What Is a Goiter?
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Medically reviewed by Do-Eun Lee, MD
A goiter is an enlarged thyroid gland. Your thyroid gland is a small butterfly-shaped organ that is located in the front of your neck, just under your larynx (voice box). Usually, a thyroid is not visible on the outside. But with a goiter, you may notice a lump or swelling in your neck.
A goiter is generally painless. However, you may experience some discomfort or difficulty with swallowing—depending on the size of the goiter. Treatment options for a goiter can vary and usually depends on the severity of your condition and the underlying cause of the goiter. Most healthcare providers may recommend medication, radioactive iodine, or surgery to improve symptoms.
Iodine deficiency is the leading cause of goiter worldwide. In the United States, where iodine deficiency is rare, autoimmune thyroid diseases commonly cause goiters. Nearly 5% of Americans develop a goiter at some point in their lifetime.
Types of Goiter
There are several different types of goiters. The type of goiter that you can have will depend on the underlying cause of the condition, how the thyroid grows, and whether the goiter affects thyroid hormone levels. The main types of goiters include:
Simple (diffuse) goiter: When the entire thyroid gland is enlarged
Nodular goiter: When a nodule or lump develops within the thyroid gland
Multinodular goiter: When multiple nodules (lumps) develop within the thyroid gland
Healthcare providers also categorize goiters based on thyroid hormone levels:
Toxic goiter: When the thyroid gland is enlarged and the thyroid overproduces thyroid hormones (a condition known as hyperthyroidism)
Nontoxic goiter: When the thyroid gland is enlarged, but the thyroid hormone levels are within the normal range
Symptoms
The symptoms of a goiter can vary and often depend on the size and underlying cause. Some goiters are not visible and do not cause any symptoms at all. When symptoms do occur, they may include:
Visible swelling or enlargement of the neck
Difficulty swallowing food
Feeling tightness or tension in your throat
Shortness of breath, especially when lying down
Hoarseness in your voice
Neck discomfort
Depending on the type of goiter you have, you may have additional symptoms related to a thyroid hormone imbalance. Symptoms of a hormonal imbalance can include:
Unintended weight gain or weight loss
Difficulty sleeping
Irritability
Causes
A goiter occurs when the thyroid (a butterfly-shaped gland in the front of the neck) becomes enlarged. A deficiency in iodine—an essential mineral that helps your body produce thyroid hormones—is the leading cause of goiters worldwide. Inadequate iodine levels disrupt the normal functioning of the thyroid gland. When this happens, your thyroid can become enlarged and cause the onset of goiter symptoms.
In the U.S. and other regions where most people receive enough iodine, other factors may contribute to the development of a goiter. These include:
Hashimoto’s thyroiditis: The immune system mistakenly attacks the thyroid gland, resulting in chronic (long-term) inflammation and destruction of thyroid tissue. This condition also causes your thyroid to not make enough thyroid hormone.
Graves’ disease: An autoimmune disorder that causes your thyroid to make an excess (too much) thyroid hormone.
Thyroid tumors: Benign (harmless) or cancerous thyroid tumors can lead to a goiter.
Thyroid nodules: Multiple lumps (solid or fluid-filled) can develop in the thyroid gland and cause your thyroid to become enlarged.
Pregnancy: Hormonal changes (e.g., a surge in estrogen levels) can increase the amount of thyroid hormone your body produces, making it easier for a goiter to develop.
Risk Factors
While anyone can develop a goiter, certain factors can increase your risk of the condition. These risk factors include:
Having a family history of goiter or autoimmune thyroid disease
Radiation exposure to your neck or chest
Being assigned female at birth
Being 40 years of age or older
Eating a diet low in iodine
Diagnosis
If you notice swelling in your neck or have other symptoms of a goiter, it's important to see a healthcare provider for proper testing. During your appointment, your provider will ask you about your medical history and symptoms, perform a physical examination of your neck, and order diagnostic tests, if necessary. These tests may include:
Thyroid function tests: Blood tests that measure your thyroid hormone levels and overall thyroid functioning. These tests will typically check a variety of thyroid hormones including T3, T4, and thyroid stimulating hormone (TSH). Your results can help your provider learn whether your symptoms are due to an overactive thyroid (hyperthyroidism) or an underactive thyroid (hypothyroidism).
Ultrasound: This imaging technique uses sound waves to create images of the thyroid gland and detect nodules or lumps in your neck.
Thyroid scan: This test involves taking a pill that contains small amounts of colored radioactive iodine. After four to six hours of taking the pill, a provider will scan your neck and take pictures of your thyroid. This helps providers evaluate the structure and function of the thyroid gland.
Fine needle aspiration (FNA) biopsy: A healthcare provider will use a thin needle to extract a small sample of cells from your thyroid nodules or lumps. Then, a lab technician can examine the sample of the cells under a microscope to determine whether your goiter is benign (harmless) or malignant (cancerous).
Treatment
The goal of treating a goiter is to restore normal thyroid function, reduce the size of the thyroid gland, relieve symptoms, and address the underlying cause of your condition. Your exact treatment plan will depend on your symptoms, the size of your goiter, and overall health.
Your healthcare provider may recommend regular monitoring of your thyroid and no other treatment if you have a small goiter and normal thyroid hormone levels. However, if you have abnormal thyroid hormone levels or a large goiter, your treatment options may include medication, radioactive iodine, or surgery.
Medications
If you have an underactive or overactive thyroid, thyroid hormone replacement therapy and anti-thyroid medications can help treat goiter and restore your thyroid hormone levels.
Thyroid hormone replacement therapy: If the cause of your goiter is an underactive thyroid (hypothyroidism), thyroid hormone replacement medications such as Synthroid (levothyroxine) can help restore normal hormone levels.
Anti-thyroid medications: In cases where your goiter is due to an overactive thyroid, medications like Tapazole (methimazole) can help limit excessive thyroid hormone production and may also shrink the goiter.
Radioactive Iodine Therapy
If you have an overactive thyroid (hyperthyroidism), radioactive iodine therapy may help shrink the goiter. You can radioactive iodine orally (by mouth) in pill or liquid form. This medicine helps kills thyroid cells, restores hormonal balance in your thyroid, and shrinks the thyroid gland. While this treatment can reduce a goiter’s size, it may also overcorrect an overactive thyroid and cause hypothyroidism (too little thyroid hormone) in some people.
Surgery
In the case of large goiters, your healthcare provider can sometimes recommend a surgical procedure called a thyroidectomy. This surgery may involve a partial or complete removal of the thyroid gland. Generally, a provider only recommends this surgery if you have significant symptoms such as difficulty breathing or swallowing.
How to Prevent Goiter
While some goiter causes, such as having a family history of thyroid concerns, are out of your control, there are some things you can do to prevent a goiter from developing. These prevention strategies include:
Getting enough iodine: Eating a balanced diet that includes iodine-rich foods like seafood, dairy products, and iodized salt.
Avoiding too much iodine intake: While iodine is essential, excessive intake can also contribute to the formation of a goiter. Limit your consumption of iodine-containing supplements or medications without medical supervision.
Treating underlying thyroid conditions: If you have an autoimmune thyroid disorder (e.g., Hashimoto’s thyroiditis or Grave’s disease), follow your treatment plan and visit your healthcare provider regularly to ensure that your thyroid is functioning normally.
Complications
If left untreated, a goiter can lead to complications—especially if the condition affects your thyroid hormone levels. Potential goiter complications include:
Difficulty swallowing or breathing: Large goiters can compress the trachea (windpipe) or esophagus (food pipe), causing symptoms like difficulty breathing, trouble swallowing food, or hoarseness.
Intra-nodular hemorrhage: Blood vessels in the thyroid nodules can rupture (break), which can cause blood to accumulate or pool together inside the thyroid. This can be life-threatening and requires prompt medical treatment.
Living With Goiter
If you notice swelling or tenderness in your neck, it's good practice to talk to your healthcare provider about your symptoms. In some cases, an enlarged thyroid gland can be a sign of an underlying thyroid condition, such as hyperthyroidism or hypothyroidism. However, it's important to note that in most cases of goiter, the condition is treatable with medication and other therapies.
While rare, sometimes your goiter may also be a sign of thyroid nodules or thyroid cancer. It's important to catch these conditions early as they can improve your treatment outlook, restore your hormone levels, and reduce your symptoms. That's why seeing a healthcare provider when you begin to notice symptoms is essential.
Frequently Asked Questions
At what age can you get a goiter?
A goiter can occur at any age but is more common in people over 40.
Can a goiter appear suddenly?
Most goiters develop slowly, sometimes growing for years before they are visible or cause symptoms. Though less common, a goiter can develop suddenly, especially if the thyroid has multiple nodules (lumps).
Does goiter mean cancer?
No, having a goiter does not necessarily mean that it is cancerous. Most goiters are benign (non-cancerous) and are caused by thyroid disorders, thyroid nodules, or iodine deficiency.
Can you have a goiter and not have thyroid problems?
Yes, it is possible to have a goiter without having thyroid problems. While a goiter is often a sign of an underlying thyroid or autoimmune disorder, it is possible to have a goiter and normal thyroid hormone levels.
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