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Seinfeld did an entire episode about it, and comedians make fun of it. Still, there's no question that goiter is no joke for sufferers. "Goiter" is the medical term for abnormal enlargement of your thyroid gland, and it's more common than you think.
What causes a goiter, and how do you shrink it, or better yet, get rid of it entirely? Let's take a look.
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What causes your thyroid gland to become enlarged? There are several common causes.
Iodine deficiency
Iodine deficiency is one of the most common causes of a goiter. Iodine is a critical ingredient in your gland's manufacture of thyroid hormone. When you are low in iodine intake, your thyroid needs to enlarge to produce enough essential thyroid hormone. A goiter that's due to lack of iodine is known as a colloid goiter.
Iodine excess
Iodine excess is a less common cause of goiter. Still, in some cases, excessive intake of or exposure to iodine can trigger thyroid enlargement.
Autoimmune thyroid disease
Both Hashimoto's thyroiditis and Graves' disease -- the two autoimmune conditions that affect the thyroid gland -- can cause an enlargement in the thyroid gland.
Pregnancy
Pregnancy can sometimes trigger a goiter because a woman's thyroid produces extra thyroid hormone for her developing baby.
Estrogen dominance
If your estrogen levels are too high – especially in a ratio to your progesterone levels – this can contribute to thyroid nodules and goiter formation. Estrogen dominance can develop during and after pregnancy, in perimenopause, or when taking birth control pills. Common symptoms include bloating, tender or lumpy breasts, reduced sex drive, irregular menstrual periods, sleep disturbances, and weight gain.
Temporary thyroiditis
A temporary inflammatory viral or bacterial infection in the thyroid can cause inflammation and enlargement of your thyroid.
Benign or cancerous thyroid nodules
The presence of one or more thyroid nodules can create swelling and a goiter. In some cases, the nodules produce thyroid hormones themselves, causing hyperthyroidism. When a goiter results from these hormone-producing nodules, the conditions are known as toxic nodular goiter or multinodular goiter.
Medications
Some medications, most notably lithium and amiodarone, can cause swelling and enlargement of the thyroid gland, in some cases with no effect on thyroid function itself. This kind of goiter is known as a nontoxic goiter.
In some cases, a minor goiter may be undetectable and cause no symptoms. But typically, the diagnosis begins with visible swelling in your neck or enlargement of your neck area. Sometimes, you may not even notice it yourself. For example, Real Housewives actress Denise Richards saw her doctor and was diagnosed with a goiter only after some of the show's viewers commented on social media about her visible neck swelling in several episodes.
An otherwise unknown goiter may also be discovered incidentally on an imaging test like an ultrasound.
When your goiter is larger or close to your trachea, you may experience symptoms such as:
- Difficulty swallowing
- Feeling like something is stuck in your throat
- Neck tenderness
- Tight feeling in your throat
- Difficulty breathing
- Frequent coughing
- Hoarse voice
A goiter may also involve related symptoms of hypothyroidism or hyperthyroidism, such as fatigue, weight gain or loss, anxiety, insomnia, or a fast heart rate.
You're at higher risk of a goiter if:
- You live in an area with iodine deficiency, or you've cut iodized salt and iodine-rich foods out of your diet
- You're a woman, or you're over 40
- You're pregnant or have just had a baby
- You have a personal or family history of autoimmune disease and/or thyroid disease
- You've had radiation to your neck or chest area or radiation from nuclear tests and accidents
- You're taking a medication that is known to trigger thyroid problems
Proper diagnosis of a goiter involves several different evaluations:
- Thyroid blood tests: including thyroid -stimulating hormone (TSH), Free T4, Free T3, and TPO antibodies tests to evaluate autoimmune thyroid disease
- Thyroid imaging: to determine if your goiter involves an overproduction of thyroid hormone or toxic nodules
- Ultrasound: to determine the size and position of the gland and to help identify any nodules
- Biopsy: When nodules appear suspicious, a fine needle aspiration (FNA) biopsy may also help rule out the possibility of thyroid cancer
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The treatment for your goiter depends on the cause, size, and location.
A small goiter that is not cosmetically visible and doesn't affect your breathing, swallowing, or thyroid function may not require any treatment. Your doctor may recommend monitoring and periodic imaging tests to gauge whether your goiter is growing larger.
If your goiter is from iodine deficiency, increasing your iodine intake from food or supplements may help reduce the goiter's size. Note, however, that it's not wise to start on iodine therapy until you've had a medical diagnosis of iodine deficiency.
If your goiter is from iodine excess, the evident approach is to reduce your iodine intake.
If you are hypothyroid with a goiter, thyroid hormone replacement treatment like levothyroxine or natural desiccated thyroid can treat the underactive thyroid and may help shrink your goiter. In some cases, suppressive treatment – maintaining a low or even undetectable TSH level bordering on hyperthyroid – is recommended to help reduce the size of a goiter.
If you are hyperthyroid, antithyroid drug treatment for the overactive gland may help reduce the size of your goiter.
If your goiter is from Graves' disease/hyperthyroidism, radioactive iodine (RAI) treatment can treat the overactive gland and eventually destroys enough thyroid cells to cause the goiter to shrink.
If you have any risk factors for or signs of estrogen dominance, treatment with progesterone – as well as nutritional support to help balance your estrogen/progesterone ratio – may help. Some women have found supplements like maca, wild nettle, and di-indole methane (DIM) helpful in resolving estrogen dominance.
Suppose a goiter is cosmetically unsightly or affects your breathing or swallowing. In that case, your doctor may tell you that surgery is the only effective treatment option.
Before you agree to surgery, be sure to get a second opinion from a doctor with expertise in interventional endocrinology, which is the less invasive medical approach for goiter and nodules. These include:
Radiofrequency ablation, known as RFA
A minimally invasive treatment is performed under local anesthesia. A small needle is inserted into your thyroid nodule, guided by ultrasound. The needle tip generates heat that helps destroy targeted tissue.
Percutaneous ethanol injection, or PEI
This method involves injecting alcohol directly into the nodule, guided by ultrasound. Research has shown that PEI effectively resolves certain types of thyroid nodules and the resulting goiter.
Note: If you do end up choosing thyroid surgery, it's essential to work with an experienced thyroid surgeon who performs at least 50 or more thyroid surgeries per year to reduce the risk of any complications dramatically.
Whether you want to try natural approaches to treat your goiter – or complement conventional treatment – be prepared to be patient and allow time for your chosen method to work.
Fundamentally, it's essential to do everything you can to provide sufficient nutrition to your thyroid. That means getting enough selenium, vitamin D, l-tyrosine, and zinc, among others – and iodine when needed. Paloma's Daily Thyroid Care supplement is a great starting point and an easy way to get thyroid nutrition.
You can also consider following an anti-inflammatory diet, like the Autoimmune Protocol (AIP) diet. Paloma Health's free mobile app takes you through a 12-week AIP program to help support Hashimoto's and thyroid health and reduce inflammation.
Some holistic and integrative physicians also recommend anti-inflammatory supplements, like curcumin – the active ingredient in the spice turmeric. Research has found that curcumin – especially in combination with the herb Boswellia -- may be helpful for nodules and goiter. My favorite go-to supplements for inflammation are therapeutic-grade Curamin and Curamed, which contain a patented form of curcumin, along with Boswellia. They also work incredibly well for pain.
You may see some natural medicine proponents recommending bladderwrack, bugleweed, and motherwort as natural remedies for goiter. It's important to note that these supplements can aggravate both hypothyroidism and hyperthyroidism for some patients.
Natural treatment for your goiter is not a "grab a bottle off the shelf" do-it-yourself proposition. If you want to treat your goiter with herbal and natural remedies and diet, work with a knowledgeable thyroid doctor who has experience treating goiter.
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