Goiter (Thyroid Gland Enlargement)
The thyroid gland is a small but highly effective organ located in the lower front part of the neck that manages the body’s energy balance. Through the thyroid hormones it produces, it maintains many systems from the heart’s working rate to body temperature, from digestion tempo to muscle strength.
Goiter is the enlargement of this gland beyond normal size for various reasons.
This enlargement may be limited to a single area or may spread throughout the entire gland. In some patients, the thyroid tissue extends beyond the neck boundaries towards the anterior chest cavity; this condition is called substernal goiter.
What Does Goiter Cause?
Goiter is not just a change in appearance. As it enlarges, it begins to press on the vital structures around it:
- Pressure on the trachea → shortness of breath, especially increased respiratory difficulty when lying on the back
- Pressure on the esophagus → difficulty swallowing, feeling of something stuck in the throat
- Pressure on neck soft tissues → tension, fullness and discomfort
Patients often express this as “there’s something in my neck”, “I have difficulty swallowing” or “my breathing becomes difficult when I lie down”.
Why Does Goiter Occur?
Goiter is not a single disease, but a result produced by different processes. The most common causes are:
- Growth of thyroid nodules over time
- Development of multinodular goiter
- Immune system-related diseases such as Graves’ disease
- Prolonged stimulation or inflammation of thyroid tissue
- Family predisposition
- Previous radiation to the neck area
Although iodine deficiency is still an important cause worldwide, it is less common in urban life today.
How is Goiter Evaluated?
Evaluation is performed under two main headings:
-
Evaluation of hormones
- TSH
- Free T3
- Free T4
-
Evaluation of tissue structure
- Thyroid ultrasonography
- Fine needle aspiration biopsy if necessary
- Computed tomography for large or deeply extending goiters
The aim is to clarify whether the goiter is benign or risky and whether it disrupts hormone balance.
How is Goiter Treated?
Not every goiter necessarily requires treatment. The decision on whether treatment is needed is made with these three questions:
- Is it causing complaints?
- Is it continuing to grow?
- Does it carry risky features?
Accordingly, the following options are evaluated:
- Follow-up
- Medical treatment
- Radioactive iodine (“atomic therapy”)
- Surgery (thyroid surgery)
When is Surgery Necessary?
Surgery becomes relevant in the following situations:
- If respiratory or swallowing function is affected
- If the goiter is growing rapidly
- If there is suspicion of cancer
- If substernal goiter is present
- If the patient is significantly bothered by cosmetic or pressure complaints
Conclusion
Goiter is usually benign; however, not every enlargement is innocent. A palpable mass in the neck, a gradually increasing feeling of fullness, or breathing-swallowing problems should definitely be evaluated. Early and correct evaluation both prevents unnecessary interventions and ensures treatment at the right time when necessary.
