An enlarged thyroid--also known as a "goiter"--generally occurs when the thyroid "malfunctions" and is unable to produce requisite amount of thyroid hormone used to regulate the body's metabolism. The presence of a goiter can be a side effect of hypothyroidism, hyperthyroidism, thyroiditis, thyroid nodules, or more rarely, thyroid cancer. The presence of an enlarged thyroid is but one of many symptoms of thyroid disorders such as Hashimoto's Disease and Grave's Disease. In most cases, the presence of a goiter will persist until its underlying cause is effectively treated.
The Healthy Thyroid
The thyroid is a tiny butterfly-shaped gland in the front of the neck comprised of two "wings" (lobes) that are attached by a stretch of tissue known as the isthmus. The thyroid's duty is to convert iodine into thyroxine (T-4) and triiodothyronine (T-3). Together, T4 and T3 are known as the "thyroid hormone." After the thyroid gland secretes the hormone into the bloodstream, it seeks out the cells that are responsible for regulating metabolism. The pituitary gland, located in the base of the brain, acts as a sort of regulatory authority for the thyroid and sends TSH (thyroid-stimulating hormone) whenever hormone production needs to be stepped up. A healthy thyroid produces 80 percent of T4 and 20 percent of T3.
What Causes an Enlarged Thyroid?
Patients with a thyroid disorder will typically manifest other symptoms prior to noticing the presence of a goiter, specifically those related to a slowing down or speeding up of the metabolism. Both Hashimoto's (hypothyroidism) and Grave's Disease (hyperthyroidism) involve an auto-immune component that causes the immune system to "attack" the thyroid and cause it to enlarge. While T3 and T4 levels can be measured through a blood test, ascertaining the size of the thyroid, as well as its distinguishing characteristics (such as the presence of nodules or cancer), may involve more comprehensive testing such as a radioactive iodine uptake test, fine-needle aspiration (FNA) biopsy, or a thyroid scan.
What Does A "Goiter" Feel Like?
People who have a goiter often feel as though it's so large, it must be obvious to onlookers. Often this it not the case, and the enlarged gland can only be ascertained through a physician's palpation. A goiter can result in excessive coughing or choking on certain food and liquid textures. Those with a goiter may experience the sensation that their breathing is restricted, as the enlarged thyroid presses up against the windpipe. Sometimes, as in the case of hypothyroidism, the voice becomes low, hoarse or "gravelly."
Oral Medication Treatment
Some disorders, such as those that cause hypothyroidism or hyperthyroidism, can be effectively treated with oral medication. Hashimoto's Disease, for example, is treated with thyroid replacement, while Grave's Disease is treated with anti-thyroid medication in conjunction with beta blockers. These medications will reduce the size of a goiter and associated symptoms but usually will not eliminate the presence of the goiter entirely.
Invasive Treatments
In certain circumstances, more invasive treatment is required when a thyroid condition is present. Thyroid cancer requires surgery called a thyroidectomy, in which the entire gland is removed. Radioactive iodine treatment is a possible solution for those with hyperthyroidism or thyroid nodules. After a thyroidectomy or radioactive iodine treatment, the patient will exhibit signs of hypothyroidism and require thyroid replacement therapy. Unless a patient has thyroid cancer, physicians generally tend not to resort to removing the thyroid surgically.
Other Types of Thyroid Disorders
Thyroiditis is an inflammation of the thyroid gland that typically needs no long-term treatment, although it can occur in conjunction with Hashimoto's Disease. De Quervain's Thyroiditis results in a sudden enlargement of the thyroid, which becomes painful and tender for several weeks until the swelling goes down. Silent Thyroiditis, which tends to follow a pregnancy, may result in an enlarged thyroid and temporary hyperthyroidism. These last two conditions ultimately resolve on their own and are remedied by bed rest and the use of certain prescription medications.
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