What is Goiter?

A goiter is an enlarged thyroid gland caused by several medical conditions. Learn more about what predisposes you to it and how functional medicine can help.

Goiter: Knowing The Facts

Know the facts about Goiter that matter. You may not hear it on the news every day, but there has been a silent battle against thyroid diseases for many years now. In the United States alone, more than 20 million people have some form of thyroid disease and 12% of the country’s entire population will develop it at some point in their life.

Around the world, the rate of thyroid conditions is also growing exponentially, especially in areas where there is a deficiency of iodine in the diet. This prompted organizations like the World Health Organization to make the iodization of salt mandatory.

But through all these efforts, there are still a lot of cases of thyroid diseases, one of the most prevalent of which is goiter.

Understanding the thyroid gland

The thyroid is one of the endocrine glands in your body located at the lower part of the neck. This butterfly-shaped gland is mainly responsible for producing and secreting thyroid hormones and maintaining iodine hemostasis in the body.

The thyroid gland produces 90% thyroxine (T4) or inactive thyroid hormone and 10% triiodothyronine (T3) or active thyroid hormone. T4 is usually converted to either T3 or an alternative form of inactive thyroid hormone.

These thyroid hormones influence all the cellular processes in the body by increasing the function and metabolism of cells. Some of the organ systems that are affected by thyroid hormones include:

  • The heart. Thyroid hormone helps maintain a good cardiac output and resting heart rate by increasing myocardial intracellular calcium, which in turn increases the contraction speed and force of the heart.
  • The lungs. Triiodothyronine (T3) normalizes arterial oxygen concentration that regulates minute ventilation and resting respiratory rates. It also helps promote oxygen delivery to the tissues.
  • The metabolism. One of the main functions of thyroid hormones is to regulate heat production and oxygen consumption in the body as well as influence the basal metabolic rate (BMR). This is why any dysfunction in thyroid hormone production will result to heat or cold intolerance.
  • The nervous system. Thyroid hormone is responsible for stimulating the peripheral nervous system that influences gastrointestinal motility and increases peripheral reflexes. T3 is also responsible for stimulating the nervous system to make a person more alert, awake and responsive to external stimuli.
  • The reproductive health. Thyroid hormone plays an important role in regulating both ovulation and spermatogenesis. It is also responsible for linear bone growth and the development of fetal growth centers during pregnancy.

With all these important functions, any disruption in the normal physiology of the thyroid gland could result to thyroid diseases that have huge impacts to a person’s health.

The facts about goiter

The American Thyroid Association defines goiter as “the abnormal enlargement of the thyroid gland.” While it is mostly associated with too much or too little hormone production, goiter can also be present even when the thyroid gland is producing adequate amounts of thyroid hormone.

This enlargement usually indicates the presence of a medical condition that’s causing the thyroid to grow.

Goiter affects up to 800 million people around the world, especially those who have an iodine-deficient diet. A study conducted by Wickham in the United Kingdom also revealed that 16% of the population had goiter.

The causes

Iodine deficiency is still the biggest cause of goiter. According to studies, at least 2 billion people suffer from iodine deficiency, 50 million of which are presenting clinical manifestations.

Iodine deficiency disorders have been a major public health problem around the world and they affect all types of demographic with children and lactating women being the most vulnerable. This resulted to the universal salt iodization program being implemented around the world.

Aside from iodine deficiency, goiter may also be caused by:

Graves’ disease

Graves’ disease is a type of autoimmune disorder where the body’s immune system mistakenly thinks of the thyroid as a foreign invader and attacks it causing an overproduction of thyroid hormones or hyperthyroidism.

This also results in the enlargement of the thyroid, which is the most distinct characteristic of the disease, because the immune system also produces a protein called thyroid-stimulating immunoglobulin (TSI) that causes the abnormal growth.

Hashimoto’s thyroiditis

Hashimoto’s disease is another autoimmune disorder where the immune system attacks the thyroid gland causing significant damage to it.

If left untreated, the thyroid gland will not be able to produce enough thyroid hormone causing hypothyroidism. It also results in the enlargement of the thyroid or goiter since low thyroid hormone levels will eventually trigger the pituitary gland to release more TSH to stimulate the thyroid causing it to grow.

Multinodular goiters

Some patients may experience nodular growth in the thyroid gland causing it to swell. Multinodular goiters are either solid or fluid-containing cysts that are non-cancerous but they need to be addressed to prevent them from multiplying further. The exact cause of nodular growth in the thyroid gland is still unknown.


Thyroiditis is the swelling of the thyroid gland that causes the over or under production of thyroid hormone. Thyroiditis could be caused by a viral infection, a drug reaction or an autoimmune disorder. If left untreated, thyroiditis will eventually lead to thyroid gland enlargement or goiter.


During pregnancy, the body releases human chorionic gonadotropin (HCG) hormone and estrogen that could cause the thyroid gland to enlarge.

Doctors will usually look for additional symptoms that would prompt for more testing to see if the enlarged thyroid gland is just caused by the pregnancy or if there is an underlying thyroid disease.

Treating thyroid conditions in pregnancy is very important because it could lead to pre-eclampsia, miscarriage, premature birth and low birth weight.

Thyroid cancer

While most nodules found on the thyroid gland are benign, there are rare cases when they become cancerous. Early diagnosis gives good prognosis for patients with thyroid cancer, although recurrence rates could be as high as 30%.

The risk factors

Aside from those common causes, your risk for getting goiter also becomes higher if:

  • You have a family history of goiter, thyroid nodules, thyroid cancer and other thyroid diseases.
  • You don’t consume enough iodine in your diet. The Recommended Dietary Allowance (RDA) for iodine in healthy adults is 150 mcg per day while pregnant and lactating women should consume up to 290 mcg.
  • You are female and over the age of 40. Women are more likely to develop goiter than men and older individuals are at a higher risk due to the aging of the thyroid gland.
  • You are going through menopause. There is no exact explanation yet as to why pregnant and menopausal women have a higher risk for developing goiter and other thyroid-related conditions.
  • You are undergoing radiation therapy in the neck or chest area. Radiation can affect the way the thyroid gland functions and it can sometimes lead to enlargement.

The types of goiter

There are three common types of goiter:

  • Endemic goiter

Also known as colloid goiter, this enlargement usually develops due to the lack of iodine in the diet. Adequate iodine intake is essential for the thyroid to produce enough thyroid hormones. Most people who have endemic goiter live in areas where iodine deficiency is a problem.

  • Sporadic goiter

There is still no exact cause as to why non-toxic goiters develop, but some studies have shown that they may be a reaction to prolonged use of medications like lithium. This drug is indicated for mood disorders like bipolar disorder.

  • Multinodular goiter

Also known as toxic goiter, this type of goiter is characterized by one or more small nodules on the thyroid gland that tend to grow over time. Since these nodule produce thyroid hormones, they tend to cause hyperthyroidism.

The signs and symptoms

Goiter can have several clinical manifestations. Its most common symptoms include:

  • A swelling on the lower part of the neck just below the Adam’s apple. This is the characteristic sign of goiter and it usually prompts individuals to seek medical consultation.
  • Tightness in the throat area and hoarseness of voice.
  • Dizziness when arms are raised above the head.
  • Visible swelling of the neck veins.

Some individuals may also experience symptoms such as frequent coughing, difficulty swallowing due to the goiter squeezing the esophagus, shortness of breath and wheezing due to the windpipe being squeezed by the goiter.

In other cases, people with goiter will also experience hyperthyroidism, which is characterized by a rapid heart rate, nausea, intolerance to heat, agitation and shaking or hypothyroidism where symptoms include fatigue and muscle weakness, dry skin, intolerance to cold temperatures, constipation and sudden weight gain.

The diagnosis

Once you seek medical consultation, the doctor will usually look for the most obvious sign of goiter, which is the swelling in the neck area. Then, several laboratory tests will be ordered to confirm the diagnosis. These include blood tests to determine any hormone level changes, a thyroid scan to see the size and condition of the thyroid, an ultrasound to produce images of the goiter and the nodules if there are any and a biopsy for nodules to be examined for cancer cells.

Goiter and functional medicine

Unlike conventional medical practice, functional medicine takes on a unique approach to treating goiter and other thyroid diseases. Although it utilizes the laboratory test results conducted by your doctor, a functional medicine practitioner will also look into other factors that lead to your diagnosis.

The first step to addressing goiter using functional medicine practice involves identifying root issues that contribute to your disease. The practitioner looks at the presence of an infection, the health of your gut, the sign of nutrient deficiency, any toxic exposures and the presence of pre-existing medical conditions that trigger goiter.

Once all these predisposing and precipitating factors are identified, the practitioner then proceeds to reduce factors that couldn’t be totally eradicated right away.

For instance, you could be removed from the toxic exposure that’s causing your goiter or your infection or inflammation is addressed so they don’t aggravate your goiter further.

Since functional medicine is more than just about treating signs and symptoms, the practitioner also focuses on creating a treatment plan that’s centered around your overall well-being.

For instance, detoxification is essential to helping the body to get rid of any toxins that may be triggering the goiter. Hydration is improved through proper water intake, mental detox is promoted through adequate sleep and regular bowel movements are encouraged to cleanse the body of any waste.

Functional medicine believes that each patient should be treated uniquely and as such, treatment plans should be created according to their needs.

The practitioner will begin treatment by allowing the patient to understand his condition, what is causing it and how his health journey will go about.

Functional medicine practices also find ways to support the immune system to not only reduce the symptoms of the disease but also to prevent other thyroid diseases from developing in the future.

In some cases, the patient would require hormone replacement to make up for the thyroid hormones that were lost. If needed, hormone replacement therapy could help alleviate the symptoms and get to the root cause of the disease.

It’s also very important to heal the gut by supplementing it with all the necessary nutrients to promote its healing. This is especially important if an autoimmune disease caused the goiter since most of them are related to intestinal permeability.

The takeaway

As thyroid diseases continue to affect millions of people around the world, it’s very important to gain a better understanding of these conditions, especially with goiter that’s one of the most common types of thyroid conditions today.

Most importantly, it’s about time to embrace functional medicine as a new way of treating the disease and promoting a better way of life for patients to avoid more health problems in the future.

So if you think you have goiter or you’ve already been diagnosed but treatments haven’t given you results, you can look for a functional medicine practitioner to help you.