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Thyromegaly: Symptoms, Causes, Types, Treatment, Medication, and Prevention

Trained in dentistry, Sree is currently pursuing lab sciences. She loves researching and sharing information on various health topics.

Thyromegaly, also known as goiter, is the enlargement of the thyroid gland and it can cause series health complications.

Thyromegaly, also known as goiter, is the enlargement of the thyroid gland and it can cause series health complications.

The thyroid is one of the glands of the endocrine system that secretes hormones in the body. It has the shape of a butterfly and is located on the neck, specifically along the front of the windpipe. The thyroid gland produces the hormones diiodothyronine (T2), triiodothyronine (T3), and thyroxine (T4). These hormones affect the body’s basal metabolic rate, protein synthesis, blood flow rate, body temperature, fetal and child development, sexual function, sleep pattern, and thought patterns. It also produces the hormone calcitonin that is responsible for the regulation of blood calcium levels.

And, like any organ in the body, the thyroid experiences disorders that can cause havoc in the body. One of such disorders is thyromegaly or goiter, which is the enlargement of the thyroid gland.

Due to various causes, the gland develops soft tissues that lead to its enlargement, which is often a sign of a dysfunctional or diseased thyroid gland. With its role in various processes in the body, abnormal thyroid function can lead to abnormalities and diseases. For this reason, it is important to be aware of the symptoms, causes, treatment, prevention, and management of this disorder.

A Normal Thyroid

A healthy thyroid gland is around 4 to 6 centimeters in length and 1.3 to 1.8 centimeters in thickness. It should also weigh between 20 to 60 grams. It tends to be on the lower end of weight, length, and thickness range when one consumes optimal levels of iodine.

Aside from its physical characteristics, a healthy thyroid would produce the normal amount of thyroid hormones that the body needs to function properly. To determine these amounts, an individual would have to undergo the following tests, and their results should be within the given range:

The thyroid system

The thyroid system

Thyroid Medical Test Information


Thyroid-Stimulating Hormone (TSH) Test

TSH is a pituitary hormone that stimulates the production of thyroid hormones. The ideal range of this hormone is between 1 to 1.5 milli-international units per liter (mIU/L).

Free T3 and Free T4 Test

The normal amount for an individual ranges from 240 to 450 picograms per deciliter (pg/dL) for T3 and 0.9 to 1.8 nanograms per deciliter (ng/dL) for T4.

Thyroid Antibody Testing

This test determines whether the body has autoimmune reactions towards its own thyroid.

Basal Body Temperature

This is done by measuring the body’s temperature immediately upon waking up and while still lying down. The ideal temperature is around 37 degrees Celsius.

Thyrotropin-Releasing Hormone (TRH) Stimulation Test

The TRH is the hormone released by the hypothalamus to stimulate the release of TSH in the anterior pituitary gland. This is done by administering TRH into an individual and measuring the change in their TSH level. Depending on the result, it identifies the cause of thyroid abnormalities. If there’s an increase in TSH levels, it means the hypothalamus is not producing enough TRH. If there is no increase, it means the anterior pituitary gland is not producing enough TSH to stimulate the release of thyroid hormones.

Thyromegaly Symptoms

Whenever these levels are outside of what is normal, this would often mean a problem with one's thyroid gland or endocrine system. And, usually, abnormal results from these tests would indicate thyroid enlargement. However, more often than not, an enlarged thyroid won't be noticeable in its early stages. For this reason, a check-up from the doctor is recommended if one experiences some of the following symptoms: bad breath, dizziness, headache, nausea, voice quality changes, stiffness or tightness of the throat, breathing difficulties, difficulty swallowing, fever, or cough.

Causes of Thyromegaly

Insufficient Hormone Production

The enlargement of the thyroid is often due to the insufficient production of thyroid hormones. This could arise from a lack of iodine in one's diet, or a defect in an individual's genetics.

Iodine deficiency causes insufficient thyroid hormone production because the said nutrient is an essential component for its production. When there's not enough iodine, the body responds by having the pituitary gland release more thyroid-stimulating hormone (TSH) to increase thyroid hormone production. Unfortunately, increased levels of TSH also stimulate thyroid growth that results in its enlargement.

As for those caused by genetic defects, the insufficient production arises from a missing protein that permits the thyroid gland to produce hormones. This results to mutations in the gland that would eventually lead to the noticeable enlargement.

Thyromegaly induced by insufficient thyroid hormone production causes symptoms such as weakness, headache, decreased physical endurance, and heart discomfort. In more severe cases, an individual could feel a squeezing sensation in their neck, labored swallowing and breathing, asthma attacks, and dry cough. If left untreated, it could lead to heart enlargement and thyroiditis.


This is the inflammation of the thyroid gland. There are a variety of causes for an inflammation to occur. Each cause results in a different type of inflammation, which would also require a different approach for treatment. Here are the different types of thyroid inflammation:

  • Autoimmune thyroiditis: This is a chronic disease wherein the body identifies the hormones T3, T4, and TSH as harmful chemical compounds. This prompts the body's immune system to produce, at least, one of the three different antibodies that attack thyroid proteins. There are two categories of this disease: Hashimoto's thyroiditis and Graves' disease.
  • In Hashimoto's thyroiditis, the thyroid is slowly destroyed by auto-antibodies that mistake the thyroid hormones as threats. This causes the formation of a painless goiter and the development of hypothyroidism and thyroid lymphoma. Common symptoms of this disease include fatigue, joint and muscle pain, depression, slow heart rate, panic disorder, weight gain, and constipation.
  • In Graves' disease, the body sees thyroid-stimulating hormones (TSH) as threats and produces antibodies for it. This causes the gland to abnormally increase the production of thyroid hormones as the antibodies chronically stimulate TSH. This disease can increase the risk of birth defects, miscarriage, stroke, vision loss and defects, and bone mineral loss. In extreme cases, it can even lead to death. Its symptoms include increased heart rate, abnormal heart rhythm, and bulging eyes.
  • Postpartum thyroiditis: As the name implies, this is experienced by women following pregnancy. This is caused by the return of the immune system from its suppression during pregnancy. This rebound of the system causes a rapid increase in thyroid antibodies. Symptoms normally include heat intolerance, palpitations, nervousness, and irritability. This would initially lead to hyperthyroidism and, after three to twelve months of the postpartum period, would eventually lead to hypothyroidism. Treatment or intervention is usually not required as thyroid function would eventually normalize after one year of the postpartum phase. If it exceeds the one year mark, it is not considered as postpartum thyroiditis.
  • Subacute thyroiditis: This type of thyroid inflammation is caused by a viral infection. Symptoms include fever and tenderness of the thyroid. During the initial stage of the infection, the gland produces above the normal levels of thyroid hormones. This would be sometimes followed by a phase of low thyroid hormone production. Treatment is usually with high doses of corticosteroids or NSAIDS and healing takes a few months.
  • Acute Infectious thyroiditis: This disease is quite rare as the thyroid normally has a high resistance against infection. But, if certain bacteria, fungi, or parasite comes in contact with it, the left lobe of the gland can become infected and form abscesses. Most cases of this disease occur after an infection of the upper respiratory tract. Treatment is done through antibiotics and, in severe cases, surgical drainage.
  • Drug-Induced thyroiditis: Certain drugs can cause the thyroid gland to swell. These drugs are often those that contain amiodarone, a-interferon, cytokines, lithium, and any other substances that interfere with thyroid hormone release or cause thyroid gland damage. And, when these substances come into effect, the thyroid compensates for insufficient hormone production and results to the swelling of the gland. There's an increased risk for this disease among women and those with already existing and previous history of thyroid abnormalities. Problems associated with drug-induced thyroiditis include heart disease, miscarriage, infertility, pituitary tumors, and, in severe instances, myxedema coma. Aside from discontinuing the medication, this type of thyroiditis is managed by taking a thyroid hormone replacement like Levothyroxine.
  • Reidel's thyroiditis: This is a chronic inflammatory disease characterized by a replacement of functional thyroid tissues with a dense formation of excess fibrous connective tissue. This causes the thyroid, along with adjacent tissues around the neck, to have a woody and stone-hard texture. Treatment of Reidel's thyroiditis includes medication with prednisolone and Tamoxifen and surgical removal of the thyroid gland.
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Thyroid Tumor

Tumor formation in the thyroid gland is another cause of goiter. The tumor is usually benign, but there are cases when it is malignant. Most tumors are thyroid nodules that result from the abnormal growth of thyroid cells. These nodules could contain fluids collected from the bleeding of the fragile blood vessels in the tumors. This bleeding is what causes the sudden onset of pain and swelling. This pain and swelling eventually subside as the bleeding recedes.

Although a thyroid tumor is often benign, it is important to know the symptoms of a malignant tumor. These symptoms are:

  • Rapid enlargement and swelling within only a few weeks
  • Difficulty swallowing
  • New thyroid-associated pain
  • Shortness of breath
  • Coughing up blood

If an individual has any one of these symptoms with their thyromegaly, they have a high likelihood of having a malignant tumor in their thyroid.

  • Age: Old age can increase the risk of having thyromegaly. This is due to the aging thyroid gland having increased inter-follicular connective tissues. This decreases the amount of thyroid hormone the gland can store. Add the fact that TSH production also decreases in age; this results to the gland having hypothyroidism. This results in the swelling characterized in thyromegaly or goiter.
  • Pregnancy: In rare cases, pregnancy can cause the thyroid to develop thyromegaly. This is due to the hormone human chorionic gonadotropin. This causes the thyroid gland to enlarge slightly and to cause hormone imbalances, including the T3 and T4 thyroid hormones.
  • Diet: Cabbage, soybeans, peaches, peanuts, spinach, and rutabagas are abundant in goitrogen. This substance can interfere with the thyroid's ability to synthesize iodine into T3 and T4 hormones. A diet rich of these foods can lead to low thyroid hormone production, which could prompt thyromegaly due to increased TSH release. Take note that, for these food items to have this effect, one must frequently consume significant amounts of it. This type of swelling would eventually subside as the levels that obstruct hormone production decrease.

However, for individuals with thyroid problems, it is best to choose foods that contain smaller amounts of goitrogen. If you have to eat these vegetables, it is best to avoid eating it raw as cooking significantly reduces the goitrogen it contains. Consuming foods rich in iodine would help to counteract the negative effects of goitrogen-rich foods.

Types of Thyroid Enlargement

Thyroid enlargement can be medically classified in four ways: thyroid function, growth pattern, size, and cause. These classifications help in the identification of goiter by medical practitioners and researchers. This identification can help in diagnosing and treating one's condition.

According to Thyroid Function

In this classification, the thyromegaly will be assessed on how it affects the thyroid gland's functions. There are three states a thyroid gland can be in, and these are:

  1. Euthyroid: In this state, the swelling of the gland does not affect the functions of the thyroid. The thyroid with thyromegaly is producing the normal levels of thyroid hormones equivalent to that of a healthy gland.
  2. Hyperthyroidism: This is a state wherein the thyroid enlargement causes the thyroid to become overactive. This causes the thyroid to produce hormones more than the normal levels of a healthy gland. Symptoms of this condition include sudden weight-loss, rapid or irregular heartbeat, palpitations, increased appetite, anxiety, irritability, trembling extremities, sweating, change in menstrual patterns, more frequent bowel movements, muscle weakness, fatigue, difficulty sleeping, fine and brittle hair, and skin thinning. Long-term over-production of thyroid hormones can lead to congestive heart failure, atrial fibrillation, weak and brittle bones, eye problems, and vision loss. The worst that can happen when one has hyperthyroidism is thyrotoxic crisis, which is a life-threatening condition characterized by a high fever that can lead to heart failure.
  3. Hypothyroidism: In this state, the goiter is causing the thyroid gland to produce less than the normal amounts of thyroid hormones. This can cause an individual to experience increased sensitivity to cold temperatures, irregular bowel movement, depression, fatigue and shortness of breath, weight gain, hoarse voice, heavy menstruation, poor hearing, and numb or tickling sensation on the skin. In the long-term, this can cause delays in the intellectual and growth development of children, infertility, and miscarriage of pregnant women, increased LDL cholesterol, heart enlargement, and damage to peripheral nerves.