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[Conditions](https://durgical.com/en/conditions/) · [Head and neck](https://durgical.com/en/anatomy/region/head-and-neck/)

# Goitre

A goitre is an enlarged [thyroid gland](https://durgical.com/en/anatomy/thyroid-gland/), seen as swelling at the front of the neck; thyroid function can be normal, low or high.

Updated 2026-10-29

## Structures involved

Tap one to see what it is and open it in 3D.

- [Thyroid gland](https://durgical.com/en/anatomy/thyroid-gland/)
- [Trachea](https://durgical.com/en/anatomy/trachea/)
- [Esophagus](https://durgical.com/en/anatomy/esophagus-abdominal-part/)
- [Recurrent laryngeal nerves](https://durgical.com/en/anatomy/recurrent-laryngeal-nerve/)
- [Sternothyroid](https://durgical.com/en/anatomy/sternothyroid-muscle/)
- [Manubrium](https://durgical.com/en/anatomy/manubrium-of-sternum/)
- [Pituitary gland](https://durgical.com/en/anatomy/pituitary-gland/)

## In biochemistry

- [Thyroid hormone synthesis: Step 4 · Thyroid peroxidase (organification)](https://durgical.com/en/biochemistry/pathways/thyroid-hormone-synthesis/#paso-4)
- [Thyroid peroxidase (TPO)](https://durgical.com/en/biochemistry/enzymes/thyroid-peroxidase/)
- [Thyroxine (T4)](https://durgical.com/en/biochemistry/molecules/thyroxine/)
- [Iodine](https://durgical.com/en/biochemistry/topics/iodine/)

## In embryology

- [Thyroid gland: from the foramen cecum to the neck](https://durgical.com/en/embryology/thyroid-gland-from-the-foramen-cecum-to-the-neck/)
- [Lithium and Ebstein anomaly](https://durgical.com/en/embryology/lithium-and-ebstein-anomaly/)

## In the clinical exam

- [Thyroid examination](https://durgical.com/en/clinical-exam/thyroid-examination/)
- [Hyperthyroidism and hypothyroidism: the signs](https://durgical.com/en/clinical-exam/hyperthyroidism-and-hypothyroidism-the-signs/)

## In physiology

- [Actions of thyroid hormones](https://durgical.com/en/physiology/actions-of-thyroid-hormones/)
- [Vitamins and minerals: a physiological overview](https://durgical.com/en/physiology/vitamins-and-minerals-a-physiological-overview/)

## Why it happens

- [Hyperplasia: physiologic and pathologic](https://durgical.com/en/general-pathology/hyperplasia-physiologic-and-pathologic/)
- [The thyroid axis: reading TSH and free T4](https://durgical.com/en/physiology/the-thyroid-axis-reading-tsh-and-free-t4/)
- [Thyroid follicles, C cells and parathyroid](https://durgical.com/en/histology/thyroid-follicles-c-cells-and-parathyroid/)

## What it is

Enlargement of the thyroid gland, diffuse or nodular, which may occur with normal, low or high thyroid function.

## Who gets it

Endemic goitre from iodine deficiency was once common in parts of the Andean region; salt iodisation programmes in Colombia and Latin America have greatly reduced it. Nodular goitre is frequent in older women.

## Causes

- Iodine deficiency (endemic goitre)
- Graves disease and Hashimoto thyroiditis
- Multinodular goitre
- Goitrogens and some medicines (lithium, amiodarone)
- Thyroid tumours and rare inborn errors of hormone synthesis

## Risk factors

- Low iodine intake
- Female sex and older age
- Pregnancy
- Family history
- Smoking

## Pathophysiology

When the gland cannot make enough hormone, the pituitary raises TSH, which stimulates thyroid growth. In Graves disease, antibodies act on the TSH receptor; in Hashimoto thyroiditis, lymphocytic infiltration enlarges the gland. Over time, uneven growth of follicles creates multiple nodules, some of which become autonomous.

## Classification

- Diffuse versus nodular (single or multinodular)
- Toxic versus non-toxic
- Endemic versus sporadic
- Substernal (retrosternal) goitre
- WHO grading by size on palpation and inspection

## Symptoms and signs

- Visible or palpable neck swelling that moves on swallowing
- Pressure in the neck, dysphagia or cough
- Breathlessness or stridor with large or substernal goitre
- Symptoms of hypo- or hyperthyroidism

## Red flags

- Stridor or positional breathlessness (tracheal compression)
- Rapid growth, hardness or hoarseness (consider cancer)
- Facial plethora on raising both arms (Pemberton sign) from a substernal goitre

## Diagnosis

**Clinical**
Inspection and palpation of the thyroid, assessment of tracheal deviation and Pemberton sign.

**Tests**
TSH and free T4; thyroid antibodies (TPO, TSH receptor); fine-needle aspiration of suspicious nodules.

**Imaging**
Neck ultrasound; CT for substernal extension and airway compression; scintigraphy in toxic goitre.

## Differential diagnosis

- Thyroid nodule or cancer
- Thyroiditis
- Thyroglossal duct cyst
- Cervical lymphadenopathy
- Pharyngeal pouch

## Goal of treatment

Correct thyroid dysfunction, relieve compression and exclude malignancy.

## Treatment

**Medical**
Iodine supplementation in deficiency; thyroid hormone for hypothyroidism; antithyroid drugs for toxic goitre.

**Medical**
Radioactive iodine to shrink toxic or some non-toxic goitres.

**Surgical**
Thyroidectomy for compression, suspected cancer, cosmetic concern or failure of other treatments.

**Follow-up**
Ultrasound and clinical follow-up for small asymptomatic goitres.

## Drugs for this condition

- [Methimazole](https://durgical.com/en/pharmacology/methimazole/)
- [Propylthiouracil](https://durgical.com/en/pharmacology/propylthiouracil/)

## Complications

- Tracheal or oesophageal compression
- Hyperthyroidism (toxic multinodular goitre)
- [Recurrent laryngeal nerve](https://durgical.com/en/anatomy/recurrent-laryngeal-nerve/) palsy
- Complications of surgery (hypoparathyroidism, nerve injury)

## Prognosis

Usually good. Many goitres are stable for years; treatment relieves compressive and hormonal symptoms.

## Prevention

- Iodised salt and adequate iodine intake, especially in pregnancy

## Test yourself

Think of the answer, then tap the question to see it.

## What is the most common cause of goitre worldwide?

Iodine deficiency.

## What is Pemberton sign?

Facial congestion and distress on raising both arms, from a substernal goitre compressing the thoracic inlet.

## Why does iodine deficiency enlarge the thyroid?

Low hormone output raises TSH, which stimulates thyroid growth.

## Which public health measure has reduced endemic goitre in Latin America?

Universal salt iodisation.

[Add to my cards (4)](https://durgical.app/estudiar/?add=/en/conditions/goitre/)

## Related conditions

- [Hypothyroidism](https://durgical.com/en/conditions/hypothyroidism/)
- [Graves disease (hyperthyroidism)](https://durgical.com/en/conditions/graves-disease/)
- [Thyroid nodule](https://durgical.com/en/conditions/thyroid-nodule/)
- [Thyroid cancer (papillary)](https://durgical.com/en/conditions/thyroid-cancer/)
- [Cervical lymphadenopathy](https://durgical.com/en/conditions/cervical-lymphadenopathy/)

Educational information, not medical advice. For any symptom, see a health professional.

Sources: [Goiter](https://www.ncbi.nlm.nih.gov/books/NBK562161/) (StatPearls (NCBI Bookshelf), 2023).

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Representative model, for educational purposes only.

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Source: https://durgical.com/en/conditions/goitre/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/conditions/goitre/