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Goiters: Abnormally Large Thyroid Glands

A goiter is an abnormally large thyroid gland. A goiter develops either because the whole gland is swollen or the gland has multiple growths or nodules on it. While some people with a goiter have no symptoms, others may have symptoms of an overactive or underactive thyroid.

  • Hyperthyroidism is the medical term for an overactive thyroid, which produces too much thyroid hormone. Symptoms may include: Anxiety, rapid heart rate, diarrhea, weight loss.
  • Hypothyroidism refers to an underactive thyroid, which products too little thyroid hormone.  Symptoms may include: Depression, fatigue, constipation, weight gain.

What Causes a Goiter?
Causes of goiters include: 

  • Iodine deficiency — A goiter may be caused by not getting enough iodine through the foods you eat. However, it is rare in the United States, because table salt is supplemented with iodine.  
  • Graves' disease — This autoimmune disorder causes hyperthyroidism. Grave’s disease causes the body to produce a protein called thyroid-stimulating  immunoglobulin that mistakenly attacks the thyroid, causing it to overproduce thyroid hormones and swell in size.
  • Hashimoto's disease — This is another autoimmune disorder in which antibodies damage thyroid cells, leaving fewer cells to produce thyroid hormones. The pituitary gland, which controls your thyroid, stimulates the thyroid to produce more hormones, making the thyroid swell. Hashimoto’s disease is the most common cause of hypothyroidism.
  • Thyroid nodules — Nodules are overgrowths of tissue that may overproduce thyroid hormone or many not cause any symptoms. Rarely, nodules may contain cancer cells.
  • Thyroiditis — This condition is an inflammation of the cells in the thyroid that may cause the thyroid to produce too much or too little thyroid hormone.
  • Thyroid cancer — Cancerous cells may grow in nodules on the thyroid.    

Treatments for Goiters
Treatment depends on the cause of the goiter and your symptoms. If your goiter is caused by low iodine intake, you may be treated with iodine supplements and thyroid hormone.

If your goiter is caused by Hashimoto’s thyroiditis, and you have hypothyroidism, treatment typically involves taking a pill containing thyroid hormone every day.

If the goiter is caused by hyperthyroidism, you may be treated with radioactive iodine, which is given as a pill and causes the thyroid gland to shrink and make less thyroid hormone. Radioactive iodine is only absorbed by the thyroid gland, so it does not harm other cells in your body. Another treatment involves removal of part or the entire thyroid by a surgeon. You may need to take thyroid hormones after surgery.  

If the goiter does not cause any symptoms, you may not need any treatment. Your doctor will monitor the goiter over time and check to see if you develop symptoms of hypothyroidism or hyperthyroidism. If the goiter keeps growing and causes breathing or swallowing problems, your doctor may suggest that you have all or part of the thyroid gland removed by an endocrine surgeon.


January 29, 2015

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