A goiter is an enlargement of the thyroid gland. It is not cancer.

There are different kinds of goiters. A simple goiter usually occurs when the thyroid gland is not able to produce enough thyroid hormone to meet the body's needs. The thyroid gland makes up for this by becoming larger, which usually overcomes mild deficiencies of thyroid hormone.

A simple goiter may be classified as either an endemic (colloid) goiter or a sporadic (nontoxic) goiter.

Endemic goiters occur within groups of people living in geographical areas with iodine-depleted soil, usually regions away from the sea coast. People in these communities might not get enough iodine in their diet (iodine is vital to the formation of thyroid hormone). The modern use of iodized table salt in the United States prevents this deficiency. However, inadequate iodine is still common in central Asia, the Andes region of South America, and central Africa.

In most cases of sporadic goiter the cause is unknown. Occasionally, certain medications such as lithium or aminoglutethimide can cause a nontoxic goiter.

Hereditary factors may cause goiters. Risk factors for the development of a goiter include female sex, age over 40 years, inadequate dietary intake of iodine, living in an endemic area, and a family history of goiter.

The main symptom is a swollen thyroid gland. The size may range from a single small nodule to large neck lump.

The swollen thyroid can put pressure on the windpipe and esophagus, which can lead to:

• Breathing difficulties
• Cough
• Swallowing difficulties
• Wheezing

There may be neck vein swelling and dizziness when the arms are raised above the head.

The doctor will feel your neck as you swallow. The doctor may be able to feel swelling in the area.

Tests that may be done include:

• Thyroid stimulating hormone (TSH)
• Free thyroxine (T4)
• Thyroid scan and uptake
• Ultrasound of thyroid -- if nodules are present, a biopsy should be done to check for thyroid cancer