Thyroid enlargement (goiter)


An enlargement of the thyroid gland, the so-called goitre or goiter, is triggered in many cases by a permanent acute iodine deficiency in the body. While in past decades patients with an externally visible enlargement of the thyroid gland the size of a tennis ball could be found in German doctors’ offices, goiter formation is more discreet in modern times.

In many cases, it is hardly possible even for the attending physician to visually detect the enlargement or to feel it with the fingers during the subsequent examination. However, experts assume that one third of the German population suffers from a slightly enlarged thyroid gland.


Iodine deficiency


As an important organ, the thyroid gland is responsible for the production of the two hormones T-3 (triiodothyronine) and T-4 (thyroxine), which play a crucial role in regulating the metabolism as well as the circulation. To produce the important thyroid hormones, the body needs an adequate amount of the trace element iodine as well as protein.

Since the body’s own cells cannot produce iodine themselves, people must ensure that they have a constantly sufficient iodine intake in their diet in order to keep the circulation and metabolism going.

In many cases, however, sufficient iodine intake is not possible through food intake because the Federal Republic of Germany, like some other Western European countries, is considered an iodine deficiency area and thus the food itself only has a low iodine content.

Abbildung einer Schilddrüsenvergrößerung - Struma

Illustration of severe thyroid enlargement (goiter)


To compensate for the iodine deficiency, the thyroid gland reacts with increased cell formation, which results in an enlargement of the organ, the so-called goiter. Goiters are classified by doctors into different categories, depending on their location and condition in the thyroid gland.


The following types of goitre are predominant in patients with the disease:

  • Struma Diffusa: the thyroid gland enlarges evenly and does not show any nodule formation.
  • Struma nodosa: older people in particular suffer from this form of thyroid enlargement, which is limited to individual areas of the thyroid gland and results in nodule formation. One (struma uninodosa) or several (struma multinodosa) nodes can not only be felt, but are often also visible from the outside. While the so-called “cold nodules” are no longer involved in hormone production in the thyroid gland, “warm or hot nodules” can continue to produce a normal to large amount of the important hormones T-3 and T-4.


Symptoms of thyroid enlargement (goiter)


A mild to moderate enlargement of the thyroid gland does not always have to be accompanied by clearly recognisable symptoms or complaints. In many cases, patients do not notice that their thyroid gland is enlarged for a long time.

However, at an advanced stage of the growth process, the first symptoms usually appear as clear alarm signals. From the typical lump in the throat feeling in the thyroid gland to shortness of breath, numerous signs point to an enlargement.


The following complaints can occur:

  • Difficulty swallowing
  • Sudden hoarseness that lasts for a long time
  • Shortness of breath
  • A feeling of pressure or tightness in the throat

If an additional hypothyroidism or hyperthyroidism has developed in the course of the disease, those affected will also complain of additional symptoms of the thyroid disease in question, such as fatigue, lack of drive, lack of concentration or a sudden change in weight.


What are the underlying causes of a goiter?


An enlargement of the thyroid gland can have various causes, which should always be clarified by a doctor. The most common cause, however, is insufficient iodine intake, since a large part of the population does not take in sufficient amounts of the important trace element with their food.

To compensate for this deficiency, the thyroid gland increases its growth and goiter forms. In order to prevent iodine deficiency goitre and the associated formation of nodules, it is therefore particularly important to ensure sufficient consumption of iodine-containing foods.

In addition to the exclusive use of iodine-containing table salt for seasoning food, there is a whole range of tasty foods that have a high iodine content.

The best sources of iodine are without doubt sea fish and seafood, which should be on the menu at least 1-2 times a week.


Foods with high iodine content:


Sea fish (iodine content per 100 g)

  • Haddock: 417 micrograms
  • Saithe: 263 micrograms
  • Plaice: 192 micrograms
  • Cod: 120 micrograms
  • Tuna: 50 micrograms


Seafood (iodine content per 100 g)

  • Mussel: 130 micrograms
  • Prawns: 130 micrograms
  • Oysters: 120 micrograms
  • Lobster: 100 micrograms


Milk and dairy products:

  • 100 ml whole milk: 7 micrograms
  • 100 g cheese 5 micrograms



  • 100 g spinach: 20 micrograms


When eating bread, you should make sure that the respective type of bread was made with iodised salt. Sufficient fluid intake with iodine-containing mineral water is also a good way to keep the iodine content in the body in check.


How is the diagnosis of goiter made?


If a patient suffers from one or more typical symptoms of goitre, in some cases the enlargement can already be palpated and visually detected by the naked eye.

In order to be able to make a more precise diagnosis, which is particularly important for the subsequent therapy measures, the doctor first carries out a blood test as well as an ultrasound examination, which can provide more precise information about the size of the thyroid gland as well as existing nodes.

If the ultrasound examination shows the first signs of a nodule, a scintigraphy is often performed. With this nuclear medical examination, the doctor can determine whether the nodules are “cold” or “warm”. While “warm nodes” usually have active hormone production, “cold nodes” with no activity can lead to thyroid cancer.

In some cases, if there are abnormal findings, the treating doctor decides to perform a puncture, in which cell tissue is removed and examined microscopically to determine whether it is benign or malignant.


According to the World Health Organisation (WHO), experts classify patients on a scale according to different degrees of goiter:

  • Grade 0a: no goiter
  • Grade 0b: goiter is palpable but not visible
  • Grade I: the goitre is palpable and also visible when the head is pulled back.
  • Grade II: the goitre is visible even with the head in a normal position
  • Grade III: large goiter that is also visible from a greater distance


What therapeutic measures are available?


The treatment of diagnosed thyroid enlargement is different for each individual patient, depending on the findings and diagnosis. A large goiter that has already existed for a long period of time, causes severe symptoms and could not be successfully treated with medication is usually removed completely by surgery.

Iodine deficiency goitre is initially treated with additional iodine-containing preparations in tablet form. If, however, no positive change in the growth of the tumour can be observed over several months of treatment, the doctor administers an additional hormone preparation (L-thyroxine), which is supposed to contribute to a reduction of the goitre.

Doctors decide in favour of radioiodine therapy for patients who are at an increased health risk and thus a surgical intervention could have life-threatening consequences. The nuclear medical therapy method is also used if the goiter keeps recurring even after successful treatment with the appropriate medication.


To the thyroid dysfunction overview