What is it?

A goiter is an enlarged thyroid gland. The thyroid gland is a butterfly-shaped organ in the lower front of the neck. It produces thyroid hormones, which are important in regulating the body’s use of energy to keep them working properly.

What causes it?

Goiters can occur as a result of a deficiency (hypothyroidism) or excess (hyperthyroidism) in thyroid hormone production, as well as the presence of thyroid nodules

What are the conditions associated with it?

Iodine deficiency is one of the most common causes of goiter worldwide. The thyroid gland is responsible for concentrating iodine to make thyroid hormone. With iodine deficiency, the patient becomes hypothyroid and the thyroid becomes enlarged.

Hashimoto’s thyroiditis is an autoimmune condition wherein there is destruction of the thyroid gland by the body’s own immune system. As the gland is destroyed, it is less able to produce adequate amounts of thyroid hormone, eventually resulting to hypothyroidism and goiter.

Graves’ disease (commonly known as toxic goiter) is another autoimmune disease, wherein the body produces a protein called thyroid stimulating immunoglobulin (TSI) which stimulates the thyroid to produce excess thyroid hormone (hyperthyroidism) and enlargement of the thyroid.

Nodular goiter is the presence of one or more nodules in the thyroid gland which can cause its enlargement. Other less common causes of goiter include genetic defects, injury or infections in the thyroid, and tumors (both cancerous and benign tumors).

Who are the persons at risk to develop it?

Anybody can develop a goiter, but they are more common in women than men. It increases in frequency with age, and commonly runs in the family (hereditary).

What are its symptoms?

Patients may not feel anything (asymptomatic), or may notice a swelling at the lower front of the neck, or even have difficulty in swallowing/breathing if the goiter is very large. Depending on the underlying cause of the goiter, there may be symptoms of:

  • Hypothyroidism: fatigue, constipation, irregular menses, muscle pain, weight gain, hair loss, sensitivity to cold
  • Hyperthyroidism: palpitations, weight loss, heat intolerance, tremors, shortness of breath, bulging eyes, sleep disturbances

How is it treated?

The treatment will depend upon the underlying cause of the goiter. If it is due to a deficiency of iodine in the diet, you will be given iodine supplementation which may lead to reduction in the size of the goiter, but often will not completely return to its previous size. If the goiter is due to hypothyroidism, you will be given thyroid hormone (Levothyroxine) usually as a lifelong replacement. If the goiter is due to hyperthyroidism, the treatment will depend upon the cause of the hyperthyroidism. In such cases, patients will be given anti-thyroid medication or radioactive iodine therapy. If the cause is multinodular goiter and there is presence of obstructive symptoms such as difficulty in swallowing or breathing, your doctor may suggest surgical removal of the goiter.

What are its complications?

Goiters that are very large may constrict the airways and may cause difficulty in breathing. If the cause of the goiter is a nodule or nodules, there may be a risk for cancer.

When do you need to see an endocrinologist?

If you (or anyone around you) notice any swelling, enlargement, or palpable mass in your neck, it is best to consult an Endocrinologist for appropriate tests, accurate diagnosis, and timely management. Other conditions that should prompt you to see an Endocrinologist:

  1. Presence of goiter with signs and symptoms of hypothyroidism or hyperthyroidism.
  2. If you develop goiter while on treatment for hypothyroidism or hyperthyroidism.
  3. If you develop goiter during pregnancy.


  1. American Thyroid Association
  2. British Thyroid Foundation