How To Understand Thyroid Goiters

A goiter simply means swelling of the thyroid gland. There are several important facts with regard to goiters, shown in the steps below.

1. Goiters are commonly caused by autoimmune thyroid diseases, in which case they are the results of auto-antibodies that are sent by the immune system to attack and damage the thyroid gland. The autoimmune response causes two diseases of thyroid autoimmunity:
   
   • Autoimmune hypothyroidism (under-active), also called "Hashimoto's Thyroiditis"
   • Autoimmune hyperthyroidism (over-active), called "Graves' Disease"

   These thyroid-attacking antibodies also cause an inflammatory reaction that results in the swelling. This enlargement in the gland can be mild, causing only minor discomfort, or can become severe enough to obstruct a person's swallowing and/or breathing.

2. Iodine deficiency can also cause goiters. In areas of the world where people's diets are lacking sufficient iodine, goiters can be a common occurrence. When the thyroid gland, which is comprised mostly of iodine, does not receive enough of this important element, swelling in the gland and hypothyroidism can occur. More highly industrialized countries have a lower rate of iodine deficiency hypothyroidism because the salt that is available to them is iodized and supplies adequate iodine for healthy thyroid function. Goiters of this type are also referred to as "endemic goiters".
3. A goiter can turn into a "multi-nodule goiter". Thyroid nodules are small tumors that can develop in the gland. If a number of them develop in a person's thyroid, they can result in enlargement, which would then be referred to as a multi-nodule goiter. While having a multiple nodules in the gland reduces the chances of any of them containing malignancy (cancer), removal of the nodules may still become necessary if they pose a problem in obstructing breathing or swallowing.
4. In some cases of hyperthyroidism, goiters can be "toxic", meaning they contribute to an overactive thyroid gland. Some people experience an overactive metabolism, due to the release of too much hormone from the thyroid, but also have enlargement in the gland. They have what is called a "toxic diffuse goiter". These types of goiters are common in autoimmune hyperthyroid patients (those with Graves' Disease). "Thyrotoxicity" is anothern term for too much thyroid hormone released in the body due to a toxic goiter.
5. The treatment for goiters is to replace low iodine states and/or to administer thyroid hormone replacement therapy. In the case of goiters caused by iodine deficiency, the treatment is to replace the low iodine. If the same patient also needs replacement of thyroid hormone, this might be an additional therapy. In cases where iodine deficiency is not the cause of a goiter, thyroid hormone therapy alone would be the likely treatment. In most cases, treating with thyroid hormone replacement medication will shrink the size of goiters and prevent further enlargement.

   In rare cases, thyroid removal (thyroidectomy) may be required. In cases of severe inflammation, a corticosteroid (adrenal cortical steroid) might also be administered to control and reduce the inflammation, which would also contribute to shrinking the goiter.

   People who experience swelling at the front of their neck, just below the Adam's apple, should seek medical advice from their treating physician.