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What is the thyroid gland?The thyroid gland is a butterfly-shaped

endocrine gland that is normally located in the

lower front of the neck. The thyroids job is to

make thyroid hormones, which are secreted

into the blood and then carried to every tissue

in the body. Thyroid hormone helps the body

use energy, stay warm and keep the brain,

heart, muscles, and other organs working as

they should.

GOITER

Posted on June 4, 2012

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WHAT IS THE THYROID GLAND?

The thyroid gland can be affected by exposure to radiation. The thyroid glands of children are

especially sensitive to radiation, much more so than the thyroid gland of an adult.

SYMPTOMS

What is a goiter?

The term goiter simply refers to the abnormal enlargement of the thyroid gland. It is important to know that the

presence of a goiter does not necessarily mean that the thyroid gland is malfunctioning. A goiter can occur in a gland

that is producing too much hormone (hyperthyroidism), too little hormone (hypothyroidism), or the correct amount of

hormone (euthyroidism). A goiter indicates there is a condition present which is causing the thyroid to growabnormally.

CAUSES

What causes a goiter?

One of the most common causes of goiter formation worldwide is

iodine deficiency. While this was a very frequent cause of goiter in

the United States many years ago, it is no longer commonly

observed. The primary activity of the thyroid gland is to concentrate

iodine from the blood to make thyroid hormone. The gland cannot

make enough thyroid hormone if it does not have enough iodine.

Therefore, with iodine deficiency the individual will become

hypothyroid. Consequently, the pituitary gland in the brain senses

the thyroid hormone level is too low and sends a signal to the

thyroid. This signal is called thyroid stimulating hormone (TSH). As the name implies, this hormone stimulates the

thyroid to produce thyroid hormone and to grow in size. This abnormal growth in size produces what is termed a

goiter. Thus, iodine deficiency is one cause of goiter development. Wherever iodine deficiency is common, goiter will

be common. It remains a common cause of goiters in other parts of the world.

Hashimotos thyroiditis is a more common cause of goiter formation in the US. This is an autoimmune condition in

which there is destruction of the thyroid gland by ones own immune system. As the gland becomes more damaged, it

is less able to make adequate supplies of thyroid hormone. The pituitary gland senses a low thyroid hormone level and

secretes more TSH to stimulate the thyroid. This stimulation causes the thyroid to grow, which may produce a goiter.

Another common cause of goiter is Graves disease. In this case, ones immune system produces a protein, called

thyroid stimulating immunoglobulin (TSI). As with TSH, TSI stimulates the thyroid gland to enlarge producing a goiter.

However, TSI also stimulates the thyroid to make too much thyroid hormone (causes hyperthyroidism). Since the

pituitary senses too much thyroid hormone, it stops secreting TSH. In spite of this the thyroid gland continues to grow

and make thyroid hormone. Therefore, Graves disease produces a goiter and hyperthyroidism.

Multinodular goiters are another common cause of goiters. Individuals with this disorder have one or more nodules

within the gland which cause thyroid enlargement. This is often detected as a nodular feeling gland on physical exam.

Patients can present with a single large nodule or with multiple smaller nodules in the gland when first detected (see

Thyroid Nodule brochure). Thus, in early stages of a multinodular goiter with many small nodules, the overall size of

the thyroid may not be enlarged yet. Unlike the other goiters discussed, the cause of this type of goiter is not well

understood.

In addition to the common causes of goiter, there are many other less common causes. Some of these are due to

genetic defects, others are related to injury or infections in the thyroid, and some are due to tumors (both cancerous

and benign tumors).

DIAGNOSIS

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HOW DO YOU DIAGNOSE A GOITER?

As mentioned earlier, the diagnosis of a goiter is usually made at the time of a physical examination when an

enlargement of the thyroid is found. However, the presence of a goiter indicates there is an abnormality of the thyroid

gland. Therefore, it is important to determine the cause of the goiter. As a first step, you will likely have thyroid

function tests to determine if your thyroid is underactive or overactive (see Thyroid Function Tests brochure). Any

subsequent tests performed will be dependent upon the results of the thyroid function tests.

If the thyroid is diffusely enlarged and you are hyperthyroid, your doctor will likely proceed with tests to help diagnose

Graves Disease (see Graves Disease brochure). If you are hypothyroid, you may have Hashimotos Thyroiditis (see

Hypothyroidism brochure) and you may get additional blood tests to confirm this diagnosis. Other tests used to help

diagnose the cause of the goiter may include a radioactive iodine scan, thyroid ultrasound, or a fine needle aspiration

biopsy (see Thyroid Nodule brochure).

TREATMENT

How is a goiter treated?

The treatment will depend upon the cause of the goiter. If the goiter was due to a deficiency of iodine in the diet (not

common in the United States), you will be given iodine supplementation given in preparations to take by mouth. This

will lead to a reduction in the size of the goiter, but often the goiter will not completely resolve.

If the goiter is due to Hashimotos Thyroiditis, and you are hypothyroid, you will be given thyroid hormone supplement

as a daily pill. This treatment will restore your thyroid hormone levels to normal, but does not usually make the goiter

go completely away. While the goiter may get smaller, sometimes there is too much scar tissue in the gland to allow it

to get much smaller. However, thyroid hormone treatment will usually prevent it from getting any larger. Although

appropriate in some individuals, surgery is usually not routine treatment of thyroiditis.

If the goiter is due to hyperthyroidism, the treatment will depend upon the cause of the hyperthyroidism (see

Hyperthyroidism and Graves disease brochures). For some causes of hyperthyroidism, the treatment may lead to a

disappearance of the goiter. For example, treatment of Graves disease with radioactive iodine usually leads to a

decrease or disappearance of the goiter.

Many goiters, such as the multinodular goiter, are associated with

normal levels of thyroid hormone in the blood. These goiters usually

do not require any specific treatment after the appropriate diagnosis

is made. If no specific treatment is suggested, you may be warned

that you are at risk for becoming hypothyroid or hyperthyroid in the

future. However, if there are problems associated with the size of the

thyroid per se, such as the goiter getting so large that it constricts

the airway, your doctor may suggest that the goiter be treated by

surgical removal.

Whatever the cause, it is important to have regular (annual)

monitoring when diagnosed with a goiter.

FURTHER INFORMATION

Further details on this and other thyroid-related topics are available in the patient information section on the American

Thyroid Association website at www.thyroid.org.

Goiter Brochure for Saving and Printing (PDF File, 899 KB)

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