Health Library

Nontoxic Nodular Goiter

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 is about nontoxic goiters which may be:

  • Diffuse—enlarging the whole thyroid gland
  • Nodular—enlargement caused by nodules, or lumps, on the thyroid
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
  • Iodine deficiency—though rare in the US and other developed countries, it 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.

Other factors that may increase your chances of 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 thyroid-stimulating hormone (TSH). TSH causes growth of the thyroid. 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 a large goiter. It is used when surgical treatment is not an option.

Surgery

Thyroidectomy is done to remove part or all of the thyroid gland. It is the treatment of choice if the goiter is so large that it makes it difficult to breathe or swallow.

Prevention

To help reduce your chances of a nontoxic goiter, be sure that your diet contains enough iodine. In the US, iodine can be found in table salt and a variety of foods. Iodine deficiency is more common in less developed countries.

Resources

American Thyroid Association
https://www.thyroid.org

Hormone Health Network—Endocrine Society
https://www.hormone.org

Canadian Resources

The College of Family Physicians of Canada
http://www.cfpc.ca

Thyroid Foundation of Canada
http://www.thyroid.ca

References

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(1):117-123.

Haugen BR, Alexander EK, Bible KC, et al. 2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid. 2016 Jan;26(1):1-133.

Freitas JE. Therapeutic options in the management of toxic and nontoxic nodular goiter. Seminars in Nuclear Medicine. 2000;30(2):88-97.

Gharib H, Papini E, Garber JR, et al; AACE/ACE/AME Task Force on Thyroid Nodules. American Association of Clinical Endocrinologists, American College of Endocrinology, and Associazione Medici Endocrinologi Medical Guidelines for Clinical Practice for the Diagnosis and Management of Thyroid Nodules. Endocr Pract. 2016 May;22(5):622-39.

Nontoxic Multinodular Goiter. EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/nontoxic-multinodular-goiter. Accessed September 23, 2020.