You may experience some confusing symptoms for the body and you do not know that the cause behind these symptoms is an enlarged thyroid gland, which is one of the most common medical conditions, especially in women, because it is closely related to the hormonal changes to which the body is exposed. If you are interested in knowing all the details about the condition of the enlarged thyroid gland, its causes, and effective treatment methods, follow this article with us until the end.

What is goiter?

Goiter is a medical condition that occurs due to an increase in the size of the thyroid gland, which is located in the front of the neck and resembles the shape of a butterfly. It is the gland responsible for producing specific hormones that control many vital body functions, such as regulating the heartbeat, body temperature, in addition to metabolism. Therefore, when the gland enlarges, a major disruption occurs in many functions and the body is exposed to severe changes that we will learn about in detail later.

Types of goiter

There are many types of goiter and vary in severity, the most prominent of which are the following:

• Simple Non-Toxic Goiter:
  It means an enlargement in the size of the gland without any defect in the production of hormones, that is, it is not accompanied by hyperactivity or deficiency in the activity of the gland. It is divided into two types, including diffuse, meaning the entire gland is enlarged, and nodular, which means the presence of small nodules inside the gland.
• Graves' Disease:
  It is also called Graves' disease, which is an autoimmune disease that attacks the gland and causes a state of hyperthyroidism, which produces a large and excessive amount of hormones in the body.  
• Toxic nodular goiter:
  It occurs when nodules form inside the gland and become active and produce excessive hormones. It is divided into single and multiple nodular hyperplasia.
• Non-toxic nodular goiter:
  It means that there are some nodules in the gland, but they do not cause overproduction or deficiency of hormones and are often discovered during a routine examination.
• Inflammatory goiter:
  It includes many types of inflammation, the most important of which is chronic autoimmune thyroiditis called Hashimoto’s thyroiditis, which is an autoimmune disease that leads to gradual damage to the gland, causing a deficiency in its activity, and subacute thyroiditis, which usually occurs after a viral infection and causes fever with severe neck pain and temporary hyperactivity of the gland.
• Neoplastic Goiter:
  It is an enlargement resulting from benign tumors that cause rapid growth in the size of the gland and is accompanied by hoarseness, difficulty breathing and swallowing, and a hard, painless nodule. 

Causes of goiter

There are many causes of goiter, including:

• Iodine deficiency: It is the most common cause, as it is necessary for the production of thyroid hormones, and with its deficiency, the size of the gland increases to compensate for iodine.
• Genetic factors:
  Some families have a genetic predisposition to gland enlargement, whether overactive or underactive, in addition to the presence of hereditary diseases that affect the size of the gland.
• Autoimmune diseases:
  The most common cases are Hashimoto's disease, as we mentioned previously, which leads to hypothyroidism, and Graves' disease, which causes hyperactivity and enlargement of the gland. 
• Hormonal changes:
  As we mentioned, cases of glandular enlargement are common among women in particular, as a result of their exposure to some hormonal changes during puberty or pregnancy.
• Due to medications:
  Taking some medications may cause the thyroid gland to enlarge, including lithium, which is used to treat bipolar disorder, and medications that prevent iodine absorption. 
• Thyroid infections:
  Frequent exposure of the thyroid gland to infections, such as viral infections or post-pregnancy infections, may result in temporary enlargement of the gland.

اقرا ايضا: ما هي Symptoms of thyroid diseases And methods of diagnosis?

Symptoms of goiter

Of course, the symptoms of goiter vary depending on the cause and size of the enlargement, in addition to the extent to which the enlargement affects the function of the gland, so the symptoms are divided as follows:

Symptoms of an enlarged thyroid gland

The most prominent symptoms of an enlarged thyroid gland are the following:

• Swelling or puffiness appears in the front of the neck, especially with swallowing.
• Shortness of breath due to pressure of the gland on the windpipe.
• Persistent cough for no apparent reason, which does not decrease even with treatment.
• Severe difficulty swallowing with a feeling of something solid in the throat.
• Hoarseness and gradual change in tone due to the pressure of the gland on the vocal cords.

Symptoms of gland dysfunction

Signs and symptoms appear due to a defect in the function of the thyroid gland and not just due to its large size. They are divided into symptoms of hyperactivity of the gland and symptoms of hypothyroidism. We will learn about both of them in detail below:

Symptoms of hyperthyroidism

Symptoms of hyperthyroidism are symptoms that occur due to increased production of thyroid hormones in the body and include the following:

• Exophthalmos.
• Tremor in the hands.
• A state of general weakness.
• Rapid heartbeat or palpitations.
• Weight loss despite good appetite.
• Menstrual disorders in women.
• Excessive sweating with intolerance to high heat.
• Anxiety and extreme nervousness with severe mood swings.

Symptoms of hypothyroidism

Symptoms of hypothyroidism are signs that appear due to a deficiency in the production of glandular hormones, which results in:

• الإمساك.
• Dry skin.
• Hair loss.
• Slow heartbeat.
• A constant state of fatigue and lethargy.
• Menstrual disorders.
• Severe weight gain for no reason.
• Intolerance to cold or low temperature.
• Depression with poor concentration and cognition.

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Methods of diagnosing goiter

The specialist doctors at Al-Mousa Specialist Hospital in Al-Ahsa offer you the best and most accurate methods for diagnosing goiter that help in early detection of any defect in the gland or its function. The most prominent of these methods are:

• Clinical medical examination:
  The doctor examines the gland and determines its size, type of enlargement, and lumps that are solid, soft, or nodular, asking about symptoms, and examining swallowing and voice.
• Laboratory tests:
  These are several examinations and tests to determine hormone levels, the most important of which are the TSH test to evaluate gland function, the Anti-TPO antibody test to diagnose Hashimoto’s disease, the TSI test to diagnose Graves’ disease, and finally the calcitonin test in the event of suspected thyroid cancer.
• Medical imaging:
  Through ultrasound to determine the size of the gland and confirm the presence of nodes, or X-rays if it is suspected that the gland is pressing on the esophagus and trachea, and scanning the thyroid gland using radioactive iodine to evaluate its function.
• Biopsy procedure:
  What is meant is a fine-needle sample, which is a diagnostic method used to rule out or confirm gland cancer.

How can goiter be treated?

Goiter can be treated in several integrated ways, some of which are chosen according to the severity of the enlargement, its cause, and the extent of its impact on the functions of the gland. Below we learn about these methods in detail:

العلاج بالأدوية

Treatment with medications varies, of course, from one case to another, depending on the activity of the gland. Whether the patient suffers from insufficiency or hyperactivity.

• In the case of hypothyroidism: In this case, the doctor recommends the hormone levothyroxine to compensate for the deficiency in thyroid hormones and gradually reduce hypertrophy.
• In the case of hyperthyroidism: The doctor recommends antithyroid medications such as methimazole to reduce the production of thyroxine, in addition to beta blockers to relieve the symptoms of heart palpitations, as they are good for the symptoms and do not treat the cause behind the enlarged gland. 

Radioactive iodine therapy

Radioactive iodine treatment is used in cases of hyperactivity of the gland or toxic nodular enlargement. The doctor gives the patient a dose of radioactive iodine until it is absorbed by the enlarged cells and destroys them completely or partially. In this case, the doctor uses a replacement hormone for life as a result of permanent deficiency in the gland’s function.

Surgical resection

Surgical removal is one of the options available to treat goiter in some cases if there is a suspicion of a cancerous tumor, or the failure of other types of treatment, or in the case of the presence of nodules that permanently cause hyperactivity, and finally in the case of the gland pressing on the trachea, which affects breathing and threatens the patient’s life. 

Lifestyle changes

Doctors usually recommend some recommendations, such as avoiding the patient's exposure to excessive iodine, quitting smoking completely, in addition to monitoring and stopping medications that affect the thyroid gland.

Medical follow-up and monitoring

It is necessary, even with appropriate treatment, to make periodic visits to the treating physician in order to monitor the enlargement and the extent of the gland’s response to treatment, in addition to checking on the general health condition and ensuring that the gland does not affect any of the body’s organs or functions.

Al-Mousa Specialist Hospital in Al-Ahsa guarantees you an accurate diagnosis of goiter in order to identify the causes of goiter and the extent of its seriousness, in addition to the appropriate treatment method to reduce goiter and thus prevent the occurrence of complications. If you notice any of the symptoms we mentioned of goiter, contact the doctors at the hospital immediately and you will receive medical care at the highest level.

اسئلة شائعة

Below we answer the most common questions we receive about glandular enlargement and how to live with it:

Is gland enlargement normal?

Yes, in some simple cases, the normal size of the gland may return with treatment and follow-up. Therefore, we always recommend quickly contacting doctors if any signs of thyroid enlargement appear.

Is goiter dangerous?

No, in many cases goiter is not dangerous, especially if treatment is organized and a healthy lifestyle is followed. Only some cases may be serious, such as the gland pressing on nerves or the enlargement turning into a cancerous tumor.

Is it possible to live with goiter?

Yes, of course it is possible to live with an enlarged thyroid gland, but with attention to treatment and follow-up, while being careful of the complications of the disease. You can contact the doctors of Al-Mousa Hospital to find out all the recommendations necessary to live with an enlarged thyroid gland.

Sources and references

 What is Goiter – clevelandclinic

Diagnosis of Goiter – thyroid