Goiter: Treatment and Symptoms

Goiter, also known as goiter, is an enlargement of the thyroid gland. The cause of such a thyroid swelling is often an iodine deficiency, which can lead to nodules in the thyroid gland. It is estimated that one in three Germans has a goiter – often without knowing it. This is because, especially in the beginning, goiter is often not accompanied by a noticeable or visible swelling in the neck, so that many affected people do not even notice any signs. Learn more about symptoms and treatment of such thyroid swelling.

Symptoms of goiter

A goiter usually causes no symptoms or hardly any discomfort initially and is therefore often discovered late or only by chance. The first signs may be difficulty swallowing or a feeling of pressure and tightness in the throat (“lump in the throat”). A thick neck, which can be seen in a shirt collar that has become tight, can also be a sign of goiter. Because the thyroid gland is close to the trachea, it can press on it when it becomes enlarged. In some sufferers, this causes shortness of breath or whistling breath sounds. Vocal cord nerves or blood vessels can also be affected by the swollen thyroid, causing hoarseness or blood congestion in the head. These symptoms increase the more the thyroid gland swells. Goiter can affect the thyroid’s hormone production. If it is accompanied by hyperthyroidism or hypothyroidism, the symptoms typical of each may occur.

Detect thyroid swelling by self-testing

In order to detect early whether the thyroid gland is swollen, doctors advise to do a “mirror test” regularly. To do this, the head is placed in the neck and the area below the larynx is observed with a hand mirror while drinking a sip of water. If swelling appears below the larynx during swallowing, a doctor should be consulted. The same applies if there is sudden difficulty swallowing or a feeling of pressure in the throat. With a palpation examination, the doctor can determine the size and condition of the thyroid gland and thus determine whether a goiter actually exists.

Goiter: diagnosis and examinations

If the palpation examination indicates swelling of the thyroid gland, an accurate diagnosis can be made with the help of further examinations:

  • A blood test shows whether there is hyperthyroidism or hypothyroidism.
  • The TSH level (thyroid-stimulating hormone) in the blood also allows conclusions to be drawn as to whether the goiter is due to a tumor.
  • Ultrasound examination can be used to examine the size and structure of the thyroid gland. This allows you to determine whether struma nodules are present.
  • If nodules are present, a thyroid scintigraphy can measure iodine accumulation in the thyroid gland to check whether they are so-called hot or cold nodules.
  • A tissue sampling (biopsy) from the thyroid gland provides clarity if a malignant nodule is suspected.
  • X-rays can show whether the goiter is pressing on the trachea or esophagus, for example.

With the help of the examinations can also rule out other possible diseases, such as Hashimoto’s thyroiditis.

Forms of a goiter

There are different forms of a goiter. The classification is based on various criteria, including the structure: in most cases, one or more nodules form in the thyroid gland (“struma nodosa”). Depending on the number of nodes, a distinction is made between “struma uninodosa” and “struma multinodosa”. If the entire thyroid gland is swollen, it is called “struma diffusa”. A further classification is made on the basis of the production of thyroid hormones. In more than 90 percent of cases, this hormone production is not impaired, in which case a “euthyroid goiter” or “euthyroidism” is present. If hormone production is increased, this is called a “hyperthyroid goiter”. Reduced hormone production is called a “hypothyroid goiter.”

Goiter: classification into degrees

In addition, a goiter is classified into different grades, also called stages, based on its size:

  • Grade 0: Neither visible nor palpable, detectable only by ultrasound.
  • Grade Ia: Palpable, but not visible.
  • Grade Ib: Palpable, but only visible when the head is bent back.
  • Grade II: Visible with normal head position
  • Grade III: Significantly enlarged thyroid gland, visible even from a distance.

In addition, there are other distinctions, for example, regarding the anatomical location of a goiter. A “struma colli” is the name for a goiter on the neck.

Hot nodes and cold nodes

In some affected individuals, part of the tissue of the thyroid gland transforms into a nodule. Depending on their activity, cold nodules and hot nodules are distinguished. A hot nodule is almost always a benign tissue change in the thyroid gland as a result of which increased iodine is absorbed and hormones are produced. Often the consequence of a hot nodule is hyperthyroidism. A cold nodule is tissue of the thyroid gland that does not absorb iodine and does not secrete hormones. This can be, for example, scarred tissue, a (usually benign) tumor, or a cyst.

Treatment for goiter

The treatment of a goiter depends on its size as well as whether thyroid function is impaired and whether nodules are present. Basically, three forms of therapy are available.

  • Drug treatment is carried out, for example, with iodide tablets, thyroid hormones or – in the case of hyperthyroidism – thyroid blockers (thyrostatic agents).
  • In radioiodine therapy, the affected person swallows radioactive iodine, whose radiation destroys the thyroid cells.
  • Surgery removes the abnormal tissue parts (unilateral or bilateral) or, if necessary, the entire thyroid gland.

Therapy of goiter often requires taking iodine or hormone tablets for a long period of time. This is also often necessary as a result of surgery or radioiodine treatment. In homeopathy, iodine-containing remedies are often used for the treatment of a goiter, which can be used supportively in consultation with a doctor.

Goiter: course and consequences

If a goiter continues to grow during the course of the disease, the symptoms also increase. In addition, the risk of hyperthyroidism (“functional autonomy”) increases. Another possible consequence is the formation of a malignant tumor. However, the risk of developing thyroid cancer (“goiter maligna”) as a result of goiter is very low. In the case of goiter with normal hormone formation, treatment with iodine, often in combination with thyroid hormones, is usually sufficient for the goiter to regress within several months. In hyperthyroidism, however, iodine should not be administered: Excessive iodine intake threatens a “thyrotoxic crisis” (thyroid poisoning), which can lead to death.

Iodine deficiency as a cause of goiter

The cause of goiter is usually insufficient iodine intake over a long period of time. Since the body cannot produce iodine itself, the trace element must be supplied through the diet. If the thyroid gland receives too little iodine, it cannot produce enough hormones and enlarges to make better use of the available iodine. In some phases of life, the iodine requirement is particularly high due to hormonal changes, which is why increased attention must be paid to sufficient iodine intake during this time. These include above all menopause and puberty, but also pregnancy and breastfeeding. This is because iodine deficiency can cause pregnant women or newborns to develop goiter.

Other causes of goiter

Besides iodine deficiency, there are other possible causes of goiter, for example:

Stress is also suspected as a possible trigger of thyroid disease. A goiter is not hereditary. Nevertheless, a clustering of the disease can be found in some families, which may be due to the fact that the iodine is genetically worse utilized.

Preventing goiter

The best way to prevent goiter is to get enough iodine. About 180 to 200 micrograms of iodine per day is recommended. This is found not only in iodized salt, but also in sea fish (for example, pollock).During pregnancy and breastfeeding, as well as in cases of goiter in the family, additional iodide tablets should be taken after consultation with a physician. In addition, older people are advised to ask their doctor for regular palpation examinations to detect goiter at an early stage.