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    Goiter - simple

    Simple goiter; Endemic goiter; Colloidal goiter; Nontoxic goiter; Toxic nodular goiter

    A simple goiter is an enlargement of the thyroid gland. It is usually not cancer.

    Causes

    There are different kinds of goiters.

    • A simple goiter can occur without a known reason. It can occur when the thyroid gland is not able to make enough thyroid hormone to meet the body's needs. This can be due to, for example, a lack of iodine in a person's diet. To make up for the shortage of thyroid hormone, the thyroid gland grows larger.
    • Toxic nodular goiter isan enlarged thyroid gland thathas a small, rounded growth or many growths called nodules. These nodules produce too much thyroid hormone.

    Iodine is needed to produce thyroid hormone.

    • Simple goiters mayoccur in people who live in areaswhere the soil and water do not have enough iodine. People in theseareas might not get enough iodine in their diet.
    • The use of iodized salt in many food products in the United States today prevents a lack of iodine in the diet.

    In many cases of simple goiter, the cause is unknown. Other than lack of iodine, other factors that may lead to the condition include:

    • Certain medicines (lithium, amiodarone)
    • Infections
    • Cigarette smoking
    • Certain foods (soy, peanuts, vegetables in thebroccoli family)

    Simple goiters are also more common in:

    • Persons over age40
    • People with a family history of goiter
    • Women

    Symptoms

    Main symptom is an enlarged thyroid gland. The size may range from a single small nodule to a large neck lump.

    Some people with a simple goiter may have symptoms of an underactive thyroid gland.

    In rare cases,an enlarged thyroid can put pressure on the windpipe (trachea) and foodtube (esophagus). This can lead to:

    • Breathing difficulties (with very large goiters)
    • Cough
    • Hoarseness
    • Swallowing difficulties

    Exams and Tests

    The doctor will do a physical exam. This involves feeling your neck as you swallow. Swelling in the area of the thyroid may be felt.

    If you have a very large goiter,you may haveswelling in your neck vein. As a result, when the doctor asks you to raise your arms above your head, you may feel dizzy.

    Blood tests may be ordered to measure thyroid function:

    • Free thyroxine (T4)
    • Thyroid stimulating hormone (TSH)

    Tests to look for abnormal and possibly cancerousareas in the thyroid gland include:

    • Thyroid scan and uptake
    • Ultrasound of the thyroid

    If nodules are found on anultrasound, a biopsymay be neededto check for thyroid cancer.

    Treatment

    A goiter only needs to be treated if it is causing symptoms.

    Treatments for an enlarged thyroid include:

    • Thyroid hormone replacement pills, if the goiter is due to an underactive thyroid
    • Small doses of Lugol's iodine or potassium iodine solution if the goiter is due to a lack of iodine
    • Radioactive iodine to shrink the gland,especially if the thyroid is producing too much thyroid hormone
    • Surgery (thyroidectomy) to remove all or part of the gland

    Outlook (Prognosis)

    A simple goiter may disappear on its own, or may become larger. Over time, the thyroid glandmay stop making enough thyroid hormone. This condition is called hypothyroidism.

    In some cases, a goiter becomes toxic and produces thyroid hormone on its own. This can cause high levels of thyroid hormone, a condition called hyperthyroidism.

    When to Contact a Medical Professional

    Call your health care provider if you experience any swelling in the front of your neck or any other symptoms of goiter.

    Prevention

    Using iodized table salt prevents most simple goiters.

    References

    Kim M, Ladenson P. Thyroid. In: Goldman L, Schafer AI, eds. Goldman’s Cecil Medicine. 24th ed. Philadelphia, Pa.: Elsevier Saunders; 2011:chap 233.

    Schlumberger MJ, Filetti S, Hay ID. Nontoxic diffuse and nodular goiter and thyroid neoplasia. In: Melmed S, Polonsky KS, et al., eds. Williams Textbook of Endocrinology. 12th ed. Philadelphia, Pa.: Elsevier Saunders; 2011:chap 14.

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      Self Care

        Tests for Goiter - simple

          Review Date: 5/28/2013

          Reviewed By: Brent Wisse, MD, Associate Professor of Medicine, Division of Metabolism, Endocrinology & Nutrition, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Bethanne Black, and the A.D.A.M. Editorial team.

          The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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