Does a goiter mean I have thyroid cancer?

Usually not. Most goiters are benign and caused by iodine deficiency, autoimmune thyroid disease or benign nodules. However, nodules within a goiter are checked with ultrasound and sometimes a needle biopsy, because a small proportion are cancerous. Early assessment of any new neck lump is sensible.

Will a goiter go away on its own?

Some goiters shrink when the underlying cause is treated, for example with iodine for deficiency or levothyroxine for an underactive gland, and goiters related to pregnancy or thyroid inflammation often settle. Long-standing multinodular goiters generally do not shrink on their own and may slowly grow, so periodic monitoring is advised.

Should I take iodine supplements for a goiter?

Only if a doctor has confirmed iodine deficiency is the cause. In countries with iodized salt, most goiters are not due to iodine deficiency, and extra iodine can worsen autoimmune thyroid disease or trigger overactivity in a nodular goiter. Have thyroid function and iodine status assessed first.

EndocrineICD-10: E04.9Common worldwide, especially where dietary iodine is low; more frequent in women and with age

Goiter

Also known as: Goitre, Enlarged thyroid, Thyroid enlargement

A goiter is an abnormal enlargement of the thyroid gland, the butterfly-shaped gland at the front of the neck that produces hormones controlling metabolism. A goiter may involve the whole gland (diffuse) or contain one or more lumps (nodular). It can occur with normal, high or low thyroid hormone levels, so the swelling itself does not tell you how the gland is working. Worldwide the most common cause is iodine deficiency, while in countries with iodized salt the usual causes are autoimmune thyroid diseases such as Hashimoto's thyroiditis and Graves' disease, and multinodular goiter in older adults. Small goiters often need no treatment, but larger ones can cause a visible swelling, difficulty swallowing or breathing, and need investigation to check hormone levels and rule out cancer in any nodules.

At a Glance

Common symptoms: A visible swelling at the base of the neck, which may be more obvious when swallowing, A feeling of tightness or fullness in the throat, Difficulty swallowing or breathing, especially when lying down, with large goiters
Main treatments: Observation with periodic checks for small goiters with normal hormone levels and no worrying features, Thyroid hormone replacement (levothyroxine) if the gland is underactive, Antithyroid medication, radioactive iodine or surgery if the gland is overactive
Category: Endocrine · Common worldwide, especially where dietary iodine is low; more frequent in women and with age
See a doctor if: Any new swelling or lump in the front of the neck

Symptoms

A visible swelling at the base of the neck, which may be more obvious when swallowing

A feeling of tightness or fullness in the throat

Difficulty swallowing or breathing, especially when lying down, with large goiters

Hoarseness or coughing

Symptoms of an overactive thyroid, such as weight loss, palpitations, heat intolerance and anxiety, in some cases

Symptoms of an underactive thyroid, such as fatigue, weight gain, cold intolerance and dry skin, in others

Often no symptoms other than the swelling

Causes

Iodine deficiency, the leading cause worldwide, as the gland enlarges to try to produce enough hormone
Hashimoto's thyroiditis, an autoimmune condition that inflames the gland and usually causes underactivity
Graves' disease, an autoimmune condition that overstimulates the gland
Multinodular goiter, in which multiple nodules develop over years, common in older adults
Thyroid nodules, cysts or, less commonly, thyroid cancer
Pregnancy, certain medications such as lithium or amiodarone, and inflammation of the thyroid

Risk Factors

Being female
Age over 40
Living in an area with low dietary iodine
A family history of thyroid disease or autoimmune conditions
Pregnancy and menopause
Radiation exposure to the neck, and certain medications

Diagnosis

Physical examination of the neck for size, texture and nodules
Blood tests for thyroid hormones (TSH, free T4) and thyroid antibodies
Ultrasound of the thyroid to assess size and the characteristics of any nodules
Fine-needle aspiration biopsy of nodules with suspicious features
Radioactive iodine uptake scan or CT scan in selected cases, for example to assess an overactive nodule or pressure on the windpipe

Treatment

Observation with periodic checks for small goiters with normal hormone levels and no worrying features
Thyroid hormone replacement (levothyroxine) if the gland is underactive
Antithyroid medication, radioactive iodine or surgery if the gland is overactive
Iodine supplementation where deficiency is the cause, under medical guidance, as excess iodine can also cause problems
Radioactive iodine to shrink a large multinodular goiter in some cases
Surgery to remove part or all of the thyroid for large goiters causing pressure symptoms, cosmetic concern or suspected cancer
Supportive: ensuring adequate dietary iodine from iodized salt, dairy, seafood and eggs

Prevention

Use iodized salt and eat iodine-containing foods, particularly during pregnancy and breastfeeding
Avoid excessive iodine from supplements or kelp products unless advised by a doctor
Have thyroid function checked if you have symptoms or a family history of thyroid disease
Tell your doctor about any neck swelling early
Discuss thyroid monitoring if you take medications such as lithium or amiodarone

When to See a Doctor

Any new swelling or lump in the front of the neck
Difficulty swallowing or breathing, or a feeling of pressure in the neck
A rapidly growing neck lump, a lump that is hard or fixed, or persistent hoarseness (needs prompt assessment)
Symptoms of an overactive or underactive thyroid
A goiter during pregnancy, as thyroid function needs careful management

Frequently Asked Questions

Related Conditions

Hypothyroidism

Endocrine

Hyperthyroidism

Endocrine

Hashimoto's Thyroiditis

Autoimmune

Graves' Disease

Autoimmune

Thyroid Nodules

Endocrine

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