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Goiter (Thyroid Gland Enlargement) Symptoms, Causes, Treatment

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What is a goiter?

Goiter is a medical condition characterized by a visible swelling of the thyroid gland which may lead to difficulty in swallowing and breathing. A goiter is not a cancer of the thyroid gland although thyroid cancer can cause a goiter. The most common cause of goiter is a deficiency of iodine. However, other causes like Graves’ disease, Hashimoto’s disease may also lead to swelling of the thyroid gland.

Enlargement of the thyroid may or may not be associated with impaired functioning of the thyroid gland. Older females with a family history of autoimmune diseases are at an increased risk of suffering from goiter. Drugs, surgical removal of the large thyroid or destruction of the thyroid gland by radioactive iodine are the most common treatment options.

Goiter Symptoms

Smaller goiters usually do not produce any symptom. Larger goiters may lead to visible swelling at the base of the neck (front – throat), feeling of tightness in the neck, coughing, hoarseness of the voice, difficulty in swallowing and shortness of breath. Other symptoms that may be seen are more likely due to impaired thyroid function that the goiter itself. However, a thyroid activity is not always abnormal even when a goiter may be present.

Poor functioning of the thyroid gland (hypothyroidism) is the most common cause of goiter and is marked by weight gain, intolerance to cold, swelling of the legs and other body parts, slowness of movement, constipation and drowsiness. Increased thyroid hormone secretion (hyperthyroidism) may also be sometimes responsible for goiter and this condition is characterized by weight loss in spite of increased appetite, increased irritability, heat intolerance, increased pulse rate, protrusion of the eyeballs and difficulty sleeping.

Causes of a Goiter

The thyroid gland is a butterfly-shaped gland present in front of the voice box or the larynx and produces thyroid hormones. The two main thyroid hormones are triiodothyronine (T3) and thyroxine (T4). Thyroid hormones are essential for normal growth and development of the body, maintenance of temperature and metabolism of carbohydrates, protein and fat. The function of thyroid gland is under control of pituitary and hypothalamus. In certain instances the thyroid gland may be overstimulated or irritated leading to enlargement of the gland.

Common causes of goiter include :

  • Iodine deficiency. Iodine is a key component for the production of thyroid hormone. Therefore a deficiency of iodine leads to hypothyroidism which in turn leads to overstimulation of the thyroid gland by the pituitary gland and resultant swelling of the thyroid.
  • Graves’ disease is a condition is characterized by excessive production of thyroid hormone as the immune system of the body wrongly attacks the thyroid gland.
  • Hashimoto’s disease is an autoimmune condition where the thyroid gland activity is lower than normal. This leads an overstimulation of the thyroid gland and subsequent enlargement.
  • Other causes of goiter include thyroid cancer, pregnancy and inflammation of the thyroid gland (thyroiditis).

Treatment

A small goiter without any symptoms or minimal symptoms does not require any specific treatment. Similarly a goiter that is not causing any cosmetic problem and with normal thyroid function despite the enlargement does not usually warrant any treatment. However, larger goiters with severe impairment of thyroid function can be managed by the following measures :

  • Drugs like synthetic thyroid hormone in case of hypothyroidism and steroids if there is any underlying inflammation.
  • Surgical removal of the thyroid gland in case of a large goiter.
  • Radioactive destruction of the gland in selected patients.

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