What causes a goiter in your neck?

A goiter is an enlarged thyroid gland. The thyroid is the gland in front of the neck just below the area of the Adam’s apple. This butterfly-shaped gland plays a critical role in regulating the metabolic processes of the body by producing thyroid hormone. Heart rate, blood pressure, growth, and breathing are examples of the many processes that depend upon thyroid hormone from the thyroid gland. When the gland becomes enlarged due to diseases or tumors, the gland is referred to as a goiter.

A goiter can develop as a result of numerous different conditions. It can be associated with over-function of the thyroid gland (hyperthyroidism, or excessive thyroid hormones) or with under-function of the gland (hypothyroidism, or inadequate levels of thyroid hormones). Also, some goiters are associated with normal levels of thyroid hormones. Both inflammation and tumors can cause thyroid enlargement. Sometimes, the entire gland may be enlarged in a symmetrical pattern, while in other goiters, nodules, or enlargement may develop in one part of the gland only.

When a goiter becomes very large, it can sometimes cause symptoms because it presses on adjacent structures such as the esophagus and trachea. Symptoms that can occur related to a large goiter include problems with swallowing, shortness of breath, hoarseness, and stridor (a wheezing sound that results from turbulent air flow in and out of the trachea).


Where is the thyroid gland located? See Answer

Goiters and Thyroid Nodules

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What Is the Thyroid?

The thyroid is a small gland below the skin and muscles at the front of the neck, at the spot where a bow tie would rest.

It’s brownish red, with left and right halves (called lobes) that look like a butterfly’s wings. It weighs less than an ounce, but helps the body do many important things, such as grow, regulate energy, and go through sexual development.

What Are Goiters and Thyroid Nodules?

An enlarged thyroid gland can be felt as a lump under the skin at the front of the neck. When it is large enough to see easily, it’s called a goiter.

A thyroid nodule is a lump or enlarged area in the thyroid gland. A nodule may simply be swollen tissue, an overgrowth of normal thyroid tissue, or a collection of fluid called a cyst. Most thyroid nodules in children are not caused by cancer.

What Causes Goiters?

Goiters can happen due to inflammation of the thyroid gland or when the gland makes too much or too little thyroid hormone. A goiter also can develop with other thyroid problems, such as infections of the thyroid or thyroid cysts, tumors, or thyroid cancer. People who don’t get enough iodine in their diets also can get an enlarged thyroid. But this is rare in the United States because foods here usually supply enough iodine.

Kids can be born with a goiter or develop one later in life. A goiter that’s present at birth is called a congenital goiter. These can be caused by:

  • a genetic disease that prevents the baby from producing thyroid hormone properly
  • thyroid issues in the mother during pregnancy
  • an expectant mother taking medicines or other substances that affect the baby’s thyroid
  • the child being born without half of the thyroid, causing the remaining half to get bigger

A goiter that develops later is called an acquired goiter. In the United States, most acquired goiters are caused by:

Hashimoto’s thyroiditis: The immune system attacks the thyroid, making it swell. Sometimes this swelling can be dramatic and even look like a growth. Over time, the thyroid can become so damaged that it can’t make enough thyroid hormone. In that case, a person might need to take a thyroid hormone.

Graves’ disease: This is the most common cause of a goiter with high thyroid hormone levels in kids, and the top cause of hyperthyroidism in teen girls. The immune system attacks parts of the thyroid gland, making it swell and produce too much thyroid hormone. It also can cause inflammation and swelling around the eyes.

Colloid goiter (also called the “adolescent goiter”): The thyroid sometimes grows a lot during puberty, and can look abnormally large. This is not associated with any thyroid hormone problems. The thyroid works normally and often gets smaller over time with no treatment.

Viral or bacterial infections: Infections can cause inflammation and enlargement of the thyroid. These goiters are often painful.

What Causes Thyroid Nodules?

The most common cause of a thyroid nodule in kids is actually a “pseudonodule” or “fake nodule.” This is when inflammation of the gland (due to an infection, Hashimoto’s thyroiditis, or Graves’ disease) makes the thyroid swell in one place. This inflammation might look like a nodule, but there isn’t really any nodule at all.

The next most common type of thyroid nodule is a cyst, which usually happens when normal fluid pockets in the thyroid get bigger. These types of nodules are always benign (are not cancers), but may continue to grow over time.

Thyroid nodules that are due to growths (tumors) are common in adults but less common in kids. Most thyroid nodules are benign and doctors don’t always know why they happen.

Kids and teens with Hashimoto’s thyroiditis have a higher risk of thyroid nodules. As with goiters, a lack of iodine can cause thyroid nodules.

What Are the Signs & Symptoms of Goiters and Thyroid Nodules?

A goiter is most often spotted because it’s in the very front of the neck and moves up and down when a person swallows. People with a goiter might have the sensation that food is stuck in the throat, especially when they lie down or sleep on their backs.

But goiters often grow very slowly over months and years before being noticed. It can be hard even for parents who pay close attention to notice the change early.

Sometimes a nodule can appear in a healthy gland. It may feel like a lump in the throat, or cause tenderness or pain in the front of the neck. A large nodule might be visible at the front of the neck. Some kids with thyroid nodules have pain in the front of the neck or feel like they have a lump in the throat.

How Are Goiters and Thyroid Nodules Diagnosed?

Goiters and thyroid nodules are often found by families and doctors by looking at and touching the neck. Lab tests and a thyroid ultrasound can give doctors a good idea of what’s going on. If a thyroid nodule is found, extra testing is sometimes needed.

A fine-needle biopsy might be done to see whether a nodule is cancerous. During the biopsy, the doctor inserts a thin needle through the skin into the thyroid nodule (the skin is numbed with medicine first). Through the needle, the doctor takes a sample of tissue or some fluid from a cyst. The tissue or fluid is then sent to a lab. In some cases, the nodule might have to be surgically removed for more a detailed examination.

Some thyroid nodules make too much hormone and so another test, a thyroid scan, might be done. For this test, a person swallows a pill containing a small amount of radioactive iodine or another radioactive substance. The thyroid absorbs the radioactive substance. Then a special camera measures where the radioactive substance is taken up by the thyroid gland. This gives the doctor a better picture of the location, size, and type of thyroid nodule.

How Are Goiters Treated?

Depending on the test results, a goiter might not need to be treated. If it does, treating the thyroid disease causing the goiter usually will decrease or control the enlargement.

Surgery might be needed if the thyroid keeps getting bigger even with treatment and causes discomfort or a very large lump in the neck.

How Are Thyroid Nodules Treated?

Thyroid nodules don’t always need treatment. Many nodules cause no symptoms and may even get smaller over time.

Thyroid nodules may need treatment if they grow or cause symptoms, or if there is concern that it could be a cancer. Surgery is the preferred treatment for thyroid nodules in children. This might involve removing part of or all the thyroid gland.

If needed, surgery is done in a hospital under general anesthesia, so the child is asleep and feels nothing. If only part of the thyroid is removed and the rest of the gland is healthy, a child may not need to take a thyroid hormone after surgery. If the rest of the gland isn’t healthy or if the whole thyroid is removed, the child will need to take a thyroid hormone.

Thyroid cancer is relatively uncommon. When it does happen, it is very treatable. Most thyroid cancers can be cured or controlled with treatment.

When Should I Call the Doctor?

Call your child’s doctor if:

  • The nodule gets bigger.
  • Your child has increased pain or tenderness.
  • Your child has trouble swallowing.
  • Your child has unexplained hoarseness.

Reviewed by: Anthony W. Gannon, MD Date reviewed: April 2018

You and Your Hormones

Alternative names for goitre

Goiter; thyroid cyst; colloid goitre; colloid goiter; Plummer disease; Plummer’s disease; follicular adenoma

What is goitre?

Swollen neck of a patient with goitre.

The thyroid gland is a butterfly-shaped gland found in the neck. A normal-size thyroid cannot usually be felt. Any increase in size of the thyroid gland is called goitre.

Goitre can be due to enlargement of the whole thyroid gland, known as ‘smooth goitre’, or part of the gland, called a ‘nodular’ or ‘cystic’ goitre. Many people with goitre have normal thyroid hormone levels but some can have an underactive thyroid (hypothyroidism) or an overactive thyroid (hyperthyroidism).

What causes goitre?

There are a number of different causes for goitre including:

  • Iodine deficiency – iodine is an essential trace element which helps the thyroid gland function properly and make thyroid hormones. There are two main hormones called thyroxine and triiodothyronine. Approximately 2.2 billion people worldwide have iodine deficiency and roughly 29% of the world’s population live in an iodine deficient area.
    In the UK, most people have sufficient iodine in their diet. Non-organic milk is a good source of iodine. Some salt is supplemented with iodine.
  • Thyroiditis – this means inflammation of the thyroid gland. A number of causes can lead to swelling of the thyroid. The most common cause worldwide is Hashimoto’s thyroiditis, which is due to antibodies that attack the thyroid gland (known as an autoimmune process). Thyroiditis can also occur for other reasons e.g. due to a viral infection, or during or shortly after a pregnancy.
  • Graves’ disease – this is an autoimmune disease where the body produces antibodies causing the thyroid to be overactive.

  • Benign growths – these can take a number of different forms but follicular adenomas are the most common.
  • Goitrogens – these are external factors that may cause the formation of goitre. They include some drugs or medicines (e.g. lithium, which is used in the treatment of mental health problems) and certain foods such as vegetables from the cabbage family, cassava or kelp, although excessively high consumption of these foods would lead to goitre formation. In addition, a lack of micronutrients such as iron, selenium and vitamin A could also cause goitre formation.
  • Physiological causes – these include increased demands for hormone production during pregnancy and puberty.
  • Inherited causes – there are a number of genetic conditions that can increase the likelihood of goitre formation.
  • Toxic nodular goitre (Plummer’s disease) – this is where a nodule is associated with overactivity of the thyroid gland.

What are the signs and symptoms of goitre?

It is common to have small nodules within the thyroid gland, which cannot be felt, but may be picked up by chance when scans or examinations are conducted for other reasons. In these cases, there have usually been no symptoms to indicate the presence of goitre. Larger goitres simply present as a lump in the neck.

How common is goitre?

Worldwide, goitre is estimated by the World Health Organization to affect around 12% of people, although the rate of goitre in Europe as a whole is slightly lower. Goitre affecting a particular area (endemic) occurs in areas where there is iodine deficiency and is defined when more than 1 in 10 people have goitre.

Is goitre inherited?

Some forms of goitre can be inherited. There is some evidence that the presence of goitre in one family member increases the chances of other family members having goitre.

How is goitre diagnosed?

Goitre is diagnosed when the thyroid gland is enlarged enough to be felt by external touch or is clearly visible without a scan. Usually a GP will undertake thyroid function tests to measure the levels of thyroid hormones and thyroid antibodies in the bloodstream. They may also arrange an ultrasound scan or make a referral to an endocrinologist for outpatient assessment. Where more complex tests are required, they may include:

  1. ‘Fine needle aspiration’ of the thyroid gland. A thin needle is inserted under the guidance of ultrasound to remove a very small amount of thyroid tissue, which is studied under a microscope to determine the cell type(s) that are present. This procedure may need to be repeated more than once to get an adequate result.
  2. A thyroid ‘uptake’ scan. This will pick up differences in the activity of different areas of the thyroid.

How is goitre treated?

Treatment depends on the underlying cause of the goitre. ‘Simple’ goitre, where there is no thyroid hormone imbalance and no problems arising from the size of the thyroid, is unlikely to cause problems. Occasionally, a large goitre will press on nearby structures, for instance making it difficult to swallow. If that happens, it may be appropriate to consider surgery (a thyroidectomy), though this will result in the patient requiring lifelong thyroxine (thyroid hormone) replacement.

Treatment of overactive and underactive thyroid is explained in articles on hyperthyroidism and hypothyroidism, respectively.

Are there any side-effects to the treatment?

Surgery carries the normal risks of any operation (the risks from anaesthetic, post-operative infection, haemorrhage, bleeding and scar formation), and will result in an underactive thyroid. It can rarely cause specific complications with damage to the recurrent laryngeal nerve (controlling the voice box) resulting in a hoarse voice, or damage to the glands around the thyroid (parathyroid glands), which control calcium. This may result in a low calcium level (hypocalcaemia) in the blood, which would require medication.

What are the longer-term implications of goitre?

Usually there are no long-term implications of goitre, and the safest thing is to avoid unnecessary surgery once medical assessment has been made.

Are there patient support groups for people with goitre?

British Thyroid Foundation may be able to provide advice and support to patients and their families dealing with goitre.

Last reviewed: Mar 2018




Graves’ disease

What Is a Goiter?

A goiter is typically painless, but a large one can make swallowing or breathing difficult.

A goiter is an abnormal enlargement of the thyroid gland, which is a butterfly-shaped organ located at the base of your neck.

The thyroid gland releases hormones that help control your metabolism and other important processes in your body.

Having a goiter doesn’t always mean that your thyroid gland is malfunctioning. Even when your thyroid gland is enlarged, it can produce a normal amount of hormones.

You can develop a goiter if your thyroid gland is producing too much of its hormones (hyperthyroidism), too little (hypothyroidism), or a normal amount of hormones (euthyroidism).

Goiter Symptoms

Symptoms of a goiter may include:

  • Swelling at the base of the neck
  • A tight feeling in the throat
  • Hoarseness
  • Coughing
  • Difficulty breathing
  • Difficulty swallowing
  • Dizziness when the arms are raised above the head
  • Neck vein swelling

Sometimes goiters don’t cause any symptoms at all.

Goiter Risk Factors

You have a higher risk of developing a goiter if you:

  • Are a woman
  • Have a family history of autoimmune diseases
  • Are older than 40
  • Smoke cigarettes
  • Have ever received radiation therapy in your neck or chest area
  • Are pregnant or going through menopause
  • Take certain medicines, including immunosuppressants, antiretrovirals, the heart drugs Cordarone or Pacerone (amiodarone), or the psychiatric drug Lithobid (lithium)

Goiter Causes

Common causes of goiters include:

Iodine deficiency: The mineral iodine is needed for the production of thyroid hormones.

Worldwide, iodine deficiency is the most common cause of goiters. But this problem isn’t as common in the United States, where iodized salt is frequently used.

Graves’ disease: In this condition, your immune system mistakenly attacks your thyroid gland, causing it to produce too much of its hormones. This can cause your thyroid gland to swell.

Hashimoto’s thyroiditis: This autoimmune disease damages your thyroid, causing it to produce too little of its hormones. This can also result in a goiter.

Thyroid cancer: Cancer of the thyroid gland can enlarge the organ.

Pregnancy: During pregnancy, women produce hormones that can cause the thyroid gland to grow.

Thyroiditis: This condition causes inflammation of the thyroid gland, which can cause it to enlarge.

Goiter Diagnosis

To diagnose a goiter, your doctor may simply feel your neck and ask you to swallow while monitoring your response.

Other ways to diagnose a goiter include:

Hormone test: Measuring certain hormone levels in a blood test can reveal whether your thyroid gland is working properly.

Antibody test: This blood test measures abnormal antibodies that are produced if you have a predisposition to autoimmune thyroid disease.

Ultrasound: This imaging test lets your doctor see the size of your thyroid gland and determine whether it contains any nodules (which can change the levels of hormones it produces).

Thyroid scan: This imaging test provides information about the size and function of your thyroid gland.

MRI or CT scan: These imaging tests may be used if your goiter is very large or has spread into the chest.

Biopsy: This procedure involves inserting a needle into your thyroid gland to obtain a tissue or fluid sample, which is then examined under a microscope or subjected to other tests.

Goiter Treatment

Treatment for your goiter will depend on its size, its causes, and your symptoms.

Your doctor may decide not to treat your goiter at all if it’s small and doesn’t bother you. In this situation, your doctor will probably keep a close eye on your condition in case the goiter grows or changes.

If you do need treatment, your options may include:

Medications : Your doctor may tell you to take aspirin or may prescribe a corticosteroid if you have inflammation of the thyroid gland.

If you have hypothyroidism (underactive thyroid), you may need to take Levothroid or Synthroid (levothyroxine) to replace the hormones you’re lacking.

If you have hyperthyroidism (overactive thyroid), you may need to take drugs to bring your thyroid hormone levels back to normal.

Surgery : Your doctor may recommend thyroidectomy, a surgical procedure to remove all or part of your thyroid gland.

Surgery is often recommended if your goiter is very large, if it causes difficulty breathing or swallowing, or if your thyroid is overactive.

Radioactive iodine : This treatment, taken by mouth, can shrink the size of your goiter.

Goiter – simple

The thyroid gland is an important organ of the endocrine system. It is located at the front of the neck just above where your collarbones meet. The gland makes the hormones that control the way every cell in the body uses energy. This process is called metabolism.

Iodine deficiency is the most common cause of goiter. The body needs iodine to produce thyroid hormone. If you do not have enough iodine in your diet, the thyroid gets larger to try and capture all the iodine it can, so it can make the right amount of thyroid hormone. So, a goiter can be a sign the thyroid is not able to make enough thyroid hormone. The use of iodized salt in the United States prevents a lack of iodine in the diet.

Other causes of goiter include:

  • The body’s immune system attacking the thyroid gland (autoimmune problem)
  • Certain medicines (lithium, amiodarone)
  • Infections (rare)
  • Cigarette smoking
  • Certain foods (soy, peanuts, vegetables in the broccoli and cabbage family)
  • Toxic nodular goiter, an enlarged thyroid gland that has a small, rounded growth or many growths called nodules, which produce too much thyroid hormone

Simple goiters are more common in:

  • People over age 40
  • People with a family history of goiter
  • Women

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