Goiter is an enlargement of the thyroid gland that often produces a noticeable swelling in the front of the neck. This enlargement can be caused by iodine deficiency, inability of the body to use iodine correctly, or a variety of thyroid disorders, including infection tumors, and autoimmune disease. Some environmental pollutants, heavy metal poisonings, and certain drugs can also contribute to goiter formation.
Medications. If you have hypothyroidism, thyroid hormone replacement with levothyroxine (Levothroid, Synthroid) 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 an inflammation of your thyroid gland, your doctor may suggest aspirin or a corticosteroid medication to treat the inflammation. For goiters associated with hyperthyroidism, you may need medications to normalize hormone levels.
Goiters of all types will regress with treatment of the underlying condition. Dietary iodine may be all that is needed. However, if an iodine deficient thyroid that has grown in size to accommodate its deficiency is suddenly supplied an adequate amount of iodine, it could suddenly make large amounts of thyroxin and cause a thyroid storm, the equivalent of racing your car motor at top speed. Hyperthyroidism can be treated with medications, therapeutic doses of radioactive iodine, or surgical reduction. Surgery is much less common now than it used to be because of progress in drugs and radiotherapy.
Surgery (thyroidectomy) to remove all or part of the gland.
Suspicion of malignancy in an enlarged thyroid is an indication for removal of the thyroid. There is often a dominant nodule within a multinodular goiter, which can cause concern for cancer. It should be remembered that the incidence of malignancy within a multinodular goiter is usually significantly less than 5%. If the nodule is cold on thyroid scanning, then it may be slightly higher than this.
If your goiter is small and doesn't cause you much of a problem, and your thyroid is functioning normally, your doctor may suggest a wait-and-see approach.
The best way to prevent this problem is by taking iodine-rich foods. But sometimes, even if a person gets enough iodine from his diet, he or she may still develop goiter. This is because certain foods may actually prevent the thyroid gland from using the iodine. Foods, which interfere with the body’s ability to manufacture the thyroid hormone, contain substances called "goitrogens."
Preoperative assessment should include laryngoscopy to assess the tracheal lumen and vocal cord function. In addition, if the patient is hyperthyroid and surgery is elective, appropriate treatment with an antithyroid drug and perhaps a beta-blocker should be given for several weeks before the operation.
Treatment of hyperthyroidism consists of both symptomatic relief and decreasing the production of thyroid hormone Beta blockers ameliorate many of the symptoms of hyperthyroidism In the absence of a contraindication, they are often started as soon as the diagnosis of hyperthyroidism is made, even before obtaining a 24-hour radio iodine uptake or scan. We usually give atenolol (25 to 50 mg/day), which has the advantages of single daily dosing and beta-1 selectivity, but all drugs of this class effectively reduce symptoms in patients with hyperthyroidism.