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A goiter (GOI-tur) is an abnormal enlargement of your thyroid gland. Your thyroid is a butterfly-shaped gland located at the base of your neck just below your Adam's apple. Although goiters are usually painless, a large goiter can cause a cough and make it difficult for you to swallow or breathe.

The most common cause of goiters worldwide is a lack of iodine in the diet. Treatment depends on the size of the goiter, your symptoms and the cause. Small goiters that aren't noticeable and don't cause problems usually don't need treatment.

Not all goiters cause signs and symptoms. When signs and symptoms do occur, they may include: a swelling at the base of your neck that may be particularly obvious when you shave or put on makeup, a tight feeling in your throat, coughing, hoarseness, difficulty swallowing, difficulty breathing.

Your thyroid gland produces two main hormones — thyroxine (T-4) and triiodothyronine (T-3). These hormones circulate in your bloodstream and help regulate your metabolism. They maintain the rate at which your body uses fats and carbohydrates, help control your body temperature, influence your heart rate, and help regulate the production of proteins.

Your thyroid gland also produces calcitonin — a hormone that helps regulate the amount of calcium in your blood. Your pituitary gland and hypothalamus control the rate at which T-4 and T-3 are produced and released. The hypothalamus — an area at the base of your brain that acts as a thermostat for your whole system — signals your pituitary gland to make a hormone known as thyroid-stimulating hormone (TSH). Your pituitary gland — also located at the base of your brain — releases a certain amount of TSH, depending on how much thyroxine and T-3 are in your blood. Your thyroid gland, in turn, regulates its production of hormones based on the amount of TSH it receives from the pituitary gland.

Having a goiter doesn't necessarily mean that your thyroid gland isn't working normally. Even when it's enlarged, your thyroid may produce normal amounts of hormones. It might also, however, produce too much or too little thyroxine and T-3.

Goiter treatment depends on the size of the goiter, your signs and symptoms, and the underlying cause. Your doctor may recommend:

• Observation. If your goiter is small and doesn't cause problems, and your thyroid is functioning normally, your doctor may suggest a wait-and-see approach.

• Medications. If you have hypothyroidism, thyroid hormone replacement with levothyroxine (Levoxyl, Synthroid, Tirosint) will resolve the symptoms of hypothyroidism as well as slow the release of thyroid-stimulating hormone from your pituitary gland, often decreasing the size of the goiter. For inflammation of your thyroid gland, your doctor may suggest aspirin or a corticosteroid medication to treat the inflammation. If you have a goiter that is associated with hyperthyroidism, you may need medications to normalize hormone levels.

• Surgery. Removing all or part of your thyroid gland (total or partial thyroidectomy) is an option if you have a large goiter that is uncomfortable or causes difficulty breathing or swallowing, or in some cases, if you have a nodular goiter causing hyperthyroidism. Surgery is also the treatment for thyroid cancer. You may need to take levothyroxine after surgery, depending on the amount of thyroid removed.

• Radioactive iodine. In some cases, radioactive iodine is used to treat an overactive thyroid gland. The radioactive iodine is taken orally and reaches your thyroid gland through your bloodstream, destroying thyroid cells. The treatment results in a diminished size of the goiter, but eventually may also cause an underactive thyroid gland.

If your goiter is caused by your diet, these suggestions can help:

• Get enough iodine. To ensure that you get enough iodine, use iodized salt or eat seafood or seaweed — sushi is a good source of seaweed — about twice a week. Shrimp and other shellfish are particularly high in iodine. If you live near the coast, locally grown fruits and vegetables are likely to contain some iodine, too, as are cow's milk and yogurt. Everyone needs about 150 micrograms of iodine a day (the amount in slightly less than half a teaspoon of iodized salt). But adequate amounts are especially important for pregnant and lactating women and for infants and children.

• Avoid excess iodine consumption. Although it's uncommon, getting too much iodine sometimes leads to a goiter. If excess iodine is a problem, avoid iodine-fortified salt, shellfish, seaweed and iodine supplements.

References:
https://www.mayoclinic.org/diseases-conditions/goiter/diagnosis-treatment/drc-20351834
Iodine deficiency. American Thyroid Association. http://www.thyroid.org/iodine-deficiency