A goiter is an enlarged thyroid gland. The medical term for a goiter is “struma”. The cause is usually an iodine deficiency. Doctors can treat a goiter with medication, surgery or radiotherapy.

At a glance

  • A goiter (referred to in medical literature as a “struma”) is an enlargement of the thyroid gland.
  • Often, the enlargement goes unnoticed or is only noticed once the swelling is large.
  • The most common cause is a deficiency of iodine in the diet.
  • In some people, the entire thyroid gland enlarges at the same time, while in others, there are one or more enlarged lumps called nodules.
  • With goiter, the thyroid produces either too few or too many hormones.
  • Goiters are usually harmless and can be treated in various ways.

Note: The information in this article cannot and should not replace a medical consultation and must not be used for self-diagnosis or treatment.

A doctor examines a young woman’s enlarged thyroid gland by touch.

What is a goiter?

A goiter (the medical term for which is “struma”) is an enlarged thyroid gland.

The thyroid gland is located at the front of the neck and is an essential organ for producing hormones. It plays an important role in metabolism, growth and helping the body reach sexual maturity. It also helps to regulate many functions in the body.

The thyroid needs iodine to produce hormones. The body has to absorb this trace element from food. If the diet is deficient in iodine, the thyroid may no longer be able to produce sufficient quantities of hormones and may respond by increasing its number of thyroid-producing cells – resulting in enlargement of the gland.

Iodine deficiency is the most common cause of an enlarged thyroid gland. 30 percent of adults and 44 percent of children in Germany don’t get enough iodine.

A goiter can develop in various forms. Treatment depends on which factors have triggered the goiter.

What are the symptoms of a goiter?

Most people with a goiter don’t notice that their thyroid is enlarged because the tissue grows slowly over many years. Goiters are often discovered accidentally during a physical examination.

Some people have a thyroid that produces either too few or too many hormones. However, a goiter can also occur with normal thyroid function.

Hormone levels can be measured in the blood. With an underactive thyroid (hypothyroidism), the gland produces insufficient quantities of hormones. This causes symptoms such as fatigue, shivering or constipation. Lethargy and weight gain may also indicate an underactive thyroid gland.

If a goiter is accompanied by an underactive thyroid gland, this is often due to an iodine deficiency or a chronic inflammation of the thyroid.

Less commonly, people with a goiter show symptoms of an overactive thyroid (hyperthyroidism), such as unwanted weight loss, sweating and restlessness.

What causes a goiter?

The most common cause of goiter is an iodine deficiency. Iodine is an essential trace element. This means that the body is unable to produce iodine itself and must absorb it from food.

The most common cause of goiter is an iodine deficiency.

In Central Europe, the soil contains relatively low levels of iodine. As a result, many plant-based and animal-based foods naturally contain very little iodine – which is why Germany was for a long time considered an iodine-deficient region. However, this situation has improved by adding iodine to table salt and manufacturing food products with added iodine.

More rarely, a goiter is caused by thyroid diseases such as Hashimoto’s thyroiditis or Basedow’s disease. In these cases, the body creates antibodies that attack the healthy tissue in the thyroid, leading to hormonal imbalances.

It is very rare for a goiter to be caused by a tumor.

What causes a goiter?

This video explains how a goiter develops.

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How common are goiters?

Goiters are very common in Germany.

The risk of developing a goiter increases with age – almost 18 percent of people between the ages of 31 and 45 have a goiter, while this figure increases to around 24 percent among those aged 46 to 65.

What is the outlook for people who develop a goiter?

Thyroid tissue normally grows very slowly. The enlargement doesn’t cause any pain and, until it reaches a large size, it cannot be seen or felt.

A distinction is made between different types of goiter depending on their composition and function.

A diffuse goiter describes a situation where the entire thyroid gland swells and is smooth without any nodules (lumps).

A nodular goiter is one where nodules (lumps) develop as the goiter grows and these can be distinguished from the normal thyroid gland tissue.

These nodules may lead to uncontrolled production of thyroid hormones. If this happens, they are known as “hot” nodules. The nodules are described as “cold” if the tissue doesn’t produce any hormones.

Goiters can affect normal thyroid production to varying extents. Some goiters allow normal hormone production to continue, while others result in too many or too few hormones being produced by the gland.

What can be done to prevent a goiter?

To prevent iodine deficiency and goiter, consumption of iodine-rich foods on a daily basis is recommended.

To prevent goiter, consumption of iodine-rich foods on a daily basis is recommended.

The German Nutrition Society (“Deutsche Gesellschaft für Ernährung”) recommends 200 micrograms of iodine daily for people aged between 13 and 50. Younger and older people need less iodine, while women who are pregnant or breast-feeding require more.

Natural sources of iodine and iodized salt

A good amount of iodine is naturally found in fish such as pollack, cod and plaice and in shellfish. Seafood should ideally be consumed once or twice a week. To meet daily requirements, iodized salt should always be used in cooking and food products containing iodized salt should be purchased. Dairy products and eggs also contain small amounts of iodine. Organic food products generally have lower levels of iodine.

Important: The amount of iodine added to iodized salt is regulated by law and is set at a level to prevent excessive intake. There is also no need for people with existing thyroid diseases to avoid iodized salt.

Iodine in vegetarian or vegan diets 

Plant-based foods contain hardly any iodine. Certain types of seaweed used in sushi are an exception to this rule. However, seaweed shouldn’t be consumed excessively because, in its dried form, it often contains excessive amounts of iodine.

Intake of food made with iodized salt should also be increased. The benefits of taking iodine tablets as a dietary supplement should be discussed with a doctor.

Iodine for pregnant and breast-feeding women  

One of the important roles played by iodine is brain development in babies. The recommended daily intake of iodine during pregnancy is 230 micrograms, increasing to 260 micrograms while breast-feeding. To meet daily requirements, pregnant and breast-feeding women should ask their doctor whether they should take iodine supplements.

How is a goiter diagnosed?

People sometimes discover a goiter themselves and sometimes it is detected unexpectedly during a routine physical examination.

An ultrasound scan provides a reliable diagnosis. It also allows doctors to determine the exact size of the goiter and whether nodules are present.

A blood sample can also be taken to determine a TSH reading and measure hormones. TSH stands for thyroid stimulating hormone, which is produced by the pituitary gland to stimulate hormone production by the thyroid. A high TSH reading indicates decreased production of thyroid hormones. If the reading is too low, meanwhile, this indicates over-production of thyroid hormones.

A changed TSH reading allows doctors to determine the level of thyroid hormones in the blood. They can also analyze the blood to detect certain antibodies that point to the cause of the thyroid gland enlargement.

If malignant tissue changes in the thyroid are suspected, a biopsy will be taken using fine-needle aspiration. In this procedure, a needle is used to take a small piece of tissue from the thyroid for further analysis.

A magnetic resonance imaging (MRI) scan or computed tomography (CT) scan may be performed to obtain images of the thyroid and determine the precise position and size of the goiter.

How is a goiter treated?

A goiter is usually harmless. Depending on the size of the goiter and whether it is continuing to grow, doctors may decide to treat it with medication, surgically remove the thyroid gland or use radiotherapy with radioactive iodine.

In cooperation with the Institute for Quality and Efficiency in Health Care (Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen – IQWiG).

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