Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at June 26, 2016

The thyroid is a butterfly-shaped gland located underneath the front of the neck. Goiter is the swelling of this gland and is also known as an enlarged thyroid. The characteristics and severity of goiter vary from person to person. Generally, goiter does not pose significant health threats, but it is wise to see a health care professional if a person has any signs of goiter. 


Definition & Facts

The thyroid gland produces a hormone, thyroxine that controls the body’s metabolic activity. Excess thyroxine speeds up metabolism while deficiencies of thyroxine slow down metabolism.

The pituitary gland secretes the thyroid-stimulating hormone (TSH) in reaction to the quantity of thyroxine in the blood, consequently controlling the thyroid. TSH intensifies the quantity of thyroxine secretion by the thyroid gland, causing it to grow. Excessive production of TSH causes the enlargement of the thyroid gland and leads to excessive secretion of thyroxine by the thyroid gland. This causes hyperthyroidism or Graves’ disease, a condition associated with goiter.

Since the thyroid is the only organ that uses iodine, inadequate consumption of iodine leads to poor production and secretion of thyroxine. This causes the pituitary glands to produce extra THS causing the thyroid gland to swell and manufacture adequate thyroxine. A swollen thyroid gland will fail to produce sufficient thyroxine if an individual does not consume iodine-rich foods regardless of TSH production.

Symptoms & Complaints

Ordinary symptoms observed with goiter include visible swelling underneath the neck, difficulty swallowing, coughing, hoarseness, and stiffness of the throat, and in rare cases difficulty breathing.

An overactive thyroid also causes weight loss, increased appetite, hair loss, hyperactivity, palpitations, tiredness, heat hypersensitivity, and excessive sweating. An underactive thyroid or hypothyroidism causes constipation, weight gain, hair loss, behavioral changes, absentmindedness, and cold intolerance.


The main cause of goiter worldwide is iodine deficiency which is linked to the absence of iodine in the diet, a problem that affects countries in Africa and Asia more so than in Europe or America where iodine exists in table salt. Many vegan dishes lack adequate iodine since it is not present in all vegetables, nuts, and grains. However, this may not be a problem to vegans who use iodine-rich salt. The trace mineral is found mainly in cow’s milk, seafood, and plants cultivated in iodine-rich soil.

Autoimmune disease is one of the main causes of goiter in developed areas. Many nutritionists and doctors believe goiter is more prevalent in people with a history of the condition in their families. Women above the age of 40 are also more susceptible to goiter.

Another cause of goiter is an underactive thyroid gland. The inflammation in the thyroid gland is caused by Hashimoto’s thyroiditis, a state in which the immune system begins to attack its own cells. Less common causes of goiter include radiation therapy to the neck, smoking, hormonal imbalances which may occur during menopause, puberty, and pregnancy, and excessive consumption of iodine. 

Diagnosis & Tests

Diagnosis is performed mainly through physical examination of the patient where the doctor feels the neck of the patient while he or she swallows. More comprehensive diagnosis may involve a hormone test. Simple blood tests can be carried out to establish the quantity of hormones produced by the pituitary and thyroid glands. A blood test can also confirm the presence of abnormal antibodies in the blood because it is among the causes of goiter.

An ultrasonography test may be recommended in some cases. This involves using a transducer to determine if the thyroid gland is swollen. The transducer uses sound waves, and images of the sound waves are shown on a computer screen.

A thyroid scan can also be used to diagnose goiter. Here, a radioactive isotope is injected into the veins located at the elbow after which a special camera is used to determine if the thyroid gland is swollen. The amount of time it takes to complete this procedure varies and is determined by how long the isotope will take to reach the thyroid glands. Although it provides an effective diagnosis of goiter, a thyroid scan may be time-consuming and complicated.

Another diagnostic test for goiter is an ultrasound-guided thyroid biopsy. As the name suggests, this procedure involves using an ultrasound to direct a needle to the thyroid glands to acquire a tissue sample for testing. This sample may be tested for the presence of benign or malignant thyroid tumors.

Treatment & Therapy

Surgery, hormone therapy, and medication can be used to treat goiter. The treatment option to use is determined by the symptoms of the goiter, its size, and whether the patient has another existing thyroid condition. Treating goiter may involve dealing with all the problems associated with the thyroid gland including hyperthyroidism, hypothyroidism, and iodine deficiency.

If a patient’s goiter prevents him or her from swallowing or breathing easily and does not react to other forms of treatment then he or she may have to undergo surgery to have a section of his or her thyroid gland removed. This procedure is known as thyroidectomy. Afterwards, the patient will have to be monitored for a while to see if the patient's condition is improving.

Prevention & Prophylaxis

Some studies suggest that goiter can also be exacerbated by eating soy products, cruciferous vegetables (e.g. cauliflower, broccoli) as well as peanuts and spinach. Sources of alternative medicine have suggested that some foods including tea, coffee, alcohol, fried or greasy foods, white flour products, spices, white sugar, and preservatives can exacerbate the symptoms of goiter and should be avoided by goiter patients.

Iodine should be consumed in adequate amounts to prevent goiter. Foods such as watercress, dandelion, strawberries, tomatoes, oats, onions, whole rice, garlic, and carrots are rich in iodine and should be consumed adequately by patients with goiter.

Home remedies to prevent or reduce symptoms include spreading an ice bag on the throat for twenty to thirty minutes. Repeating the process every two to three hours or thrice daily may help. Plenty of rest is recommended for patients within the first two months of treatment after which an exercise regimen should be established. Finally, pursuing techniques to reduce stress may help mitigate or prevent goiter that is aggravated by psychological stress.

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