goiters

Goiter is an enlargement of the thyroid gland, which can be diffuse (uniform enlargement) or nodular (enlargement with one or more nodules). It may occur with normal thyroid function (euthyroid goiter), or with hypothyroidism or hyperthyroidism. The most common cause worldwide is iodine deficiency, leading to endemic goiter. In iodine-sufficient areas, goiters are often due to autoimmune thyroid disease (Hashimoto thyroiditis or Graves' disease), nodular thyroid disease, thyroiditis, or medication effects (such as lithium or amiodarone). Other contributors include pregnancy, puberty, and genetic factors. A goiter may be asymptomatic or cause neck fullness, cosmetic concerns, or compressive symptoms such as coughing, hoarseness, or difficulty swallowing or breathing if large.

Diagnosis relies on clinical examination and thyroid function tests (serum TSH and free T4). Additional tests include thyroid antibody testing, ultrasound to evaluate structure and nodules, scintigraphy to assess gland function, and fine-needle aspiration biopsy if nodules have concerning features for cancer.

Treatment targets the underlying cause and the size of the goiter. Iodine supplementation is used in iodine-deficient regions. Thyroid hormone replacement (levothyroxine) may reduce goiter size in hypothyroidism. Hyperthyroid goiters may be treated with antithyroid medicines or radioactive iodine. Large or structurally suspicious goiters are often managed with surgery, particularly if they cause symptoms or suspicion of malignancy. Prevention focuses on adequate iodine intake through iodized salt and public health measures. Prognosis is generally favorable with appropriate management.