Goiter
A goiter is an enlargement of the thyroid gland that can arise from multiple causes -- iodine deficiency, autoimmune thyroid disease, multinodular changes, or thyroid cancer. The clinical approach depends on whether the gland is functioning normally, over-producing, or under-producing thyroid hormone, and whether compressive symptoms are present.
Symptoms
A visible or palpable swelling at the base of the neck, sensation of tightness or fullness in the throat, difficulty swallowing with large goiters, cough, or, rarely, breathing difficulty. Symptoms of hypothyroidism or hyperthyroidism may coexist depending on the underlying cause.
Causes and risk
The most common global cause is iodine deficiency. In iodine-sufficient countries, Hashimoto's thyroiditis and multinodular goiter (non-toxic) are the predominant causes. Graves' disease causes diffuse toxic goiter. Risk factors include female sex, age over 40, family history, and prior neck radiation.
How it is evaluated
Thyroid function tests (TSH, free T4) define whether the goiter is toxic, hypothyroid, or euthyroid. Ultrasound characterizes size, texture, and nodules. Anti-TPO and TRAb antibodies clarify autoimmune etiology. Large goiters may require CT imaging to assess tracheal compression.
Treatment
Euthyroid goiter without compressive symptoms is monitored. Hypothyroid goiter is treated with levothyroxine, which may reduce size modestly. Hyperthyroid goiter is managed with antithyroid medications, radioiodine, or surgery. Symptomatic large goiters compressing the trachea or esophagus require surgical referral.