CT/MRI

Goiter

*What is a goiter?*
The thyroid gland resembles a butterfly shape and is located at the base of the neck just below the Adam’s apple. When the thyroid grows abnormally large it is known as a goiter. Most goiters are painless, but the larger they grow the more difficult it is for a patient to breathe and swallow. A goiter can occur in a gland that develops too much hormone (hyperthyroidism), too little hormone (hypothyroidism), or the correct amount of hormone (euthyroidism). Any of these conditions would indicate there is some abnormality of the thyroid.

*Causes*
One of the most common causes of goiter formation worldwide is iodine deficiency. This is not the case for majority of First-World countries, where iodine is added to table salts and other foods. Another cause of goiters can be Graves’ disease. In Graves’ disease antibodies produced by the immune system mistakenly attack the thyroid causing it to produces excess thyroxine. This overproduction of hormone (hyperthyroidism) causes the thyroid to swell. Another cause of goiters is Hashimoto’s disease. This disease is due to an underactive thyroid. The pituitary senses the low hormone level (hypothyroidism) and produces and excessive amount of thyroid-stimulating hormone (TSH), which causes the thyroid to swell. Some other causes of goiters are thyroid cancer, pregnancy, and inflammation of the thyroid.

*Symptoms*
Not all goiters show symptoms. When symptoms do take place they may include, but are not limited to: a visible swelling at the base of the neck that may range from a small nodule to a large lump, and a tight feeling in the throat. The enlarged thyroid can put pressure on the esophagus that can lead to a cough, difficulty swallowing, and difficulty breathing.

*Treatment*
Goiter treatment depends on the size of the goiter, the cause of the goiter, and the symptoms the patient experiences. Some possible treatment options include, but are not limited to: observation, if the goiter is small and the thyroid is functioning normally and not causing the patient any difficulties the doctor may choose to monitor the size of the goiter and the symptoms of the patient before taking the next step. Medications are another treatment that some patients take. There are medications that can make up for the difference of hypothyroidism and hyperthyroidism. Hypothyroidism medications slow down the release of TSH and hyperthyroidism medications normalize the hormone levels. With inflammation of the thyroid, medications such as aspirin can be prescribed to the patient to try and reduce the size of the goiter. Another treatment option is surgery. If a patients symptoms worsen and the size of the goiter becomes extremely large the patient can have a partial or total thyroidectomy. The last treatment option is radioactive iodine. Radioactive iodine is taken orally and destroys thyroid cells. This treatment reduces the size of the goiter. Hormone medicine may have to be taken by the patient after the treatment to maintain normal hormone levels.