Goiter problems usually lessened by medication


Q: When I saw my doctor about a swelling in the front of my neck, he told me that I have a goiter and ordered some blood tests. What is a goiter and how is it likely to affect me?

A: Goiter is a general term for an enlargement of the thyroid gland. With an enlarged thyroid, production of thyroid hormone can be excessive (hyperthyroidism), reduced (hypothyroidism) or normal.

Goiters are rarely due to thyroid cancers, but an occasional thyroid malignancy may cause generalized enlargement of the thyroid.

The combination of a goiter and hyperthyroidism, known as Grave's disease, is treated either by medication to suppress thyroid hormone production or by the administration of radioactive iodine, which concentrates in the thyroid, destroys the overactive cells and reduces the size of the gland.

Hypothyroidism associated with a goiter is most often due to an autoimmune disorder call Hashimoto's thyroiditis.

This and all causes of hypothyroidism are treated with lifelong thyroid hormone replacement.

Goiters may be a cosmetic problem and, when large enough, can exert pressure on and compress the trachea (windpipe) or esophagus, leading to hoarseness or difficulty in breathing or swallowing. In some cases, the goiter is so large that surgical removal of part of the gland may be necessary.

Dr. Margolis is professor of medicine and biological chemistry at the Johns Hopkins School of Medicine.

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