurs when the body's immune system attacks and destroys healthy body tissue by mistake. There are more than 80 types of aut...
ImageRead Article Now Book Mark Article - Certain medicines (lithium, amiodarone)
- Infections
- Cigarette smoking
- Certain foods (soy, peanuts, vegetables in the broccoli and cabbage family)
- Toxic nodular goiter, an enlarged thyroid gland that has a small, rounded growth or many growths called nodules, which produce too much thyroid hormone
Simple goiters are more common in:
- People over age 40
- People with a family history of goiter
- Women
Symptoms
The main symptom is an enlarged thyroid gland. The size may range from a single small nodule to a large mass at the front of the neck.
Nodule
Skin nodules are solid or cystic raised bumps in the skin that are wider than 1 centimeter (cm), but less than 2 cm.
Some people with a simple goiter may have symptoms of an underactive thyroid gland.
Underactive thyroid
Hypothyroidism is a condition in which the thyroid gland does not make enough thyroid hormone. This condition is often called underactive thyroid....
In rare cases, an enlarged thyroid can put pressure on the windpipe (trachea) and food tube (esophagus). This can lead to:
-
Breathing difficulties
(with very large goiters), especially when lying flat on the back
Breathing difficulties
Breathing difficulty may involve:Difficult breathingUncomfortable breathingFeeling like you are not getting enough air
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- Hoarseness
- Swallowing difficulties, especially with solid food
- Pain in the area of the thyroid
Exams and Tests
The health care provider will do a physical exam. This involves feeling your neck as you swallow. Swelling in the area of the thyroid may be felt.
If you have a very large goiter, you may have pressure on your neck veins. As a result, when the provider asks you to raise your arms above your head, you may feel dizzy.
Blood tests may be ordered to measure thyroid function:
-
Free thyroxine (
T4
)
T4
T4 (thyroxine) is the main hormone produced by the thyroid gland. A laboratory test can be done to measure the amount of free T4 in your blood....
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Thyroid stimulating hormone (
TSH
)
TSH
A TSH test measures the amount of thyroid stimulating hormone (TSH) in your blood. TSH is produced by the pituitary gland. It tells the thyroid gla...
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Tests to look for abnormal and possibly cancerous areas in the thyroid gland include:
-
Thyroid scan
and uptake
Thyroid scan
A thyroid scan uses a radioactive iodine tracer to examine the structure and function of the thyroid gland. This test is often done together with a ...
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Ultrasound of the thyroid
Ultrasound of the thyroid
A thyroid ultrasound is an imaging method to see the thyroid, a gland in the neck that regulates metabolism.
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If nodules are found on an ultrasound, a biopsy may be needed to check for thyroid cancer.
Treatment
A goiter only needs to be treated if it is causing symptoms.
Treatments for an enlarged thyroid include:
- Thyroid hormone replacement pills if the goiter is due to an underactive thyroid
- Small doses of Lugol's iodine or potassium iodine solution if the goiter is due to a lack of iodine
- Radioactive iodine to shrink the gland, especially if the thyroid is producing too much thyroid hormone
-
Surgery (
thyroidectomy
) to remove all or part of the gland
Thyroidectomy
Thyroid gland removal is surgery to remove all or part of the thyroid gland. The thyroid gland is a butterfly-shaped gland located inside the front ...
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Outlook (Prognosis)
A simple goiter may disappear on its own, or may become larger. Over time, the thyroid gland may stop making enough thyroid hormone. This condition is called hypothyroidism .
Hypothyroidism
Hypothyroidism is a condition in which the thyroid gland does not make enough thyroid hormone. This condition is often called underactive thyroid....
In some cases, a goiter becomes toxic and produces thyroid hormone on its own. This can cause high levels of thyroid hormone, a condition called hyperthyroidism .
Toxic
Toxic nodular goiter involves an enlarged thyroid gland. The gland contains areas that have increased in size and formed nodules. One or more of th...
Hyperthyroidism
Hyperthyroidism is a condition in which the thyroid gland makes too much thyroid hormone. The condition is often called overactive thyroid.
When to Contact a Medical Professional
Call your provider if you experience any swelling in the front of your neck or any other symptoms of goiter.
Prevention
Using iodized table salt prevents most simple goiters.
References
Hegedüs L, Paschke R, Krohn K, Bonnema SJ. Multinodular goiter. In: Jameson JL, De Groot LJ, de Kretser DM, et al, eds. Endocrinology: Adult and Pediatric . 7th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 90.
Kim M, Ladenson PW. Thyroid. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine . 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 226.
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Thyroid enlargement - scintiscan - illustration
This image shows enlargement of the thyroid gland and extension down behind the breastbone (retrosternal space). The image, called a scintiscan, was generated using a radioactive isotope.
Thyroid enlargement - scintiscan
illustration
-
Thyroid gland - illustration
The thyroid gland, a part of the endocrine (hormone) system, plays a major role in regulating the body's metabolism.
Thyroid gland
illustration
-
Thyroid enlargement - scintiscan - illustration
This image shows enlargement of the thyroid gland and extension down behind the breastbone (retrosternal space). The image, called a scintiscan, was generated using a radioactive isotope.
Thyroid enlargement - scintiscan
illustration
-
Thyroid gland - illustration
The thyroid gland, a part of the endocrine (hormone) system, plays a major role in regulating the body's metabolism.
Thyroid gland
illustration
Review Date: 4/23/2015
Reviewed By: Brent Wisse, MD, Associate Professor of Medicine, Division of Metabolism, Endocrinology & Nutrition, University of Washington School of Medicine, Seattle, WA. Internal review and update on 07/24/2016 by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.
