An enlarged thyroid gland is the classical symptom of goiter. The size of the enlarged gland may either appear as a single nodule, or large lump. In rare cases, goiter may produce the following signs and symptoms [5]:

• Difficulty in breathing
• Hoarseness in voice
• Coughing
• Trouble in swallowing
• Feeling of tightness in throat

• Goiter

  Click here for Frequently Asked Questions on a Toxic Multinodular Goiter. A multinodular goiter is simply a thyroid gland that is usually enlarged and contains multiple thyroid nodules. [mythyroid.com]

  Abstract Retrosternal goiter is one of the common causes of anterior mediastinal masses. [ncbi.nlm.nih.gov]

  […] return to Swine Manual index Hyperplastic thyroid glands (goiter) occasionally occur in swine. [vetmed.iastate.edu]

  goiter Autonomously functioning thyroid goiter Congenital hypothyroidism w diffuse thyroid goiter Congenital hypothyroidism with diffuse goiter Congenital hypothyroidism with diffuse thyroid goiter Euthyroid goiter Goiter Goiter due to thyroiditis Goiter [icd9data.com]

• Thyroid Nodule

  How Are Thyroid Nodules Treated? Thyroid nodules don't always need treatment. Many nodules cause no symptoms and may even get smaller over time. [kidshealth.org]

  Our Approach to Thyroid Nodules and Goiter UCSF offers comprehensive consultations and treatments for thyroid conditions, including goiter (enlarged thyroid gland) and thyroid nodules. [ucsfhealth.org]

  The examination revealed a newly occurred thyroid nodule in the right central lobe. Unexpectedly the Tc-pertechnetate scan revealed several extrathyroidal foci right-sided supraclavicular, beside a cold thyroid nodule in the right lower lobe. [ncbi.nlm.nih.gov]

  If a thyroid nodule has less iodine uptake than the rest of the thyroid gland, then the thyroid nodule is called a "cold nodule". [thyroidcancer.com]

  Revised 2018 Also available in Arabic, Polish and Urdu What are thyroid nodules and swellings? A swelling in the neck due to an enlarged thyroid gland is called a goitre. Nodules are lumps in the thyroid gland. [btf-thyroid.org]

• Weight Gain

  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. [endocrineweb.com]

  In these cases patients may have symptoms such as sleeping problems, increased irritability, fatigue and unintentional weight loss or weight gain, which can cause further problems for some patients. [ic.steadyhealth.com]

  […] thyroid can cause symptoms such as: cold intolerance constipation forgetfulness personality changes hair loss weight gain Aside from the swelling itself, many people with goiter present no symptoms or signs at all. [medicalnewstoday.com]

  Warning Iodine deficiency is a serious condition that may lead to birth defects, miscarriage, mental retardation, learning disorders and weight gain. Follow your doctor's treatment plan carefully. [livestrong.com]

• Fatigue

  Phonatory symptoms included hoarseness, vocal fatigue, vocal straining, lump sensation, and aphonia. The Voice Handicap Index 10 was used to assess the impact of phonatory symptoms on quality of life. [ncbi.nlm.nih.gov]

  / For instance, if your fatigue is the result of anemia, blood tran... [studysite.org]

  Autoimmune diseases -- including chronic fatigue syndrome, vasculitis, juvenile diabetes, alopecia, Graves' disease, Sjögren's syndrome, lupus, rheumatoid arthritis, and multiple sclerosis -- are among the hottest topics in the medical community. [books.google.com]

  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. [endocrineweb.com]

• Fever

  Herein, the multimodality imaging features in 3 cases of amyloid goiters secondary to familial Mediterranean fever are presented. [ncbi.nlm.nih.gov]

  […] a serious malarial fever occurring in the East Indies अपने स्कोर: [collinsdictionary.com]

  Chorea कोरिया, लास्य, नर्तनरोग, The hallmarks of rheumatic fever include arthritis, carditis, cutaneous disease, chorea, and subsequent acquired valvular disease. [studysite.org]

  […] abnormal functioning 2 n a form of tuberculosis characterized by swellings of the lymphatic glands Synonyms: king's evil, scrofula Type of: T.B., TB, tuberculosis infection transmitted by inhalation or ingestion of tubercle bacilli and manifested in fever [vocabulary.com]

  This page focuses on type II necrotizing fasciitis where group A strep is the cause… symptom icon Acute Rheumatic Fever A delayed sequela of pharyngitis due to group A strep, this disease is usually characterized by fever and affects multiple organ systems [cdc.gov]

• Hoarseness

  An 82-year-old male musician presented abrupt thyroid enlargement, hoarseness, and trachea compression when he was playing the clarinet. Thyroid and renal function tests were normal. [ncbi.nlm.nih.gov]

  Signs and Symptoms Swelling of the neck Hoarseness Sore throat Coughing Difficulty swallowing Feeling of pressure in the neck Rarely, difficulty breathing at night Treatment Treatment for goiter will depend on what underlying condition is causing the [virginiamason.org]

  Affected individuals also experience hoarseness in voice. Diagnosis A preliminary physical examination is done, followed by blood tests to determine the levels of thyroid hormones. [symptoma.com]

• Cough

  A 53-year-old man was referred to our department with a history of cough, especially at night, for 3 months. He was found to have a huge retrosternal goiter. [ncbi.nlm.nih.gov]

  But large goiters can make it hard to breathe or swallow and can cause a cough and hoarseness. [mayoclinic.org]

  Clinical Categorization Treat Phlegm Dry Dampness and Expel Phlegm Cautions Avoid in patients with yin deficiency - i.e. cough from dryness. [theory.yinyanghouse.com]

  Signs and Symptoms Swelling of the neck Hoarseness Sore throat Coughing Difficulty swallowing Feeling of pressure in the neck Rarely, difficulty breathing at night Treatment Treatment for goiter will depend on what underlying condition is causing the [virginiamason.org]

• Overeating

  Many of the pigs have a mucinous edema, especially over enlarged foreparts of the body. The skin in these areas is thick and doughy. The tongue is often edematous and may protrude from the oral cavity. [vetmed.iastate.edu]

  These include: Blood tests – this is usually the first test performed and is done to ensure that your thyroid is not over- or under-active. [btf-thyroid.org]

  Over time, the thyroid can become so damaged that it can't make enough thyroid hormone. In that case, a person might need to take a thyroid hormone. [kidshealth.org]

  There are a number of different guidelines as to which nodules should be biopsied, but in general, nodules over 1 cm should be biopsied. [columbiasurgery.org]

  Blues. over 2 years ago submitted Various - Christiesgate 14. over 2 years ago submitted Good Time Charlie (3) - Ready To Rumble. over 2 years ago submitted Legendary Shack Shakers - Agri·Dustrial. over 2 years ago submitted HM Johnsen - Chased. over [discogs.com]

• Dysphagia

  In patients with a rapidly enlarging thyroid gland presenting with dysphagia, dyspnea, or hoarseness, amyloid goiter and malignancy should both be suspected, even when systemic amyloidosis is not suspected. [ncbi.nlm.nih.gov]

  A 67-year-old woman presented with a 6-month history of dyspnea and dysphagia. Physical examination revealed a small cervical goiter, but the lower poles of the thyroid were not palpable. The serum thyrotropin and free thyroxine levels were normal. [nejm.org]

• Diarrhea

  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. [endocrineweb.com]

  Also call if you have diarrhea, nausea, vomiting, sweating without exercise or increased room temperature, shaking, agitation, shortness of breath, or signs of hypothyroidism such as fatigue, constipation, or dry skin. [uclahealth.org]

  Symptoms of hyperthyroidism can include: An increased resting pulse rate Rapid heartbeat Diarrhea, nausea, vomiting Sweating without exercise or increased room temperature Shaking Agitation Some people with goiter may also have hypothyroidism, or underactive [my.clevelandclinic.org]

• Abdominal Pain

  Chest pain Rapid and/or irregular heartbeat Shortness of breath Abdominal pain Vomiting Extreme agitation or irritability Dizziness Disorientation (person has no knowledge of the date or location) Fever Coma Severe goiter or nodule problem : Seek immediate [emedicinehealth.com]

• Neck Swelling

  These conditions include swelling around the neck, swelling, and inflammation of lymph glands and other tissues. Based on this, it can help in mumps, goiter, cervical lymphadenitis, lymphadenopathy, thyroid disorders, etc. [ayurtimes.com]

  Due to the location of the thyroid gland, it causes a swelling in the neck. The condition is caused by the use of lithium in the treatment of bipolar disorder. [healthhype.com]

  Should patients develop neck swelling or difficulty breathing, they should go immediately to the nearest emergency room. Complications Bleeding Infection. [woundcaresociety.org]

  On physical examination, there will be a central neck swelling that could be smooth or nodular and the mass moves with swallowing. It may deviate the trachea or extend retrosternally. [ncbi.nlm.nih.gov]

  Goiter is a swelling of the neck resulting from enlargement of the thyroid gland. A goiter is an enlarged thyroid gland. The thyroid is the gland in front of the neck. [nigeriagalleria.com]

• Lethargy

  […] increase in oxygen consumption, metabolic changes in protein metabolism, immunologic stimulation of diffuse goitre, and ocular changes (exophthalmos).[4] Hypothyroid individuals may have weight gain despite poor appetite, cold intolerance, constipation and lethargy [en.wikipedia.org]

Several tests are employed for diagnosing goiter. These include:

• Physical examination: A preliminary examination of the neck of the individual is done. The individual would be asked to swallow, and swelling can be determined in the neck region. 
• Blood tests: Blood tests will be done to detect the levels of T3 and T4. The levels of thyroid hormones, and TSH would indicate the underlying cause of goiter. In addition, antibody test would also be required.
• Thyroid scan: This would furnish information about the size and nature of the thyroid.
• Ultrasonography: This test provides information about the size of the thyroid gland and presence of nodules, if they had been missed out during physical examination [6].
• Biopsy: This is achieved using fine needle aspiration technique, wherein a sample is obtained for analysis of the nature of the thyroid [7].

Treatment of goiter would depend on the nature and size of the enlarged gland, underlying disease conditions if any, and symptoms experienced by the individual. The following types of methods are employed for treating the condition:

• Medications: Hormone replacement medications are required if goiter is caused due to underactive thyroid. In addition, if inflammation is the cause, then medications to reduce the same will be administered. If hyperthyroidism is the underlying cause, then medications to normalize the levels of hormones is given.
• Surgery: Surgery is the method of choice if goiter causes uncomfortable signs and symptoms. It is also considered in patients with nodular goiter [8].
• Radioactive iodine is considered in cases, when overactive thyroid has caused goiter. The radioactive material destroys the thyroid cells, thereby reducing the size of the gland [9].

In certain cases, simple forms of goiter can resolve on its own, without treatment. In some other cases, the gland can eventually enlarge, as a result of which, thyroid gland can stop producing enough thyroid hormone, leading to hypothyroidism.

In yet some other cases, goiter can turn toxic, and begin producing thyroid hormones on its own, causing over production of hormones, leading hyperthyroidism.

Iodine deficiency is the most common cause of goiter in countries that do not use iodized salt. However, goiter is also a common occurrence in those parts of the world that routinely use iodized salt. In such conditions, following are the factors that lead to goiter:

• Disease conditions: Underlying disease conditions, such as Graves disease, or Hashimoto thyroiditis, which are autoimmune disorders, cause the development of goiter.
• Development of nodules: Development of fluid filled sacs at both sides of the thyroid glands causes it to enlarge, giving rise development of multinodular goiter.
• Solitary thyroid nodules: In this, a single nodule takes shape in one part of the gland causing goiter.
• Pregnancy: In such conditions, the thyroid gland can enlarge due to hormone HCG that is produced during pregnancy.
• Thyroiditis: This condition can cause the thyroid gland to swell and enlarge [2].

Iodine deficiency is the most common cause of goiter worldwide. It has been estimated that about 200 to 800 million individuals with iodine deficiency develop goiter. In the US, majority of the cases of goiter occur due to underlying autoimmune disease, such as Hashimoto thyroiditis [3]. Females are more prone to develop goiter, as compared to males, with female to male ratio been 4:1.

The functioning of the thyroid gland is regulated by the hormone TSH, which is produced by the pituitary gland. The thyroid gland produces 2 hormones, namely T3 and T4. These hormones are responsible for regulating the metabolism. Along with T3 and T4, the gland also produces the hormone known as calcitonin which regulates the calcium levels in blood. The pituitary gland along with hypothalamus, also controls and regulates the hormones that are produced.

Any form of deficiency occurring in synthesis of thyroid hormone, causes increased production of TSH. Increase in the levels of TSH causes the thyroid gland to enlarge, causing in order to normalize the levels of thyroid hormones. When such a phenomenon continues for prolonged duration, goiter develops [4].

Taking iodized salt can prevent the development of most forms of simple goiter [10]. Other forms of goiter can seldom be prevented.

Improper functioning of the thyroid gland causes it to enlarge, which eventually paves way for development of compressive syndromes. The thyroid gland is anatomically linked to the trachea, larynx, esophagus and laryngeal nerves. As a result of this, the enlargement of the gland, also gravely affects the functioning of the neighboring regions. Goiter is a painless condition; however in some it can pose difficulty in swallowing food [1].

Definition

Goiter is a condition characterized by enlarged thyroid gland. Enlargement of the gland is in many cases non cancerous in nature. Such a type of condition strikes more women than men.

Cause

Iodine deficiency is the most common cause of goiter worldwide. However, in countries where iodized salt is regularly used, certain underlying disease conditions, and autoimmune diseases cause goiter.

Symptoms

In majority of the cases, goiter does not cause any symptoms. In cases when the gland enlarges to a great extent, individuals experience difficulty in breathing and swallowing. Affected individuals also experience hoarseness in voice.

Diagnosis

A preliminary physical examination is done, followed by blood tests to determine the levels of thyroid hormones. In addition, thyroid scans, ultrasonography and biopsy, are also indicated to analyze the fundamental cause of goiter.

Treatment

Simple forms of goiter do not require treatment. In many cases, a wait and watch approach is considered. When symptoms are experienced, the mode of treatment is designed, depending on nature and size of thyroid gland. Medications, surgery and radioactive iodine, are administered for treating goiter. 

1. Bardin CW. Endemic goiter. In: Current Therapy in Endocrinology and Metabolism. 6th ed. Mosby-Year Book; 1997:101-112.
2. Knudsen N, Perrild H, Christiansen E, et al. Thyroid structure and size and two-year follow-up of solitary cold thyroid nodules in an unselected population with borderline iodine deficiency. Eur J Endocrinol 2000; 142:224.
3. Sawin CT, Geller A, Hershman JM, Castelli W, Bacharach P. The aging thyroid. The use of thyroid hormone in older persons. JAMA. May 12 1989;261(18):2653-5.
4. Elte JW, Bussemaker JK, Haak A. The natural history of euthyroid multinodular goitre. Postgrad Med J 1990; 66:186.
5. Braverman LE, Utiger RD. Thyroid diseases: nontoxic diffuse and multinodular goiter. In: Werner and Ingbar, eds. The Thyroid: A Fundamental and Clinical Text. 7th ed. Lippincott-Raven; 1996:889-900.
6. Hegedüs L. Thyroid ultrasound. Endocrinol Metab Clin North Am 2001; 30:339.
7. Arda IS, Yildirim S, Demirhan B, Firat S. Fine needle aspiration biopsy of thyroid nodules. Arch Dis Chil. 2001;85(4):313-7.
8. Romanchishen AF, Iakovlev PN. [Special surgical treatment of patients with nodular tumors of the thyroid gland against the background of diffuse toxic goiter]. Vestn Khir Im I I Grek. 2005;164(1):21-4.
9. Fast S, Nielsen VE, Grupe P, et al. Prestimulation with recombinant human thyrotropin (rhTSH) improves the long-term outcome of radioiodine therapy for multinodular nontoxic goiter. J Clin Endocrinol Metab 2012; 97:2653.
10. Dohán O, De la Vieja A, Paroder V, et al. The sodium/iodide Symporter (NIS): characterization, regulation, and medical significance. Endocr Rev. Feb 2003;24(1):48-77