Nontoxic Nodular Goiter
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Definition
A goiter is an enlargement of the thyroid. The thyroid is a gland. It produces hormones that help regulate your body’s metabolism. It is located on the front of the neck, right below the Adam’s apple. Goiters are seldom painful. They tend to grow slowly.

There are different types of goiters. This sheet focuses on nontoxic (or sporadic) goiter. It is a type of simple goiter that may be:

  • Diffuse—enlarging the whole thyroid gland
  • Nodular—enlargement caused by nodules, or lumps, on the thyroid
The development of nodules marks a progression of the goiter. It should be evaluated by your doctor.

Goiter (Enlargement of the Thyroid Gland)

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Causes
The exact causes of nontoxic goiter are not known. In general, goiters may be caused by too much or too little thyroid hormones. There is often normal thyroid function with a nontoxic goiter. Some possible causes of nontoxic goiter include:

  • Family history of goiters
  • Regular use of medications such as lithium, propylthiouracil, phenylbutazone, or aminoglutethimide
  • Taking a lot of substances (goitrogens) that inhibit production of thyroid hormone—common goitrogens include foods such as cabbage, turnips, Brussels sprouts, seaweed, and millet
  • Iodine deficiency—Iodine deficiency is rare in the United States and other developed countries, due to the use of iodized table salt; this is a primary cause of goiter in other parts of the world, particularly in mountainous areas, or areas that experience heavy rainfall or flooding
Risk Factors
Nontoxic goiter is more common in women and in people over age 40.

The following factors increase your chance of developing nontoxic goiter:

  • A diet low in iodine
  • Family history of goiter
  • History of radiation therapy to head or neck, especially during childhood
Symptoms
Nontoxic goiters usually do not have noticeable symptoms, unless they become very large. Symptoms may include:

  • Swelling of the neck
  • Breathing difficulties, coughing, or wheezing with large goiter
  • Difficulty swallowing with large goiter
  • Feeling of pressure on the neck
  • Hoarseness
Diagnosis
You will be asked about your symptoms and medical history. A physical exam will be done. Your doctor may recommend a specialist. An endocrinologist focuses on hormone related issues.

Your body fluids and tissues may be tested. This can be done with:

Images may be taken of your body structures. This can be done with:

Treatment
Nontoxic goiters usually grow very slowly. They may not cause any symptoms. In this case, they do not need treatment.

Treatment may be needed if the goiter grows rapidly, affects your neck, or obstructs your breathing.

If a nontoxic goiter progresses to the nodular stage, and the nodule is found to be cancerous, you will need treatment. Talk with your doctor about the best plan for you. Treatment options include the following:

Hormone Suppression Therapy
Thyroid hormone medication is used to suppress secretion of thyrotropin (TSH). TSH is the thyroid-stimulating hormone that causes growth. This therapy is most effective for early stage goiters that have grown due to impaired hormone production. It is less effective for goiters that have progressed to the nodular stage.

Radioactive Iodine
Radioactive iodine treatment is used to reduce the size of large goiter. It is used in the elderly when surgical treatment is not an option.

A surgery to remove a portion or all of the thyroid gland. It is the treatment of choice if the goiter is so large to cause difficulty in breathing or swallowing.

Prevention
Be sure that your diet contains enough iodine.




RESOURCES:
The American Thyroid Association

The Hormone Foundation

CANADIAN RESOURCES:
The College of Family Physicians of Canada

Thyroid Foundation of Canada

References:
Bonnema SJ, Bennedbek FN, et al. Management of the nontoxic multinodular goiter: a North American Survey. J Clin Endocrinol Metab. 2002;87:112-117.

Bonnema SJ, Nielsen VE, et al. Improvement of goiter volume reduction after 0.3 mg recombinant human thyrotropin-stimulated radioiodine therapy in patients with a very large goiter: a double-blinded, randomized trail. J Clin Endo Metab. 2007;92:3424-3428.

Diehl LA, Garcia V, Bonnema SJ, et al. Management of the nontoxic multinodular goiter in Latin America: comparison with North America and Europe, an electronic survey. J Clin Endocrinol Metab. 2005;90:117-123.

Freitas JE. Therapeutic options in the management of toxic and nontoxic nodular goiter. Seminars in Nuclear Medicine. 2000;30:88-97.

Hurley DL, Gharib H. Evaluation and management of multinodular goiter. Otolaryngol Clin North Am. 1996;29:527-540.

Last Reviewed December 2014



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