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What are Goiters?

By Elaine Moore on 9/12/2008

Goiter refers to an enlargement of the thyroid gland. Usually, goiters are visible and appear as a prominent thickening in the anterior (front) of the neck. However, if the thyroid gland is situated further back in the throat (retrosternal), it may not be visible even though it can cause symptoms.

Symptoms

  • Hoarseness
  • Difficulty swallowing
  • Swelling below the Adam’s apple
  • Coughing
  • Feeling of tightness in the throat
  • Shortness of breath
  • Wheezing
  • Neck vein bulging
  • Dizziness when the arms are raised overhead

Causes

  • Goiters can occur in hypothyroidism, as thyroid cells in their effort to trap more iodine and produce more thyroid hormone.
  • Goiters can occur in hyperthyroidism and thyroid cells enlarge and store more thyroid hormone.
  • Endemic goiters can occur in areas of iodine deficiency although this is rare today.
  • Goiters can be sporadic, meaning there’s no real cause. Some drugs such as lithium are known to cause goiter although in most cases of goiter in patients on lithium, the patient develops an autoimmune thyroid disease.

 

Types of Goiter

  • Goiters can be nodular, in which case clusters of thyroid tissue grow together. When multiple nodules produce increased levels of thyroid hormone, the condition is called toxic multinodular goiter.
  • Goiter of Pregnancy—the hormone beta hCG, which is increased in early pregnancy, is very similar to the hormone TSH. High levels of beta hCG can cause goiter.
  • Nontoxic goiter—this term is used for goiter that is not associated with hyperthyroidism, malignancy or nodules.

Treatment

In patients with hyperthyroidism, goiters generally resolve when thyroid hormone levels fall back into the normal range. In Graves' disease, goiter may not resolve until stimulating TSH receptor antibody (TSI) levels fall. Like TSH, TSI induces thyroid cell growth.

In patients with thyroiditis or hypothyroidism, goiter resolves when TSH levels fall back into the normal range. TSH causes thyroid cells to grow and enlarge. Often, patients with nodules are treated with thyroid replacement hormone to suppress TSH levels.

In nodular goiter, a low iodine diet or anti-thyroid drugs can reduce the size of nodules and goiter.

Goiters that interfere with breathing or that compress the esophagus or trachea may need to be surgically removed.




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Graves' Disease and Autoimmune Disease Education
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