Conditions Iodine-deficiency goiter

The thyroid gland is located in the front of the neck, below the larynx. It is a vital hormone-secreting gland. 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 must absorb this trace element through food: It can be found in various foods, such as in saltwater fish, dairy products, or eggs.

If the diet is deficient in iodine, the thyroid can no longer produce enough hormones and responds by increasing its number of hormone-producing cells – resulting in enlargement of the gland. Medical professionals refer to this as an “iodine-deficiency goiter”. If the enlargement is clearly visible from the outside, it is also called a visible goiter.

A goiter can also have other causes – such as thyroid nodules, inflammation, or autoimmune conditions like Graves’ disease. Treatment depends on what caused the enlargement.

Most people with an iodine-deficiency goiter don’t notice that their thyroid is enlarged because the tissue grows slowly over many decades. However, if it is left untreated and continues to grow, it eventually becomes visible on the neck.

At this stage, symptoms can occur if the greatly enlarged gland presses on the esophagus, larynx or windpipe. This can lead to a sensation of a lump in the throat, difficulty swallowing, hoarseness, or breathing difficulties.

Iodine deficiency is the cause in approximately 90 percent of all people with an enlarged thyroid. Iodine is an essential trace element. This means that the body is unable to produce iodine itself and must absorb it from food.

If you do not get enough iodine over a long period, a normal-sized thyroid gland can no longer produce enough hormones and begins to grow. This allows it to make better use of the available iodine and maintain thyroid hormone levels within the normal range. Symptoms of an underactive thyroid (hypothyroidism) or an overactive thyroid (hyperthyroidism) do not therefore typically occur with iodine-deficiency goiter.

In Central Europe, the soil contains relatively low levels of iodine. Therefore, many plants and animal-based foods naturally contain very little iodine. Germany was therefore long considered an “iodine-deficiency area”. However, this situation has improved by adding iodine to table salt and manufacturing food products with added iodine.

Worldwide, nearly two billion people are affected by iodine deficiency.

However, severe forms of iodine-deficiency goiter are now rare in Germany. They only occur if the condition goes undetected and a person continues to consume too little iodine. At some point, the enlarged thyroid gland may no longer be able to compensate for the iodine deficiency and ultimately produce too few hormones after all. This leads to an underactive thyroid.

Adolescents and young adults, as well as pregnant and breastfeeding women in particular have a high requirement for iodine.

The following recommendations apply in Germany:

• eat saltwater fish up to twice a week – for example, herring, plaice, or cod
• regularly consume milk, dairy products, and eggs
• season with iodized table salt
• when buying salted foods such as ready meals, sausage or bread, make sure that iodized salt has been used

Using iodized salt and products containing iodized salt is particularly important for people who follow a vegetarian or vegan diet.

Pregnant and breastfeeding women should follow an iodine-rich diet and additionally take 100 to 150 micrograms of iodine per day in tablet form.

It is unlikely that you will consume too much iodine – unless you eat large quantities of foods high in iodine, such as algae or seaweed. For these foods, you should heed the relevant information on the packaging regarding consumption amounts.

A thyroid enlargement can be readily detected using an ultrasound examination (sonography). This allows doctors to precisely measure the size of the thyroid. An iodine-deficiency goiter can sometimes also be felt in the neck or, in an advanced stage, be visible from the outside. Distended blood vessels in the neck are sometimes visible. A whistling sound when breathing in can also indicate a goiter.

If a goiter has been identified, special tests are performed. They show whether the thyroid gland is producing enough hormones. To determine whether iodine deficiency might be the cause, the doctor asks about dietary habits.

The causes of a goiter as well as other thyroid disorders can be determined using various tests. More detailed information about thyroid examinations can be found at gesundheitsinformation.de.

A goiter is usually harmless. The goal of goiter treatment is to shrink the thyroid gland again or at least prevent further enlargement. To this end, the underlying cause – iodine deficiency – is remedied. For this, it is usually enough to eat a balanced diet, regularly eat food containing iodine such as fish, and iodized table salt.

In cases of severe iodine deficiency, it may be advisable to supplement with iodine in the form of potassium iodide tablets after consulting a doctor.

Depending on the circumstances, an individual may receive a combination of iodine tablets and the thyroid hormone L-thyroxine for a period of time. This keeps the hormone level in the upper normal range. This is to stop the thyroid from being stimulated to grow further.

However, sometimes these measures are not enough to shrink the thyroid gland back to its normal size – for instance, when the goiter has been present for a long time and has become indurated (hardened) due to connective tissue. Those who are not bothered by this need take no further action. However, if the goiter is pressing on the windpipe and esophagus, for example, a surgical procedure may be necessary. In this process, the thyroid gland is usually largely removed and only a remnant of thyroid tissue is left behind. Although this remnant can still produce hormones, many affected individuals have to take additional thyroid hormones permanently after the procedure.