Guest Author - Jim Lowrance

When a thyroid patient has a goiter, this simply means they have swelling of the thyroid gland, which is located at the front of the neck, in the area just below the Adam’s apple. Goiters are recognized as different types and as affecting part of the thyroid, such as one of the two lobes or the middle part of the gland called the isthmus or as affecting the entire gland as a whole. They are also considered different types depending upon the causes of them. A major cause of goiters, are autoimmune thyroid diseases.

If a goiter is caused by iodine deficiency, it is referred to as a “colloid nodular” or “endemic’ goiter. This type is rare in the U.S. and many other industrialized countries that use iodized table salt, which usually provides those that consume it, enough iodine to avoid iodine deficiency hypothyroidism and the resulting endemic goiters.

If a person’s thyroid gland has swelling plus a number of small tumors called “nodules” within it, they refer to this type as a “multi-nodular goiter”. The nodules within a gland that has goiter can be the type that causes the thyroid gland to produce excess thyroid hormone, in which case, they will add the term “toxic” to the term, calling it a “toxic multi-nodular goiter”. People with Hashimoto’s thyroiditis, commonly have multi-nodular goiters that are non- toxic.

When a person is termed as having a “diffuse goiter”, this means there is general swelling throughout the gland that is not caused by nodules. This type of goiter can also cause toxicity or over-activity of the thyroid gland (hyperthyroidism), in which case it is referred to as a “toxic diffuse goiter”. These types are found commonly in patients with Grave’s Disease, as well as toxic multi-nodular goiters.

Temporary types of thyroiditis, such as those that occur with viral infections and in pregnant women can also cause goiter (asymmetrical enlargement) but these type will resolve within a few weeks, along with the thyroiditis. These type goiters can flare up short term with these types of thyroiditis and cause severe pain in the thyroid gland, which is referred to as “sub-acute thyroiditis”, while others types do not cause a painful thyroid which is referred to as “silent thyroiditis”.

A goiter can be mild, so that it is barely visible by looking at the affected person’s neck or sometimes not visible at all with the naked eye. The same is true of detecting a goiter by human feel or what they refer to as “palpation”. Some cannot be felt or seen but may still have enough swelling, present within them, to cause mild discomfort and a mild feeling of inflammation in the neck.

When goiters become severe, they can become large enough to obstruct swallowing and breathing and in these cases, thyroid removal ( total-thyroidectomy) might be an option a treating Doctor would consider. When goiters are less severe, treating any thyroid hormone imbalance that is present in the patient can help to shrink them and prevent further growth.

Patients, who have goiters or are suspected of having them, may be referred for a “thyroid ultrasound” (sound-wave imaging/sonogram) or “thyroid uptake scan” (radiology/radioactive iodine) and possibly even an MRI (Magnetic Resonance Imaging). These are diagnostic tests that give detailed images of the thyroid gland, to determine the size of goiters and whether they contain nodules within them that are not detectable by palpation.

If you feel tightness or swelling in your throat in the area of the thyroid gland, or can actually see visible swelling, report to your Doctor for a check up and evaluation of your symptoms, making sure to list any other symptoms you are having, in detail. Most goiters can be treated, so that any symptoms they are causing are improved or significantly relieved.