Goiter
A goiter is any enlargement of the thyroid gland, whether diffuse or nodular, toxic or non-toxic, per the ATA statement on surgical management of goiter.
Symptoms
Most people with a goiter have no symptoms beyond the visible or palpable enlargement itself. Larger goiters can cause pressure symptoms -- a sense of fullness, difficulty swallowing, positional shortness of breath, or voice changes -- that track with size and location.
Causes and risk
Iodine deficiency is the leading cause worldwide (less common in the U.S. given iodized salt); Hashimoto's, Graves' disease, and nodular thyroid disease are the more common domestic causes, along with smoking and pregnancy.
How it is evaluated
TSH is checked first, followed by ultrasound; a radioactive iodine uptake scan is added if TSH is low, and CT or MRI for large or substernal (extending into the chest) goiters.
Treatment
Observation is appropriate for small, asymptomatic goiters. Levothyroxine suppression has limited efficacy and is used cautiously, especially over age 60. Radioactive iodine, per EANM guidance, and surgery are reserved for large, substernal, or suspicious goiters, or those causing compressive symptoms.
When to seek care
Stridor, choking sensation, or rapid swelling (which can signal bleeding into the gland) are airway emergencies requiring immediate care.