Thyroid Nodules and Goiter

A goiter is an enlargement of the thyroid, the H-shaped gland that wraps around the front of your windpipe, just below your Adam's apple.

A goiter can be smooth and uniformly enlarged, called diffuse goiter, or it can be caused by one or more nodules within the gland, called nodular goiter. Nodules may be solid, filled with fluid, or partly fluid and partly solid.

Thyroid nodules are quite common. When examined with ultrasound imaging, as many as one-third of women and one-fifth of men have small thyroid nodules.

It's possible for an enlarged thyroid to continue functioning well and producing the right amounts of hormones. In fact, most goiters and nodules don't cause health problems. However, goiter can also be a sign of certain conditions that cause the thyroid to produce too much thyroid hormone (called hyperthyroidism) or too little (called hypothyroidism).  

Causes

Almost all cases of enlarged thyroid result from one of the following problems:

Inefficient Production of Thyroid Hormone

When the thyroid can't produce enough thyroid hormone, it compensates by getting bigger. Worldwide, the most common cause is not enough iodine in the diet. However, this is rare in the United States. Other causes include a genetic defect or certain medications, such as lithium carbonate.

Inflammation of the Thyroid

Common causes of an inflamed thyroid include autoimmune thyroiditis (also called Hashimoto's thyroiditis), which occurs when the person's immune system attacks its own thyroid, causing swelling and inflammation. Hashimoto's thyroiditis often results in a permanently underactive thyroid (hypothyroidism).

Another common cause is postpartum thyroiditis. This affects about 5 percent of women in the year after pregnancy. It usually goes away on its own without treatment.

Thyroid inflammation can also be caused by an infection or by certain medications.

Thyroid Tumors

Thyroid tumors are usually benign, but can be cancerous. Most tumors are nodules, but they can also appear as generalized swelling of the gland.

Our Approach to Thyroid Nodules and Goiter

UCSF offers comprehensive consultations and treatments for thyroid conditions, including goiter (enlarged thyroid gland) and thyroid nodules. Many goiters and thyroid nodules are harmless, so we often can take a watch-and-wait approach. However, treatment may be necessary for goiters or nodules that are causing bothersome symptoms or health concerns, such as the production of too much or too little thyroid hormone. Additionally, some cases are caused by thyroid cancer, although this is rare.

Treatment options include thyroid hormone medication, radioactive iodine therapy and surgery. For patients considering surgery, UCSF offers less invasive approaches that leave either no scar or a small scar hidden under the chin.