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Goiter can be defined as the enlargement and swelling of the thyroid gland located in the lower front part of the neck. It is quite common in our country and is more frequently seen in individuals with iodine deficiency. It is also five times more common in women than in men. In this condition, the thyroid gland may enlarge with or without nodules. When it becomes very large, it can sometimes cause shortness of breath and difficulty swallowing.
However, if thyroid hormones are produced excessively, treatment is previously required. The development of hyperthyroidism is commonly referred to as “toxic” goiter. We will also explain its symptoms, treatment, and who is more likely to develop it. First, let’s review the causes.
What Are the Causes of Goiter?
Numerous studies have been conducted worldwide on the causes of goiter. These studies show that the most common cause is iodine deficiency. It is frequently seen in people living in iodine-poor regions or those whose diets lack iodine. Therefore, iodine deficiency stands out as the primary cause. In addition, the following factors can also lead to this condition:
- Graves’ disease (toxic goiter)
- Family history of nodules
- Exposure to radiation in the neck area
- Cysts
- Pregnancy
- Thyroid cancer
- Hashimoto’s disease
- Inflammation of the thyroid gland
- Unilateral swelling or nodules in the thyroid gland
What Are the Symptoms of Goiter?
It should be noted that not every individual with goiter experiences symptoms. Therefore, it is not correct to assume that all patients will show symptoms. Common symptoms include:
- Swelling in the neck area
- Difficulty breathing
- Coughing
- Difficulty swallowing
Depending on whether the condition is associated with hypothyroidism or hyperthyroidism, additional symptoms may appear:
- Irritability
- Weight loss
- Sleep problems
- Persistent fatigue
How Is Goiter Diagnosed?
A thorough evaluation is required before diagnosing goiter. If nodules are present, it is important to determine whether they are malignant. In cases of excessive hormone production, the pressure of large nodules on the airway is also evaluated. A physical examination of the neck is performed to check for swelling.
Several tests are also required:
Thyroid ultrasonography:
- A simple imaging method that shows whether nodules are present.
- Provides information about the size and structure of nodules.
- Nodules larger than 3 cm are usually treated surgically.
Thyroid scintigraphy:
- Used especially in patients with nodules.
- Helps determine whether a nodule is benign or malignant.
- Cold nodules may carry a risk of cancer.
Fine needle aspiration biopsy (FNAB):
- A sample is taken from the thyroid to check for cancer.
- Performed based on ultrasound or scintigraphy findings.
- A simple procedure using a thin needle.
Blood tests:
- T3, T4, and TSH levels are measured.
- Helps determine conditions such as Graves’ disease or Hashimoto’s.
- Additional tests like anti-TPO and anti-thyroglobulin may be required.
How Is Goiter Treated?
After diagnosis, the most appropriate treatment option is determined based on hormone levels and thyroid structure. Treatment options include monitoring, medication, radioactive iodine therapy, and surgery.
Medication type and dosage depend on the severity of the disease. In some cases, radioactive treatment or surgery may be required. The patient’s age, gender, and overall health are also considered.
Who Is More Likely to Develop Goiter?
People living in iodine-deficient regions or those who do not consume iodine-rich foods are at higher risk. Women are more likely to develop goiter than men. Pregnancy, autoimmune diseases, certain medications (such as amiodarone, interferon, and lithium), menopause, and age over 40 also increase risk.
When Should You See a Doctor?
Even if only one symptom appears, it is important to consult a doctor without delay. Difficulty breathing, swallowing issues, or noticing a lump in the neck should not be ignored. Early diagnosis allows for more effective treatment.
When Is Goiter Surgery Performed?
Goiter surgery involves removing the thyroid gland through a surgical procedure. It is typically performed in the following cases:
- Enlargement causing pressure on the neck
- Failure of medical treatment
- Thyroid size exceeding 2–3 cm
- Risk of cancer in nodules
- Dangerous swelling in the neck
The surgery is performed under general anesthesia and usually takes 90–120 minutes. An incision is made in the front of the neck to access and remove the thyroid gland. Blood vessels are also tied off during the procedure. It is crucial that the surgery is performed by an experienced surgeon to avoid nerve damage, particularly to the vocal cords.
Graves’ Disease (Toxic Goiter)
- Second most common cause after iodine deficiency
- An autoimmune disease causing excessive thyroid hormone production
- Symptoms may include bulging eyes, irritability, hair loss, heat intolerance, and weight loss
Treatment options:
- Medical therapy
- Surgery if medication fails
- Radioactive iodine therapy for non-surgical candidates
Hashimoto’s Disease
An autoimmune condition causing reduced thyroid hormone production.
Symptoms:
- Weight gain and fatigue
- Hair loss
- Edema
- Constipation
- Cold intolerance
- Memory problems and menstrual irregularities
Treatment:
- Usually managed with medication taken on an empty stomach
- Regular monitoring is required
Evaluation of Thyroid Nodules
Multiple nodules usually carry a lower cancer risk, but dominant nodules require careful evaluation. Diagnosis includes ultrasound, scintigraphy, blood tests, and biopsy. Factors such as age, gender, radiation exposure, and family history are also considered.
Hot Nodules Treatment
Hot (hyperactive) nodules are evaluated for hyperthyroidism and treated accordingly. If no hyperthyroidism is present, regular monitoring is sufficient.
Substernal Goiter
Occurs when the thyroid extends below the sternum. It is more common in older individuals and usually requires surgical treatment due to breathing difficulties.
Misconceptions About Goiter
Terms like “internal goiter” or “female goiter” are not medically accurate and are often used colloquially rather than scientifically.
