Goiter: Types, Causes, Risk Factors, Symptoms, Diagnosis, Treatment, Prediction and Prevention

It is a Latin term that refers to a structural problem with the thyroid gland, specifically a globally enlarged thyroid gland.

The enlarged thyroid may or may not have another type of structural problem of the thyroid called thyroid nodules.

The symptoms that goiter may suggest depend on the speed at which the thyroid grows and whether there is a functional problem with the thyroid.

The symptoms of goiter include compressive-type signs (suffocation and difficulty breathing), neck enlargement, hypothyroidism, and hyperthyroidism.


Goiter patients may also have functional thyroid problems, so there are two types of goiter: non-toxic goiter and toxic multinodular goiter.

  1. Non-toxic simple goiter is defined as any enlargement of the thyroid that is associated with hyperthyroidism or hypothyroidism.
  2. The toxic multinodular goiter refers to the enlarged thyroid glands related to hyperthyroidism. Graves’ disease is a subset.


It has traditionally been thought that goiter is an adaptive response of the thyroid to any factor that affects thyroid hormone synthesis.

This classic concept of a goiter does not explain all aspects of all types of goiters.


Years ago, it was thought that iodine deficiency was the leading cause of goiter since iodine is the main component of thyroid hormone. But there is a role for genetic factors in the formation of goiters.

This is suggested by the presence of several patients with a goiter within the same family, the higher rate of concordance of goiters in monozygotic twins than in dizygotic twins.

The female to male ratio of 1: 1 in iodine-deficient areas, 9: 1 in sporadic goiters, and the presence of goiters in those areas where iodine is no longer deficient.

Endocrinologists currently believe that goiter should be considered a complex genetic trait, which is affected by certain environmental factors.

Although iodine deficiency is the most common environmental cause, other factors such as smoking, infections, medications, and goitrogens can also affect it.

The thyroid gland is located in the front of the neck, where the clavicles meet and are the gland responsible for producing the hormones that control the body’s energy and metabolism.

Iodine deficiency is the most common cause of goiter since the body needs iodine to produce thyroid hormone.

The thyroid is enlarged to capture as much iodine as possible and be able to produce the amount of thyroid hormone.

Then, a goiter can signify that the thyroid can not produce enough thyroid hormone. Common causes of goiters include:

Iodine deficiency

Iodine mineral is necessary for the production of thyroid hormones. But this problem can be solved with the simple use of iodized mineral salt in the daily preparation of food.

Graves’ disease

Graves disease is a condition in which the immune system mistakenly attacks the thyroid gland, thus causing excessive production of hormones in the body.

This can cause the thyroid gland to swell.

Tiroiditis de Hashimoto

It is an autoimmune disease that causes damage to the thyroid, thus causing the production of hormones to be reduced.

This can also cause goiter.

Thyroid cancer

Cancer that occurs in the thyroid gland can increase the size of this organ in the body.

The pregnancy

During pregnancy, women produce hormones that can cause the thyroid gland to increase in size.


Thyroiditis is a condition that causes inflammation of the thyroid gland.

Other causes of goiter include:

  • The body’s immune system attacks the thyroid gland (autoimmune problem).
  • Certain medications such as lithium and amiodarone.
  • The presence of infections.
  • The habit of smoking cigarettes.
  • Certain foods such as soy, peanuts, and vegetables such as broccoli and cabbage.
  • Toxic nodular goiter is an enlarged thyroid gland with a small rounded growth or many growths called nodules, which produce too much thyroid hormone.

Risk factor’s

There is a greater risk of developing a goiter if:

  • If the patient is female.
  • If you have a family history of autoimmune diseases.
  • Be over 40 years old.
  • If you have ever received radiation therapy in the neck or chest area.
  • I am pregnant or going through the period of menopause.
  • Take certain medications, including immunosuppressants, antiretrovirals, heart medications such as Cordarone or pacer one ( amiodarone ), or psychiatric medications such as Lithobid (lithium).


The main symptoms are the enlargement of the enlarged thyroid gland.

Rarely a thyroid that has been enlarged can exert some pressure on the trachea and the food tube (esophagus). This can cause:

  • Respiratory difficulties (when the goiters are considerable), especially those extending towards the back.
  • Cough.
  • The hoarseness
  • Difficulty swallowing, excellent foods.
  • Pain in the area of ​​the thyroid.
  • The swelling at the base of the neck.
  • A feeling of apprehension in the throat.
  • Dizziness when the arms are raised above the head.
  • Swelling of the neck vein

It is also likely that goiters will not cause any symptoms.


The doctor performs a physical examination to diagnose a goiter, starts palpating the neck, and causes the patient to swallow.

Other ways to diagnose a goiter include:

  1. Hormone test:  the measurement of certain levels of hormones in a blood test is done to reveal if the thyroid gland is functioning correctly.
  2. Antibody test:  Abnormal antibodies that occur if you are predisposed to autoimmune thyroid disease are measured during this blood test.
  3. Ultrasound:  in this imaging test, you are allowed to check the size of the patient’s thyroid gland and thus determine if it contains any nodules (which can modify the levels of hormones it produces).
  4. Thyroid scan: This imaging test provides information on the size and function of your thyroid gland.
  5. Computed tomography and magnetic resonance imaging: These imaging tests can be used to check the size of the goiter or if it has spread to the inside of the chest.
  6. Biopsy: This procedure involves inserting a needle into the thyroid gland to obtain a sample of tissue or fluid, then examined with a microscope for the differential diagnosis of thyroid cancer.


Goiters are often associated with functional diseases such as hypothyroidism and hyperthyroidism.

Thyroid nodules may need evaluation by fine-needle aspiration.

A goiter only requires treatment if it is causing symptoms.

The treatment applied to the case of enlarged thyroids includes any of the following:

  • Thyroid hormone replacement tablets if the goiter is due to an underactive thyroid. If you have hypothyroidism (underactive thyroid), your doctor may prescribe Levothroid or Synthroid (levothyroxine) to replace your missing hormones.
  • The small doses of Lugol iodine or potassium iodide solution, in case the enlargement of the gland can be treated to the lack of iodine.
  • Radioactive iodine: This is a treatment administered orally to reduce the gland, mainly if the thyroid produces too much thyroid hormone and can reduce the size of your goiter.
  • Surgery (thyroidectomy): the doctor may recommend a thyroidectomy; this is a surgical procedure to remove all or part of your thyroid gland.
  • Medications: the doctor may indicate the use of aspirin or may prescribe a corticosteroid if the patient has an inflammation of the thyroid gland and certain medicines that succeed in inhibiting the growth of the thyroid gland.


A simple goiter can go away on its own (occurs more often in patients), or on the contrary, it can get bigger. Over time, the thyroid gland can stop producing enough thyroid hormone, causing hypothyroidism.

In some cases, the goiter becomes toxic and can cause high thyroid hormone levels; hyperthyroidism.


To prevent the enlargement of the thyroid gland, the use of iodized table salt in the diet is recommended as an essential factor in preventing simple goiter.