An enlarged thyroid gland is called a goiter. Goiter may be due to altered thyroid hormones, inflammation or nodules in the gland itself. The goiter is usually painless but can cause discomfort due to size and growth.


The thyroid gland (thyroid) is a hormone-producing gland located on the front of the neck, just below the larynx. It belongs to the hormonal system and secretes hormones that control metabolism – i.e. how the body’s cells use energy. Hormones affect heart rate, body temperature, muscle strength and many other functions of the body.


Normally, the thyroid gland is not visible, but it can grow and become enlarged for various reasons. Goiter is more common in women.
Goiter is mainly seen in countries with iodine deficiency. The thyroid gland needs iodine to produce metabolic hormones. Instead, it may be associated with high and low metabolism, hyper- or hypothyroidism.


Growth can give rise to voice changes, hoarseness, sore throat, and difficulty swallowing.


Different disease states affect the thyroid’s ability to produce metabolic hormones – in some cases this can lead to goiter.


Hashimoto’s thyroiditis is an autoimmune condition in which the thyroid is attacked by its own immune system. When the gland is destroyed, hormone production becomes insufficient. If the level becomes too low, the pituitary secretes more thyroid-stimulating hormone (TSH). This stimulation can cause the thyroid to grow. 


Another common cause of goiter is Graves’ disease. The immune system then produces the protein thyroid-stimulating immunoglobulin (TSI) which causes the thyroid to enlarge. TSI also stimulates the thyroid to make too much hormone causing hyperthyroidism.

Although the pituitary gland stops secreting TSH, the thyroid gland continues to grow and create thyroid hormone. In Graves’ disease you may have a goiter and hyperthyroidism. 


One or more hormone-producing nodules in the thyroid gland can cause goiter and are called multinodal or colloidal goiter. This is more common in older people as it is a condition that develops over a long period of time.


Thyroid cancer is unusual but can appear as a painless lump in the gland. It can also be felt like a pressure against the neck. A lump in the thyroid does not have to mean that you have cancer but should always be investigated.


It is known that certain drugs affect the functioning of the thyroid gland and can be associated with a goiter. Iodine intake, via salt, algae and herbal remedies can affect thyroid hormone production.

Prevention and protection

Goiter prevention is to consume enough iodine-rich food. It is useful to eat food prepared with the addition of iodized salt.


Goiter treatment depends on the size of the gland, your signs and symptoms, and the underlying cause.


  • Observation. If your goiter is small and doesn’t cause problems, and your thyroid is functioning normally, your doctor may suggest a wait-and-see approach.
  • Medications. If you have hypothyroidism, thyroid hormone replacement with levothyroxine will resolve the symptoms of hypothyroidism, as well as slow the release of thyroid-stimulating hormone from your pituitary gland, often decreasing the size of the goiter.


For inflammation of your thyroid gland, your doctor may suggest aspirin or a corticosteroid medication to treat the inflammation. If you have a goiter that is associated with hyperthyroidism, you may need medications to normalize hormone levels.


  • Surgery. Removing all or part of your thyroid gland (total or partial thyroidectomy) is an option if you have a large goiter that is uncomfortable or causes difficulty breathing or swallowing, or in some cases, if you have a nodular goiter causing hyperthyroidism.


Surgery is also the treatment for thyroid cancer.

You may need to take levothyroxine after surgery, depending on the amount of thyroid removed.


  • Radioactive iodine. In some cases, radioactive iodine is used to treat an overactive thyroid gland. The radioactive iodine is taken orally and reaches your thyroid gland through your bloodstream, destroying thyroid cells. The treatment results in a diminished size of the goiter, but eventually may also cause an underactive thyroid gland.

When to consult a doctor

Seek urgent care in case of soreness or pain in the thyroid gland in combination with a feeling of illness or fever, anxiety, restlessness, palpitations and weight loss.


If you have a goiter in combination with palpitations, increased heart rate, sweating, anxiety and have lost weight you should seek care.


In case of a goiter in combination with fatigue, frozenness, depression and weight gain, you can consult a doctor for investigation.


If your thyroid is enlarged, swollen, sore you should seek care.


Pregnant women should seek care if they suspect a goiter, to investigate whether the metabolism has changed.

How Appotek can help

APPOTEK can help you with goiter. A nurse or physician will make an individual assessment based on your symptoms, after which you may be prescribed treatment or referred for further examination. In the case of goiter, a physical examination is required.


Bear in mind that if your child has a problem, he or she should see a doctor.


Vadym Diadiun, Doctor of Medicine, M.D.