What Is a Goiter?
A goiter is defined as an abnormal enlargement of the thyroid gland, a butterfly-shaped organ located at the front of the neck just below the Adam’s apple. This swelling can result from different underlying thyroid conditions and appears as either a diffuse or nodular growth. For some, the goiter might be barely noticeable, while in others it can present as a significant visible lump in the neck.
Goiters can be associated with normal, increased, or decreased thyroid hormone production. Not all goiters cause noticeable symptoms, but when they do, they can significantly impact comfort and quality of life.
Common Symptoms of Goiter
- Noticeable swelling at the base of the neck
- A feeling of tightness, fullness, or pressure in the throat
- Difficulty swallowing or breathing
- Persistent cough or hoarseness
- Change in voice
- Swelling of neck veins
- Dizziness when raising arms
The severity and type of symptoms depend on the size of the goiter and whether it is accompanied by underlying thyroid dysfunction (either hypothyroidism or hyperthyroidism).
Causes and Risk Factors
Goiters develop due to a variety of causes, including:
- Iodine deficiency: The most common cause worldwide, but rare in the United States due to iodized salt.
- Autoimmune diseases: Graves’ disease and Hashimoto’s thyroiditis can both result in thyroid enlargement by causing overactive or underactive thyroid function.
- Thyroid nodules: Benign masses within the thyroid may cause localized enlargements, leading to a multinodular goiter.
- Medications, inflammation, infections: Certain drugs, radiation exposure, or thyroiditis can also contribute.
Other risk factors include a family history of thyroid disease, previous radiation to the head and neck, and, less commonly, pregnancy or inherited conditions.
How Are Goiters Diagnosed?
Diagnosis of a goiter generally starts with a physical examination by a healthcare provider. This is usually followed by:
- Blood tests to check thyroid hormone levels
- Ultrasound imaging to assess the size, structure, and presence of nodules
- Fine-needle aspiration biopsy if suspicious nodules are found
Additional imaging or tests may be recommended based on individual findings and symptoms.
Treatment Options for Goiter
Small, asymptomatic goiters that do not affect thyroid function or structure may only require observation and regular monitoring. However, goiters that cause discomfort, compress nearby structures, or are cosmetically concerning typically require treatment.
Traditional treatments include:
- Medications to address underlying hormone imbalances
- Surgical removal (thyroidectomy) for large, symptomatic, or suspicious goiters
- Radiofrequency ablation for selected benign nodules
- A modern, less invasive alternative for many patients—especially those unsuitable for surgery or wishing to avoid it—is Thyroid Artery Embolization (TAE).
