Goiter – Symptoms and Causes

What Is A Goiter?

A goiter happens when your thyroid gland grows larger than normal. The thyroid sits at the base of your neck, just below the Adam’s apple. It has a butterfly shape.

Sometimes the whole thyroid gets bigger. Other times, one or more lumps (nodules) form in the gland. When your thyroid swells, it creates a visible bulge in your neck.

Goiters don’t always affect how your thyroid works. You might have normal hormone levels, or they could be too high or too low.

In many countries, not getting enough iodine causes most goiters. In the United States, where people use iodized salt, other factors typically cause thyroid swelling, including:

• Autoimmune diseases
• Thyroid inflammation
• Hormone imbalances
• Genetic conditions

Treatment Options

Most small goiters that don’t cause symptoms need no treatment. Your doctor might recommend:

1. Medication – to balance thyroid hormones.
2. Radioactive Iodine – to shrink the thyroid.
3. Surgery – for large or problematic goiters.

When to see a doctor:

• Trouble swallowing or breathing
• Hoarseness that doesn’t go away
• Noticeable swelling at the base of your neck

Signs and Warning Signs

Low Thyroid Function

When the thyroid is underactive, several physical changes may occur. People often feel tired all the time and find they’re more sensitive to cold temperatures. They might sleep more than usual but still feel exhausted. Other common signs include:

• Dry, rough skin
• Ongoing constipation
• Weakness in muscles
• Trouble remembering things or staying focused

These symptoms often develop slowly, making them hard to notice at first.

High Thyroid Function

With an overactive thyroid, the body’s systems speed up. Key signs include:

• Losing weight without trying
• Heart beating too fast
• Feeling too hot when others are comfortable
• Sweating more than normal
• Shaky hands
• Feeling anxious or on edge
• Muscle weakness
• Frequent bowel movements
• Changes in periods for women
• Trouble sleeping
• High blood pressure
• Feeling hungry all the time

Children with high thyroid function may grow unusually tall, show behavior changes, and have bone growth that happens faster than normal for their age.

Neck Swelling Effects

When a goiter grows large or sits in certain positions, it can block airways and affect the voice box. Watch for these warning signs:

• Hard time swallowing food or drinks
• Breathing problems, especially during physical activity
• Persistent cough
• Voice changes or hoarseness
• Loud snoring that wasn’t present before

How Your Thyroid Works

Thyroid Gland Basics

The thyroid gland makes two main hormones: T-4 (thyroxine) and T-3 (triiodothyronine). These hormones enter your bloodstream and control many body functions. They help manage how your body uses energy, keeps warm, and maintains heart rate and blood pressure.

Thyroid hormones also work with other body systems and help children grow. The thyroid makes another hormone called calcitonin that helps control calcium levels in your blood.

Brain Control Centers

Two parts of your brain work together to manage your thyroid. The hypothalamus sits at the base of your brain and acts like a thermostat for your body systems.

The pituitary gland sits below the hypothalamus. These brain structures send signals that tell your thyroid what to do.

Hormone Regulation

Your thyroid works through a feedback system. Here’s how it happens:

1. The hypothalamus checks hormone levels in your blood
2. It signals the pituitary gland to make thyroid-stimulating hormone (TSH)
3. TSH travels to your thyroid gland
4. Your thyroid responds by making more or less hormones

This system works like a thermostat in your home. When thyroid hormone levels drop, the pituitary sends more TSH. When levels are high, it sends less TSH.

Why Goiters Form

A goiter is an enlarged thyroid gland that can create a visible swelling in your neck. Several things can cause this:

• Lack of Iodine: Your body needs iodine to make thyroid hormones. Without enough, your thyroid works harder and gets bigger. This is rare in countries where salt contains added iodine.
• Hashimoto’s Disease: This immune system problem damages the thyroid, reducing hormone production. Your pituitary gland then signals for more hormones, causing the thyroid to grow.
• Graves’ Disease: In this condition, your immune system makes a protein that acts like TSH. This causes your thyroid to make too many hormones and can make it enlarge.
• Pregnancy: Hormone changes during pregnancy can sometimes make the thyroid slightly larger.
• Inflammation: Thyroiditis (swollen thyroid) can result from immune problems, infections, or medications. This swelling can change hormone levels and thyroid size.

Thyroid Nodules

Nodules are growths of thyroid cells that form lumps. You might have one nodule or many (called a multinodular goiter). Most nodules are not cancerous. Doctors aren’t completely sure what causes them, but these factors may play a role:

• Genetics
• Diet
• Environmental factors
• Lifestyle choices

About 5% of thyroid nodules turn out to be cancer. Thankfully, thyroid cancer typically responds well to treatment compared to other cancers.

Nodules can make your thyroid much larger than normal, creating a noticeable bulge in your neck. This can happen with single nodules, multiple nodules, or when the thyroid is inflamed from immune system problems.

Risk Factors

A goiter can develop in anyone at any age, though certain factors may increase the chance of getting one:

• Diet low in iodine – People who don’t get enough iodine in their food face higher risk, especially in developing countries. This is uncommon in the United States.
• Gender – Women develop goiters and thyroid problems more frequently than men.
• Hormonal changes – Women going through pregnancy or menopause experience a higher likelihood of thyroid issues.
• Age over 40 – The risk of developing a goiter increases as people get older, particularly after age 40.
• Family history – Having relatives with goiters or other thyroid conditions raises your risk. Genetic factors may play a role.
• Certain medications, including:
  • Amiodarone (heart medication)
  • Lithium (used for psychiatric treatment)
• Previous radiation – People who received radiation treatments to their neck or chest area have an increased risk of developing goiters later.

These risk factors don’t guarantee someone will develop a goiter, but they may increase the likelihood of thyroid enlargement.

Complications

A goiter itself rarely causes problems. However, some people may feel self-conscious about its appearance.

When a goiter grows very large, it might block the airway or affect the voice box.

The main concerns come from changes in thyroid hormone levels that often accompany goiters. These hormone imbalances can affect multiple body systems. They can lead to various health issues if left untreated.