Goiter is an enlargement of your thyroid gland \u2014 a small, butterfly-shaped gland
weighing less than an ounce, located just below your Adam's apple. Hormones
produced by your thyroid gland regulate all aspects of your metabolism, from the rate
at which your heart beats to the speed at which you burn calories.

The possible causes are numerous. In the past, the most common cause of goiter was a
shortage of iodine in the diet in areas where the soil was deficient in iodine. Without
enough dietary iodine, your thyroid can't make and release enough of the two
essential iodine-containing hormones. Goiter became rare in the United States after
iodized salt was introduced. In some parts of the world, however, goiter is still
common because of iodine deficiency.

Normally, your thyroid gland produces two main hormones \u2014 thyroxine 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 \u2014 a
hormone that regulates the amount of calcium in your blood.

Your pituitary gland and hypothalamus control the rate at which these hormones are produced and released. The process begins when the hypothalamus \u2014 an area at the base of your brain that acts as a thermostat for your whole system \u2014 signals your pituitary gland to make a hormone known as thyroid-stimulating hormone (TSH). Your pituitary gland \u2014 also located at the base of your brain \u2014 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.

Enlargement of the gland can be uniform (diffuse goiter), or the gland may be
enlarged due to one or more nodules (nodular goiter). Nodules are lumps within an
otherwise normal thyroid gland.

One cause of goiter is iodine deficiency. In this situation, your thyroid can't make and release enough thyroxine and T-3 \u2014 both of which contain iodine \u2014 and it enlarges in response to excess stimulation from the pituitary.

cause of an overactive thyroid (hyperthyroidism). In Graves' disease,
antibodies produced by your immune system stimulate the thyroid to produce
too much thyroxine. Normally, your immune system uses antibodies to help
protect against viruses, bacteria and other foreign substances that invade the
body. In Graves' disease, antibodies mistakenly attack your thyroid gland and
occasionally the tissue behind your eyes and the skin of your lower legs. The
overstimulation of your thyroid in Graves' disease results in uniform and
nonpainful swelling of the gland.

thyroiditis, is a common cause of an underactive thyroid (hypothyroidism).
Hashimoto's disease also is an autoimmune disorder and causes inflammation,
which impairs your thyroid's ability to produce hormones. Then, your pituitary
gland attempts to stimulate your thyroid gland to produce more thyroid
hormones, causing your thyroid gland to enlarge.

Various types of thyroiditis can result in an enlargement of your thyroid gland.
Some may cause thyroid pain, often aggravated by swallowing or pressure.
Some types of thyroiditis are associated with hyperthyroidism, while others
are associated with hypothyroidism.

If you have had persistent widespread swelling of the front of your neck, above and
between your collarbones, your thyroid gland may be enlarged. See your doctor, who
can determine whether your thyroid is causing your neck to be swollen and what the
reason might be.

Goiter may cause your neck to appear swollen. By examining your neck, your doctor can determine the degree of gland enlargement and the areas of tenderness. In some cases, your doctor may be able to feel the presence of nodules.

by your thyroid and pituitary glands. If your thyroid is underactive, the level
of thyroid hormone will be low. At the same time, the level of thyroid-
stimulating hormone (TSH) will be elevated because your pituitary gland tries
to stimulate your thyroid gland to produce more thyroid hormone. Goiter
associated with an overactive thyroid usually involves a high level of thyroid
hormone in the blood and a lower than normal TSH level.

Sound waves bounce through your neck and back, forming images on a
computer screen. The images reveal the size of your thyroid gland and
whether the gland contains nodules that your doctor may not have been able to