Goiter and Multinodular Goiter

Goiter essentially means an enlargement of the thyroid, which is the butterfly-shaped gland located at the lower front of the neck. Goiters can be a Goiter essentially means an enlargement of the thyroid, which is the butterfly-shaped gland located at the lower front of the neck. Goiters can be an enlargement of only a portion, or of the entire thyroid, and are often referred to as multinodular goiters because they involve multiple nodules. At Mount Sinai’s Center for Thyroid and Parathyroid Diseases, our team of thyroid physicians and surgeons monitors (clinically observes) and treats goiters of all types. Small goiters not causing physical issues often do not require treatment; however, a large goiter may require surgery, as it can cause difficulties with swallowing, breathing, and/or voice.

Causes and Risk Factors for Goiter

Worldwide, the most common cause of goiter is an iodine-deficient diet. Iodine is essential for the production of thyroid hormones and can be found in foods such as dried seaweed, cod fish, shrimp, yogurt, turkey, cranberries, tuna, white bread, and eggs. Additionally, a family history of goiters and certain genetic factors and diseases have been correlated with goiter. Some conditions that may cause a goiter include Grave’s disease (autoimmune disease), Hashimoto’s disease (autoimmune disease associated with underproduction of thyroid hormones), exposure to radiation, and thyroiditis (inflammation due to a virus or occurring within a year after childbirth).

Signs and Symptoms of Goiter

Goiter can cause many symptoms, including the following:

  • Swelling of the thyroid gland in the front of the neck
  • A feeling of tightness in the throat
  • Hoarseness
  • Dizziness when arms are raised above the head
  • Difficulty swallowing or breathing
  • Coughing or wheezing

Additional symptoms may occur if an individual also has hyperthyroidism (overactive thyroid) or hypothyroidism (underactive thyroid). Symptoms of hyperthyroidism include increased heartbeat, sweating, agitation, and/or weight loss. Symptoms of hypothyroidism include weight gain, dry skin, and/or fatigue.

Diagnosis of Goiter

If your physician suspects or detects an enlarged thyroid during a physical exam, various tests may be performed to determine goiter. These include:

  • Hormone testing for hyper- or hypothyroidism: This blood test measures the amount of hormones your thyroid and pituitary glands are producing.
  • Antibody tests: These blood tests assess antibodies, which normally help thwart viruses and other agents that may cause disease or infection. However, in some thyroid diseases, the body can produce antibodies against normal thyroid receptors, causing a hormone imbalance.
  • Ultrasound of the thyroid: A physician will hold a wand-like device over your neck as sound waves form images on a computer screen. The images will reveal the size of your thyroid gland and whether it contains nodules.
  • CT scan or MRI of the thyroid: This test, which can measure the size of a growing goiter, may be required if the goiter has spread into the chest.
  • Fine needle aspiration (FNA) biopsy: This is an office test that can sample the cells in a thyroid nodule and help assess risk for malignancy. The sample can even be sent for additional genetic testing for more accurate prediction when necessary.

Treatments for Goiter

Treatment for goiter depends on the size of the thyroid gland, your symptoms, and the cause of your condition. Given these variables, your physician may recommend:

  • Observing/”watchful waiting”: Even if your goiter is small enough not to warrant immediate treatment, it most likely will require regular monitoring for any potential changes in size.
  • Medications: If the cause of the goiter is underactive thyroid (hypothyroidism), levothyroxine may be prescribed. Other medications are available for an overactive thyroid (hyperthyroidism) as well, such as methimazole and propylthiouracil. Aspirin may also be prescribed if the cause of the goiter is inflammation.
  • Radioactive iodine treatment: Sometimes for overactive thyroid glands, this treatment is recommended, as the radioactive iodine (taken orally) can kill thyroid cells and shrink the gland. Patients often need to take thyroid hormone replacement therapy after this treatment for the remainder of their lives.
  • Surgery: An operation may be recommended to remove the thyroid or part of it if the goiter is large and causing difficulties breathing and swallowing. Surgery may also be performed in cases where biopsying a goiter has revealed a thyroid cancer. Patients may need to take thyroid hormone replacement for the remainder of their lives, depending on the amount of thyroid that is removed.