Goiter

Symptoms Of Goiter

The main distinguishing feature of goiter is a swollen thyroid gland which looks like a lump at the front of the neck. It does not present any symptoms if the swelling is small. The size of the goiter may vary from person to person. In some cases, the enlarged thyroid gland obstructs the respiratory tract and larynx (voice box) and can cause symptoms such as: 

• Coughing

• Tight feeling in the throat

• Difficulty in swallowing 

• Difficulty in breathing 

• Hoarseness

• Snoring

Some symptoms depend upon changes in thyroid function. People with goiter can have either underactive (hypothyroidism) or overactive (hyperthyroidism) thyroid gland. However, both hypothyroidism and hyperthyroidism can develop without goiter also. 

Symptoms of hypothyroidism

The common symptoms include: 

• Tiredness

• Weight gain

• Constipation

• Body aches

• Dry skin

• Increased sensitivity to cold

• Muscle weakness

Symptoms of hyperthyroidism

The common symptoms include:

• Weight loss

• Sweating

• Shortness of breath

• Diarrhea

• Palpitations

• Hair thinning 

• Menstrual changes

• Tiredness

• Muscle weakness

Types Of Goiter

Classification based on levels of thyroid hormones

Toxic goiter

In this, the amount of thyroid hormones produced by the enlarged thyroid gland increases. 

Non toxic goiter

In this, the thyroid gland is enlarged without an increase in the level of thyroid hormones. Non toxic goiter is associated with the absence of hypothyroidism or hyperthyroidism.

Classification based on the cause

Endemic goiter

It occurs due to deficiency of iodine in a community. More than 10% of the people of the community are affected. 

Sporadic goiter

In this a lesser number of individuals from the community are affected. It can affect people with possible factors such as family history, iodine deficiency, age (over 40 years) and female gender.

Classification based on how it enlarges

Simple (diffuse) goiter

In this, the whole thyroid gland swells and it feels smooth to touch. 

Nodular goiter

In this, thyroid nodules develop in the thyroid gland. Nodules are solid or fluid filled lumps in the thyroid gland. They can be: 

• Uninodular (with one nodule)

• Multinodular (with more than one nodule)

Causes Of Goiter

Iodine deficiency

Iodine is the crucial element needed by the thyroid gland to make thyroid hormones. Lack of iodine in the diet can lead to swelling of the thyroid gland as it tries to make enough hormones. About 30% of the world’s population remains at a risk of iodine deficiency due to lack of iodine in the diet. 

Know more about iodine deficiency. 
Click To Know!

Grave’s disease

It is an autoimmune disorder in which the body starts attacking the thyroid gland. This can result in swelling of the thyroid gland.

Know more about Grave’s disease.
Click To Read!

Thyroiditis

Thyroiditis refers to the inflammation of the thyroid gland and can predispose to goiter. It can be due to several causes such as: 

• Hashimoto’s thyroiditis (autoimmune disease) 

• Infections

• Radiotherapy

Thyroid cancer

Infiltrating papillary thyroid cancer, lymphoma, and anaplastic thyroid cancer can also be a possible cause of goiter. 

Medications

Some medicines such as lithium, phenylbutazone and amiodarone can cause the thyroid gland to swell. 

Goitrogenic food 

Goitrogens are food items that can interfere with the thyroid function. The excessive consumption of these foods may lead to goiter. It includes foods such as Brussel sprouts, kohlrabi, turnips, strawberries, radishes, cabbage, broccoli, kale, and cauliflower.

Risk Factors For Goiter

Gender

The chances of goiter are higher in women than men when exposed to iodine deficiency. Women have 2 to 10 times more chances of developing it than men. 

Age

The association between age and goiter is dependent on iodine status. In case of severe iodine deficiency, the risk of developing goiter is more in teenagers. 

Smoking

Tobacco smoking is also linked with the increase in chances of developing goiter due to the formation of thiocyanate in smokers. Thiocyanate leads to deficiency of iodine and is an important risk factor in the formation of multiple nodules.

Trying to quit smoking? Explore our smoking cessation product range.
Explore Now!

Pregnancy

Pregnancy is also a risk factor for goiter in iodine deficient women. The incidence of goiter can be easily prevented by increasing the iodine in the diet.  

Menopause

The postmenopausal women are at higher risk of developing goiter. 

Family history

People with a family history of thyroid disorders are having higher chances of developing goiter. 

Radiations

Studies suggest that exposure of radiation (such as during CT scans) to the thyroid gland increases the risk of nodular goiter in early years of life. This is commonly seen in people under 20 years of age. 

Environment

The exposure to several harmful chemicals such as nitrates, benzene, formaldehyde, pesticides, bisphenol A, polychlorinated biphenyl, polyhalogenated aromatic hydrocarbons, and polybrominated diphenyl ether also increase the chances of developing goiter. These chemicals can be consumed through contaminated water, air, and food. 

Mutations

Mutations refers to the change in the gene which is a unit of heredity. Several mutations such as change in genes RAS, SPOP (4/38), ZNF148 (6/38), and EZH1 (3/38) are known to be associated with an increase in risk of nodular goiter and benign nodules. 

Insulin resistance and metabolic syndromes

Several studies suggest that insulin resistance and other metabolic syndromes such as obesity increases the risk of goiter and papillary thyroid cancer. Obesity in both males and females makes the individuals more prone to thyroid cancer also. 

Elevation in thyroid stimulating hormone (TSH)

The elevated levels of TSH increases the thyroid volume over a period of time. This increases the risk of goiter, especially nodular goiter. This is commonly seen in iodine sufficient endemic goiter and in obesity. Obese person often have high levels of TSH than normal people. This makes them more prone to goiter. 

Hyperinsulinemia

It refers to the excess insulin secretion in the body. Insulin receptor levels have been shown to be increased in thyroid cancers. It is also associated with an increased risk of thyroid nodules. 

Diagnosis Of Goiter

1.Physical examination & medical history

The doctor physically examines the patient for any signs of thyroid enlargement. The lymph nodes adjacent to the thyroid gland are also checked. Patient is asked about his/her medical history and the symptoms he/she is experiencing for the detailed understanding of the disease. 

2. Blood tests

Thyroid stimulating hormone (TSH): TSH is the principal hormone that regulates the production of thyroid hormones which includes triiodothyronine (T3) and thyroxine (T4).

High level of TSH mostly indicates underactive thyroid gland (hypothyroidism). Low levels can be due to an overactive thyroid gland(hyperthyroidism).

Thyroxine total (T4): Most of the T4 in the blood is attached to a protein called thyroxine-binding globulin. The “bound” T4 can’t get into body cells. Only about 1%–2% of T4 in the blood is unattached (“free”) and can get into cells. The free T4 and the free T4 index are both simple blood tests that measure how much unattached T4 is in the blood and available to get into cells. In hypothyroidism, the thyroxine levels are lower than normal whereas in hyperthyroidism, they are elevated.

Thyroxine total (T3): Triiodothyronine (T3) Total Test measures the total levels (both free and bound forms) of triiodothyronine (T3) hormone in the blood and is usually done as a part of the thyroid profile total test.

Along with these three tests, supporting tests may be required to evaluate and monitor the condition, such as:

• Anti thyroglobulin antibody

• Thyroxine binding globulin

3. Imaging tests 

The following imaging tests can be used to find the cause of hypothyroidism:

Thyroid scan: Thyroid scan can help to evaluate the size, shape, and position of the thyroid gland. This test uses a small amount of radioactive iodine to help diagnose the cause of goiter and check for thyroid nodules as well.

Ultrasound: Ultrasound of the thyroid is used to closely look at thyroid nodules. Thyroid nodules are solid or fluid-filled lumps that form within the thyroid gland. Ultrasound can also help the doctor to evaluate if the nodules are cancerous in nature.

Radioactive iodine uptake test: A radioactive iodine uptake test also called a thyroid uptake test, measures how much radioactive iodine the thyroid takes up from the blood after swallowing a small amount of it. It can help check thyroid function and find the cause of goiter. 

MRI or CT scan: These imaging tests are used in case the size of the goiter is very large or the goiter has spread to the chest. 

4. Biopsy

During biopsy, a small amount of tissue is removed from the nodule which is then examined for the presence of cancer. It is mostly recommended in case the size of the thyroid nodule is more than ½ inch.

Specialist To Visit

You should visit a doctor, if you are experiencing symptoms of either hypothyroidism or hyperthyroidism alongwith the enlarged thyroid gland. You can consult the following doctors for a diagnosis:

• General physician 

• Endocrinologist

• Surgeon

If you are facing such an issue, seek advice from our professionals.
Consult Now!

Prevention Of Goiter

Take proper diet 

The iodine is very essential for the synthesis of thyroid hormones. If deficiency of iodine in diet is the cause of goiter, the following measures can be taken to maintain the iodine levels: 

Use iodized salt

Iodized salt is the major source of iodine in the diet. It has been the mainstay of the prevention of iodine deficiency. Use of iodine-containing supplements is recommended in areas where iodized salt is not available. 

The recommended dietary allowance (RDA) for iodine in adult men and women is 150 microgram/day as per The Institute Of Medicine. The recommendations are higher in pregnant and breastfeeding women. It is 220 microgram/day for pregnant women and 290 microgram/day for breastfeeding women. 

Consume iodine rich foods

Iodine is a mineral that is mostly found in soil and oceans which makes it available in seafoods. Iodine rich foods should be included in the diet to prevent goiter and other thyroid related problems such as hypothyroidism. The iodine rich food include: 

• Cheese

• Cows milk

• Eggs

• Frozen yogurt

• Saltwater fish

• Seaweed (including kelp, dulce, nori)

• Shellfish

• Soy milk

• Soy sauce

Limit goitrogenic foods

Some foods reduce the absorption of iodine which can be a cause of goiter. Limiting such foods and avoiding their raw form may help in the prevention of goiter through balancing the body's iodine demand. The common goitrogenic foods include:

• Cabbage

• Cauliflower

• Brussels sprouts

• Broccoli

• Turnips

• Mustard greens

• Kale

• Cassava root

• Lima beans

• Sweet potato

• Millet

• Soy and soy products

• Green tea

Avoid overexposure to radiation

Radiation at the workplace or during any treatment can cause several thyroid disorders including goiter. Avoiding radiation helps prevent goiter. 

Treatment Of Goiter

The cause and size of goiter decides the treatment approach for it. 

• Iodine supplements are recommended, if the cause is deficiency of iodine in the diet. The iodine supplements prevent the enlargement of the thyroid gland, however reducing the size of the already enlarged gland is difficult. 

• There are various cases of asymptomatic goiter with normal thyroid function. If such cases are found to be benign in ultrasound, normal follow-up ultrasounds are required depending upon the size of nodules without specific treatment. 

Depending upon the other conditions causing goiter, the following treatment approaches are discussed in detail: 

Medications

Goiter can be due to hypothyroidism or hyperthyroidism, both of them have a different treatment approach. 

Medications for hyperthyroidism

In case of overactive thyroid or hyperthyroidism, there is an excess production of thyroid hormones. Here the objective of the treatment is to control the production of hormones. Antithyroid medicines such as thionamide, methimazole, and propylthiouracil are given to reduce the function of the thyroid gland. 

Medications for hypothyroidism

In hypothyroidism, treatment involves the use of synthetic replacement of thyroid hormone to restore the activity of underactive thyroid. The common medication used is levothyroxine. The dose of the medication (hormone) is gradually increased to avoid the chances of side effects. The hormone helps in reducing the size of enlarged thyroid gland and symptoms usually start to improve within the first week of initiating the treatment. 

Anti-inflammatory medications 

In some conditions associated with the thyroid such as thyroiditis, anti-inflammatory medications are used to reduce the size of the thyroid. One such commonly used medication is aspirin.

Radioactive iodine

In this, the iodine is given to the patient as a capsule or liquid which accumulates in the thyroid gland. This helps in shrinking the enlarged thyroid or goiter. 

Surgery 

Surgical removal of the goiter is required if the size of goiter is very large and is compressing the adjacent cervical structures. It involves removal of either the entire thyroid gland or part of it. Thyroid gland surgery is advised in the following conditions: 

• If the nodule of the thyroid gland is cancerous or may become cancerous. This can be confirmed by biopsy. 

• If the size of the gland has become so big that it is causing symptoms such as trouble swallowing, difficulty in breathing, or changes to the voice due to the compression of nearby structures.

• If the patient with an overactive thyroid is not responding to the treatment, this can be seen in conditions such as Grave’s disease.

Types of surgery

The removal of the thyroid gland can be performed in several ways. A certain type can be recommended to you considering the condition of your thyroid gland and overall health. 

• Hemithyroidectomy or lobectomy: This surgery involves removal of only one lobe of the thyroid gland. It is performed in case a nodule is only present on one side of the thyroid gland. 

• Isthmusectomy: It involves removal of the isthmus which acts as a bridge between two lobes of the thyroid. It is useful in cases where small tumors are present only on the isthmus. 

• Total thyroidectomy: As the name suggests, it involves removing the entire thyroid gland. It is required in case of  thyroid cancer, bilateral thyroid nodules, and Graves’ disease. 

Home-care For Goiter

Showers with cold water

It is advisable to end the shower with cold water targeting mainly the thyroid gland (throat and neck). It is known to stimulate the blood flow to the thyroid gland and increases the accessibility of essential nutrients to it. This helps in the smooth functioning of the thyroid gland. 

Use of medications 

Some medications can trigger goiter, so it is important to keep a tab on medications taken for any other disease. 

Regular neck exercises

These exercises help in reducing swelling by targeting the tissues of the thyroid gland. It is always good to recommend your doctor before including these exercises in your regimen. Some common neck exercises are: 

1. Upward neck stretch: 

• Sit on a chair

• Lift your chin towards the ceiling

• Stretch the neck as much as possible

• Stay in that position for a few seconds

• Repeat this exercise 10-12 times.

2. Sideways neck stretch

• Slowly bend your neck to the side 

• Make sure that ear touches your shoulder

• Stretch as much as possible

• Repeat on the other side.

• Do 10 repetitions on each side.

Note: Avoid overexertion while doing these exercises. Stretch as much as you can without a feeling of discomfort or pain. Stop the exercise immediately, in case you are experiencing any pain.

Gentle massages

Gentle massages over the area of swelling with olive oil or coconut oil is also helpful for the patients with enlarged thyroid gland. 

Complications Of Goiter

The major complications that can develop due to untreated goiter are: 

• Compression of the trachea 

• Iodo-Basedow phenomenon, which is the development of hyperthyroidism if exposed to iodine intake

• Intra-nodular hemorrhage or necrosis

Complications due to hyperthyroidism: 

• Bulging eyes, blurred vision, double vision or even vision loss

• Tachycardia and problems with heart rhythm.

• Osteoporosis

• Red and swollen skin

• Thyrotoxic crisis

Complications due to hypothyroidism: 

• Hypercholesterolemia

• Tingling sensation in the nerves

• Infertility 

• Birth defects

• Miscarriage

• Depression 

• Myxedema

Read more about complications of hypothyroidism.
Read To Know!
Complications associated with thyroid surgery

Thyroid surgery is a safe procedure, however it is associated with certain risks which includes: 

• Bleeding in the neck

• Hoarseness/voice change

• Hypocalcemia

• Seromas

• Infection

Alternative Therapies For Goiter

Home remedies

Apple cider vinegar: It is mildly acidic and helps to restore the pH balance of the body. It also helps in the balanced production of hormones. It also increases the iodine absorption and is also found to reduce swelling. It can be consumed with honey and warm water, preferably on an empty stomach. 

Watch this video by our expert to know more about apple cider vinegar.

Castor (Arandi) oil: It reduces swelling of the thyroid gland as it possesses anti-inflammatory properties. It has to be massaged around the swollen neck area. Leave it overnight until the swelling reduces.

Coconut (Nariyal) oil: It contains medium chain fatty acids that help in the proper functioning of the thyroid gland. It also possesses anti-inflammatory and anti-microbial properties. It is also shown to improve metabolism. It can be added to hot drinks, smoothies, or can be used in cooking for health benefits. 

Bentonite clay: It is a natural clay with antimicrobial properties. It is useful in goiter due to its toxin absorption property which helps in the absorption of toxins from the goiter. This helps in reducing the swelling. A smooth paste of bentonite clay made by adding water to it is applied on the swollen area. It is then rinsed off with water after drying. 

Seaweed: It is a good source of iodine that helps in the production of thyroid hormones. It also contains amino acids such as tyrosine that aids the production of thyroid hormones. It can be taken as a salad or can be added as dressing. 

Dandelion leaves: It also helps in reducing swelling of the thyroid gland due to its antioxidant and anti-inflammatory properties. The leaves are grinded with some water to make a paste that is applied on the neck. 

Lemon juice: It aids in removing toxins that may be present due to infection in the thyroid gland. It also possess antimicrobial properties that help in killing any microbes present in the thyroid gland. 

Turmeric (Haldi): It is shown to exhibit healing properties. It also reduces swelling of the thyroid gland due to its antiinflammatory nature. 

Garlic (Lehsun): Garlic stimulates the production of glutathione in the body. Glutathione increases the amount of selenium in the body which is required for normal functioning of the thyroid gland. 

Acupuncture 

This is also known to ease the symptoms of goiter. However, the efficacy of acupuncture also needs more relevant research.

Living With Goiter

Goiter is not a very severe disease but it is not something that can always be treated with the right medical intervention. It is necessary to visit the doctor for the correct diagnosis and effective treatment.

Correcting iodine levels

It is not always necessary that the cause of goiter is iodine deficiency. After the consultation with the doctor, he/she will guide you about the recommendations of iodine needed by your body. It is necessary to correct the iodine levels to make the treatment plan work. 

So, the following measures should be considered for correcting iodine levels: 

• This recommended daily serving of iodine is 150 mcg/day for adults. It helps in the normal functioning of the thyroid gland. If the goiter is caused due to malnutrition, then getting enough iodine could help treat it.

• If iodine deficiency is diagnosed as the cause of thyroid, do not start taking supplements without medical consultation. This is because too much iodine can also cause several thyroid problems. 

• The main source of iodine is iodized salt. Switch over to iodized salt, if you are using non-iodized salt to get your daily iodine serving. Frozen and processed foods are usually very salty, but in most cases they don’t use iodized salt. Don’t rely on these food items for your daily iodine intake. 

• It is advised to reduce the iodine if the cause of goiter is excess iodine. In this case, take steps to reduce your iodine intake. For this following measures can be taken such as switching from iodized to non-iodized salt and reducing the intake of seafood and seaweed

• Cut your iodine intake after the consultation with your doctor, if the cause of goiter is found out to be because of excess of iodine. 

• The excess consumption of salt can also cause several other health problems, so take it as per recommendations. 

Post-operative care

The patients who have undergone surgery are advised to limit their physical activity. The patient can resume his lifestyle including exercise and physical activity gradually as per the surgeon’s indications. 

Post-operative medications

In case of thyroidectomy, where all the thyroid gland is removed, lifelong thyroid supplements are required to be taken by the patient. Sometimes, calcium supplements are also required to be taken by patients after surgery. These are required for a short period of time depending on the calcium levels. 

Lifestyle modifications

Some lifestyle changes are also required to be adopted by the patient for the smooth functioning of the thyroid gland. This includes: 

• Limiting alcohol

• Limiting smoking

• Eating healthy

Planning while traveling

Patients with goiter can travel normally but they are recommended to carry the medications for the entire trip. Patients who have undergone their surgery should pack their thyroid supplements with them. 

Goiter during pregnancy 

Pregnant women should inform their endocrinologist about their condition well in advance. This will help the doctor to create a customized treatment plan for them.