A 40 Year Old Woman Presents With A Painless Swelling In Her Neck

A 40 year old woman was brought to the doctor's office by her cousin for a swelling in her neck. The patient lives in a mountainous region of the country and has little or no medical facilities. She was in the city visiting her cousin when she was insisted to get a checkup for the swelling. The patient describes the swelling to appear gradually over the last few years and it is painless and is not causing any symptoms.
On further questioning she says that her diet mostly consists of vegetables and she never knows about iodized salt. She mentions many people in her village has similar swellings in the neck.
The swelling on her neck is shown in the picture below:

A diagnosis of goiter secondary to iodine deficiency was made.

Case Discussion:
Goiter is defined as a swelling in the neck due to enlargement of the thyroid gland.


Causes: There are a number of causes that can lead to enlargement of the thyroid gland some of them are discussed below:

1. Iodine deficiency: Iodine is essential for the production of thyroid hormones and is mostly found in seawater and in the soil of the coastal areas. Nowadays iodine deficiency is less common because of widely used iodized salt, but it is still a major cause of goiter in developing countries among the people who live in high elevation areas. The thyroid gland enlarges in an effort to obtain more iodine.

2. Grave's Disease: Thyroid gland can enlarge in conditions like Grave's disease in which the thyroid gland is overactive and producing increased thyroid hormone. In Grave's disease autoantibodies overstimulate the thyroid gland causing it to sell and enlarge.

3. Hashimoto's Disease: Goiter can alo result from an under active thyroid Hashimoto's disease is also an autoimmune disorder. When ever there is decreased thyroid hormone production , the pituitary gland secretes increased TSH, stimulating the gland resulting in gland enlargement.

4. Pregnancy: Sometimes during pregnacy due to increased body metabolism along with the effect of the hormone Beta HCG , the thyroid gland may enlarge slightly.

5. Thyroid Nodules: Sometimes a single or multiple nodules may develop in the thyroid gland which are usually benign in nature but can cause the thyroid gland to enlarge symmetrically or asymmetrically.

6. Inflammation: Any inflammatory condition of the thyroid gland can cause it to swell but in this case the swelling is usually painful.

7. Thyroid cancer: Although rare compared to benign thyroid nodules, cancer can also cause enlargement of the thyroid gland.