This is an abnormal enlargement of the thyroid gland. We know that our thyroid is butterfly – shaped gland which is located at the base of the neck just below the Adam’s apple. Goiters are usually painless but a large goiter can cause a cough and it can make difficult for you to breathe or swallow. A lack of iodine in the diet is the most common cause of goiter all around the world. In the United States of America where the use of iodized salt is very common, a goiter is more often due to the underproduction or overproduction of thyroid hormones or due to the nodules which develop in the gland itself.  The treatment for this condition depends on the size of the goiter, the underlying cause and the symptoms. Small goiters are not noticeable and they do not cause problems. Usually small goiters do not need treatment.
Symptoms of goiter
You should know that now all goiters cause signs and symptoms. When signs and symptoms happen, they can include:
- Difficulty breathing
- Difficulty swallowing
- A tight feeling in your throat
- If you have a visible swelling at the base of your neck which can be particularly obvious when you put on makeup or you have shave
Causes for goiter
When someone has a goiter, then this does not necessarily mean that the thyroid gland is not working normally. Even when the thyroid gland is enlarged, it can produce normal amounts of hormones. Also it can produce too much or too little T – 3 and thyroxine. There are many factors which can cause your thyroid gland to enlarge. Here are the most common factors:
- Inflammation: Thyroiditis is an inflammatory condition which can cause swelling and pain in the thyroid. Also it can cause underproduction or overproduction of thyroxine.
- Pregnancy: A hormone produced during pregnancy, HCG, human chorionic gonadotropin, can cause the thyroid gland to enlarge slightly. 
- Thyroid cancer: This type of cancer is far less common than benign thyroid nodules. A biopsy of thyroid nodule is very accurate in determining it is cancerous. 
- Solitary thyroid nodules: In this case, a single nodule develops in one part of your thyroid gland. Most nodules are benign (noncancerous) and they do not lead to cancer.
- Multinodular goiter: In this condition, several solid or fluid – filled lumps called nodules develop in the both sides of your thyroid which is resulting in overall enlargement of the gland.
- Hashimoto’s disease: Hypothyroidism which is an underactive thyroid can cause goiter. Hashimoto’s disease is an autoimmune disorder which damages your thyroid so that it produces too little hormone. When your pituitary gland is sensing a low hormone level, then it produces more THS to stimulate the thyroid which then can cause the gland to large. 
- Grave’s disease: There are some cases in which goiter can happen when your thyroid gland produces too much thyroid hormone, a condition known as hyperthyroidism. When someone has Grave’s disease, then antibodies which are produces by their immune system mistakenly attack their thyroid gland, causing it to produce excess thyroxine. This overstimulation causes the thyroid to swell. 
- Iodine deficiency: Iodine is important element for the production of thyroid hormones. It is primarily found in the soil in coastal areas and in seawater. Nowadays, most people live in high elevations or live inland and they have iodine deficiency which can easily lead to development of goiters when the thyroid enlarges in an effort to obtain more iodine. Also the initial iodine deficiency can be even worse when a diet is high in hormone – inhibiting foods such as cauliflower, broccoli and cabbage. The lack of iodine is the most common cause for goiters in many parts of the world but this is not the case in the countries in which iodine is constantly added to table salt and other foods. 
Risk factors: Goiters can affect every single person. They are present at birth and they can happen at any time throughout the life. Here are some common risk factors for iodine:
- Radiation exposure 
- Certain medications
- Pregnancy and menopause 
- Medical history
- Your age
- Being female 
- A lack of dietary iodine 
 NCH Healthcare system. Goiter. 2019. Retrieved from www.nchmd.org/education/mayo-health-library/details/CON-20164026
 Fujishima A, Sato A, Miura H, et al. Fetal goiter identified in a pregnant woman with triiodothyronine-predominant graves’ disease: a case report. BMC Pregnancy and Childbirth. 2020.
 Shimaoka K, Badillo J, Sokal JE, Marchetta FC. Clinical differentiation between thyroid cancer and benign goiter: An evaluation. J
 Hennessey J, Wartofsky L. Hashimoto’s disease. The Journal of Clinical Endocrinology & Metabolism. 2007;92(7):E1.
 Girgis CM, Champion BL, Wall JR. Current concepts in Graves’ disease. Therapeutic Advances in Endocrinology and Metabolism. 2011;2(3):135–44.
 Sinnott B, Ron E, Schneider AB. Exposing the thyroid to radiation: A review of its current extent, risks, and implications. Endocrine Reviews. 2010;31(5):756–73.
 Malboosbaf R, Hosseinpanah F, Mojarrad M, et al. Relationship between goiter and gender: A systematic review and meta-analysis. Endocrine. 2012;43(3).