Short answer: A goiter is an enlarged thyroid gland, in the words of the Endocrine Society, and the American Thyroid Association says Hashimoto's thyroiditis is a more common cause of goiter in the US. The ATA says a goiter can come with too much thyroid hormone, too little, or the correct amount. When a goiter causes symptoms, the Cleveland Clinic lists a lump in the front of your neck, a feeling of tightness in your throat, coughing, hoarseness, difficulty swallowing and wheezing. Doctors usually find a goiter during a physical exam, and the ATA says the first step after that is likely thyroid function tests. MedlinePlus says to contact your provider if you notice any swelling in the front of your neck. Write down what you notice, with dates. What's causing yours is a question for your doctor.
What to note about your neck, with dates
Maybe a collar sits tighter than it used to. Maybe the front of your neck looks fuller in a photo, or your voice goes hoarse by the afternoon. Whatever made you look twice, it's worth writing down before anyone tells you what it is. Here's what to note, and where each row comes from.
| What you notice | What to write down | Who lists it |
|---|---|---|
| Swelling or a lump at the front of your neck | The date you first saw it, whether it's on one side or across the front, and whether it has changed since | The Cleveland Clinic lists a lump in the front of your neck. NIDDK says the front of the neck may look swollen |
| Tightness or fullness in your throat | When you feel it, and whether a collar or a necklace bothers you | The Cleveland Clinic and the Endocrine Society list tightness. NIDDK describes a feeling of fullness |
| Hoarseness or a change in your voice | The dates, and whether it comes and goes or stays | The Cleveland Clinic, MedlinePlus and the Endocrine Society all list hoarseness |
| A cough | When it started, and whether you have it without a cold | Coughing is on the same three lists: the Cleveland Clinic, MedlinePlus and the Endocrine Society |
| Trouble swallowing | Whether it's solids, liquids or both, and how often | MedlinePlus lists swallowing difficulties, especially with solid food. The ATA's Hashimoto's page names difficulty swallowing |
| Trouble breathing or wheezing | When it happens, especially lying flat or reaching your arms up. If breathing is hard, get urgent care | MedlinePlus names breathing difficulties with very large goiters, especially lying flat on your back or reaching up with your arms. The Cleveland Clinic lists wheezing |
| Pain or tenderness in the area | Where it is, and since when | The Cleveland Clinic says most goiters are painless, but an inflamed thyroid can be painful. MedlinePlus lists pain in the area of the thyroid |
| Your thyroid results | Each test name, the value, the range your lab printed, and the date of the draw | The ATA says thyroid function tests are likely the first step |
| A side photo of your neck | Same light, same angle, every few weeks, with the date | A practical habit rather than a medical guideline: a photo holds what memory blurs |
You don't have to keep that note on a scrap of paper. Osmi's daily check-in takes about a minute: you answer seven questions, or you speak with Rose, your thyroid mascot. Today's questions holds the seven: energy, sleep, stress, hair, digestion, resting pulse and your period, so a tight collar or a hoarse afternoon is one for Talk to Rose. It opens with one question, "How was today?", and you tell her in your own words. She files it on your dated record, the same record as your labs, cycle, and sleep. Missed days don't void anything. Osmi never diagnoses, treats, or prescribes.
What a goiter is
The ATA's definition is short: a goiter "simply refers to the abnormal enlargement of the thyroid gland." The ATA describes your thyroid as a butterfly-shaped gland normally located in the lower front of the neck, and MedlinePlus, from the US National Library of Medicine, places it "just above where your collarbones meet."
The Cleveland Clinic describes three types. In a simple, or diffuse, goiter the whole gland swells and feels smooth to the touch. In a nodular goiter, a solid or fluid-filled lump called a nodule forms within your thyroid. In a multinodular goiter, there are many nodules. It adds that a goiter "can be very small and barely noticeable", or it can grow large and cause symptoms by pressing on your airway or voice box. MedlinePlus says a simple goiter "is usually not a tumor or cancer."
There are two separate questions here: how big your thyroid is, and how much hormone it makes. The ATA says: "A goiter can occur in a gland that is producing too much hormone (hyperthyroidism), too little hormone (hypothyroidism), or the correct amount of hormone (euthyroidism)." MedlinePlus says the same from the Hashimoto's side: "Not everyone with thyroiditis or a goiter has low levels of thyroid hormone."
How Hashimoto's and a goiter are linked
The ATA says "Hashimoto’s thyroiditis is a more common cause of goiter formation in the US." Hashimoto's is autoimmune. The ATA's Hashimoto's page says thyroid antibodies "cause inflammation in your thyroid gland", and that over time the inflammation can make the gland bigger, or leave it with trouble making enough thyroid hormone.
The ATA's goiter page explains how the growth happens. As the gland is damaged, "The pituitary gland senses a low thyroid hormone level and secretes more TSH to stimulate the thyroid. This stimulation causes the thyroid to grow, which may produce a goiter."
NIDDK, part of the National Institutes of Health, describes what you might notice: "Your thyroid may get larger and cause the front of the neck to look swollen." It says the goiter may create a feeling of fullness in your throat, though it's usually not painful. MedlinePlus lists an enlarged neck or a goiter among the symptoms of Hashimoto disease, one "which may be the only early symptom". And it doesn't always stay that way: NIDDK says that after many years, or even decades, damage to the thyroid may cause the gland to shrink and the goiter to disappear.
Hashimoto's isn't the only cause on the lists. The ATA names Graves' disease and multinodular goiters among other common causes, and the Endocrine Society lists nodules. Working out which one applies to you is your doctor's job, and the Cleveland Clinic says so plainly: "A goiter is a sign that something is affecting your thyroid. They’ll need to figure out what the issue is."
If the Hashimoto's diagnosis itself is new, start with what to do when you've just been diagnosed with Hashimoto's.
The symptoms US bodies list
The Endocrine Society describes two kinds of symptoms, and it helps to keep them apart.
The first kind comes from the swelling itself. The Endocrine Society says: "You can have a goiter but have no symptoms at all, other than having some swelling at the lower part of your neck." Because of the swelling, the Endocrine Society says, some people also may have tightness in the throat, coughing, hoarseness, trouble swallowing or trouble breathing. MedlinePlus says pressure on the windpipe and the food tube happens "In rare cases", and the Cleveland Clinic says a goiter "doesn’t usually cause serious problems", though "A large goiter can make it hard to breathe, swallow or talk."
The second kind comes from how much hormone your thyroid is making. If a goiter is making your thyroid underactive or overactive, the Endocrine Society says you may also have a wide range of symptoms, "from fatigue and weight gain to involuntary weight loss, irritability, and sleep disorders." MedlinePlus says some people with a simple goiter may have symptoms of an underactive thyroid gland.
On pain, the bodies line up. NIDDK says the goiter in Hashimoto's is usually not painful. The Cleveland Clinic says "Most thyroid goiters are painless, but if you have an inflamed thyroid gland, it can be painful."
A list can't tell you which of these applies to you. A dated note shows your doctor what changed, and when.
The tests doctors use
It usually starts with an exam. The ATA says "the diagnosis of a goiter is usually made at the time of a physical examination when an enlargement of the thyroid is found." MedlinePlus describes the exam: "This involves feeling your neck as you swallow."
After that, the US bodies list these tests:
- Thyroid blood tests. The ATA says that as a first step, you'll likely have thyroid function tests to see whether your thyroid is underactive or overactive. MedlinePlus names free T4 and TSH.
- Antibody tests. The Cleveland Clinic and the Endocrine Society both list them, and the Endocrine Society names them for Hashimoto disease and Graves' disease. What TPO and Tg antibodies are, and what a positive result lets you ask, is in thyroid antibodies, explained.
- A thyroid ultrasound. The Cleveland Clinic says an ultrasound "helps your provider see your thyroid’s size and if it has nodules."
- A thyroid scan. The Cleveland Clinic lists a thyroid uptake and scan. The Endocrine Society notes that a scan with a radioactive substance is not safe if you're pregnant or breastfeeding.
- A biopsy. The ATA lists a fine needle aspiration biopsy. MedlinePlus says that if nodules are found on an ultrasound, a biopsy may be needed to check for thyroid cancer.
- A CT scan or MRI. The Cleveland Clinic says these are used if the goiter is very large or spreads into your chest. The Endocrine Society lists scans of the neck to check your windpipe.
Not every test on that list is for everyone, and the bodies frame it differently. For diagnosing Hashimoto's itself, MedlinePlus says: "Imaging studies and fine needle biopsy are generally not needed to diagnose Hashimoto thyroiditis." The ATA says an ultrasound "may or may not be needed." NIDDK says you may have one if your doctor suspects Hashimoto's but you don't have antithyroid antibodies in your blood. Which tests you need is your doctor's call, and asking why a test was ordered is a fair question.
When the results come back, Osmi's lab album keeps them. Photograph the paper, upload the PDF, or type one number. Osmi files every result with its unit, date, lab and printed range, and a re-draw stacks on the same card and shows what moved.
When to call your doctor
The US bodies agree on the first move. MedlinePlus: "Contact your provider if you experience any swelling in the front of your neck or any other symptoms of a goiter." The Endocrine Society: "If you notice a lump or swelling on your neck, schedule an appointment with your endocrinologist to evaluate your thyroid gland." The Cleveland Clinic says to talk to your healthcare provider if you notice new symptoms, and it adds: "If you notice a lump in the front of your neck, don’t ignore it or worry alone."
You're allowed to bring it up even if your last results came back in range. And once a goiter is found, the ATA says: "Whatever the cause, it is important to have regular (annual) monitoring when diagnosed with a goiter."
Questions to take with you
- What is causing my goiter? (This one comes straight from the Endocrine Society's list of questions for your provider.)
- Is my thyroid making too much hormone, too little, or the right amount?
- Which tests do I need, and what is each one for?
- Do I need an ultrasound?
- If you're pregnant or breastfeeding: is this scan safe for me?
- How often should we check my neck from here?
- What change should make me call before my next appointment?
- Can I have a copy of my results?
For the rest of what to bring, from your labs to the symptoms you keep forgetting to mention, see walk into your thyroid appointment with a real record. With Osmi's appointment sheet, you share your labs, trends, and daily record in one tap. It doesn't diagnose anything and it doesn't read your results for you.
A neck change is easy to date this week and hard to date next year. Write it down while it's happening.
Questions women ask about goiter with Hashimoto's
Can you have a goiter with normal thyroid levels? The ATA says a goiter can occur in a gland producing too much hormone, too little, or the correct amount. MedlinePlus says not everyone with thyroiditis or a goiter has low levels of thyroid hormone, and that you "may just need regular follow-up by your health care provider." Your doctor can tell you where your own levels sit.
Can a goiter go away? The Cleveland Clinic says some may shrink or go away depending on the cause, and says to talk to your healthcare provider about the chances in your case. MedlinePlus says "A simple goiter may disappear on its own, or may become larger." With Hashimoto's, NIDDK says that after many years, or even decades, the gland may shrink and the goiter disappear. None of them gives a timeline for you, so ask your doctor what to expect.
Is a goiter cancer? MedlinePlus says a simple goiter "is usually not a tumor or cancer." The ATA lists tumors, both cancerous and benign, among the less common causes of goiter, and the Cleveland Clinic says a biopsy can check for cancer. If it's on your mind, ask your doctor directly whether you need one.
Does a goiter hurt? NIDDK says the goiter in Hashimoto's is usually not painful, though it may create a feeling of fullness in your throat. The Cleveland Clinic says most thyroid goiters are painless, but an inflamed thyroid gland can be painful. MedlinePlus lists pain in the area of the thyroid among the rare pressure symptoms. Note any pain with the date and tell your doctor.
Do you need an ultrasound to diagnose Hashimoto's? MedlinePlus says imaging studies and fine needle biopsy are generally not needed to diagnose Hashimoto thyroiditis. The ATA says an ultrasound may or may not be needed, and NIDDK says you may have one if your doctor suspects Hashimoto's but you don't have antithyroid antibodies. To find a goiter's cause, the ATA, the Cleveland Clinic and the Endocrine Society all list ultrasound among the tests. Ask your doctor whether you need one.
Should I see a doctor about swelling in my neck? MedlinePlus says to contact your provider if you notice any swelling in the front of your neck or any other symptoms of a goiter. The Endocrine Society says to schedule an appointment with your endocrinologist if you notice a lump or swelling on your neck. The Cleveland Clinic says a provider can determine if it's a goiter and the underlying cause, and adds: "don’t ignore it or worry alone."
Educational, not medical advice.
