Swollen & Enlarged Thyroid: What it Means & What Causes it

May 7, 2018

—

Dr. Westin Childs

in Thyroid

Does it feel like you have an enlarged thyroid?

Do you notice a bulge in your neck or does your neck appear thicker?

Have you felt your thyroid and noticed that it is “lumpy” or “inconsistent”?

Are you experiencing symptoms that make you think there is a problem with your thyroid?

If you answered yes to any of these questions then you may have an issue with your thyroid gland.

This post will teach you all that you need to know about an enlarged/swollen thyroid including what it means, how to diagnose it, your next steps, and more:

What is an Enlarged/Swollen Thyroid?

Let’s start with some thyroid basics:

Your thyroid is an endocrine (hormone) gland that sits at the base of your neck.

It produces some of the most important hormones known in the human body: T3 and T4 known as thyroid hormones.

Disorders, including anatomical changes to the thyroid, can cause serious problems in the body which often present with certain symptoms.

These symptoms range from minor fatigue to massive weight gain, hair loss, constipation, and so on.

For such an important little gland in your body, there are a lot of potential problems that can arise with its function.

One of these problems is an enlargement of the gland.

This enlargement is often termed a “goiter” or a “swollen thyroid” and it is incredibly common.

The problem with an enlarged thyroid is that it is a nonspecific term that is simply used to describe the shape and size of the thyroid gland (1).

Knowing that your thyroid is enlarged or swollen doesn’t necessarily say anything about the function of your gland (which is perhaps one of the most important aspects of your thyroid).

We will talk about how to properly assess if your gland is functioning properly in the testing section below, but for now, let’s discuss the potential causes of an enlarged thyroid.

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Causes of an Enlarged Thyroid

Knowing that your thyroid is enlarged is not a diagnosis by itself.

It’s more helpful to think of an enlarged thyroid gland as an observation or as a description of what is happening.

This is because there are actually many different conditions that result in thyroid gland enlargement.

These conditions range from infections, inflammation of the gland, nutrient deficiencies, cancer, and even autoimmune disease.

An important part of treating an enlarged thyroid gland is correctly identifying and diagnosing what is happening.

This important step can be done through blood testing and imaging (discussed below).

The range of medical conditions which can cause thyroid gland enlargement include:

Thyroid nodules and thyroid cysts (VERY common with up to 4-10% of the entire population who has one of these)
Thyroiditis caused by inflammation, infection, or autoimmune disease
Thyroid cancer or other cancers
Hashimoto’s thyroiditis (2) (autoimmune disease)
Iodine deficiency (3) (results in diffuse enlargement of the entire gland)

These diseases can be differentiated based on how they present (your symptoms), how they affect the size of your thyroid gland (diffuse enlargement or isolated enlargement), how they look on ultrasound imaging, and how they affect thyroid hormone production.

Enlarged Thyroid vs Painful Thyroid

It’s important to differentiate between an enlarged thyroid gland and a painful thyroid gland.

This one single symptom is unique to very few conditions and can easily help you figure out a diagnosis.

Your thyroid gland is an organ that is susceptible to inflammation and infection, just like other parts of your body.

This condition occurs very rarely, however, because for the most part your thyroid is protected from the rest of your body.

Infections such as viral and bacterial bugs can result in a condition known as subacute thyroiditis (4).

This is one of the very few conditions that cause pain in the thyroid gland when touched.

Subacute thyroiditis can also result in an enlargement of the thyroid gland but it’s almost always associated with pain.

This pain is important because it can easily help differentiate other, more serious, conditions which cause an enlargement of your thyroid gland.

Does an Enlarged Thyroid Cause Symptoms?

Anatomical changes to your thyroid, such as changes to the size or shape of your thyroid, are most often found incidentally.

Patients are often quite surprised that they even have a thyroid issue until they are notified by their physician during a routine exam.

Problems that cause changes in the shape and size of the thyroid usually do NOT cause problems with the production of thyroid hormone.

This is important because the symptoms associated with dysregulated thyroid hormone production are often profound and easy to identify.

Instead, disorders of the shape and size usually are asymptomatic.

What this means is that they do NOT cause any symptoms.

Now, this isn’t true for all disorders because there are always exceptions.

One such exception is if the size of your thyroid grows to a size large enough to cause local anatomical issues (5).

These issues might present as problems swallowing, changes to your vocal cords or a change in your voice, or a bulge that is noticeable in your neck.

Occasionally, if your enlarged thyroid is due to swelling or inflammation, then you might also experience pain when touching your neck.

Some conditions which result in an enlargement of your thyroid gland are reversible and may go away on their own (such as some causes of Thyroiditis) while others may persist and cause permanent thyroid damage (such as Hashimoto’s thyroiditis).

Hopefully, you’re beginning to understand that in order to really understand what is happening with your thyroid gland you will need further evaluation.

Imaging and Evaluating Your Thyroid

One of the best ways to look at your thyroid gland is by imaging it or looking at it via ultrasound (6).

Ultrasound is a nearly painless procedure that allows radiologists to look at the size, shape, texture, and other characteristics of your thyroid gland.

Because the thyroid gland is near to the surface of your skin it can easily (usually) be assessed with this type of imaging.

The good news about ultrasound testing is that it is NOT associated with radiation exposure and is therefore considered to be very safe (7) (perhaps the safest of all imaging methods).

Doctors are often taught that the only way to hurt someone with ultrasound is by throwing the machine at them.

Ultrasound is very important if you have an enlarged thyroid because it can further help to diagnose what exactly you are dealing with.

For instance:

If you have a single large thyroid nodule, an ultrasound can pick up that nodule and give information regarding the size, shape, and consistency of the nodule.

This information can help to determine if the nodule is benign (about 97% of all nodules are benign and harmless (8)) or potentially cancerous (around 3% of nodules may be cancerous) and also help determine if you need a biopsy.

Other conditions that cause thyroid enlargement may be consistent and make your thyroid look “irregularly inconsistent” throughout the entire gland.

Conditions that cause this type of pattern tend to result in inflammation of the entire gland or may be caused by nutrient deficiencies such as iodine deficiency.

In addition to ultrasound testing, there are other ways to check your thyroid gland such as uptake tests or CT scans (computed tomography).

These tests usually come after ultrasound testing and your doctor can help you determine if you need them.

Lab testing for Your Thyroid

Looking at your thyroid gland via imaging doesn’t usually give you any information about the FUNCTION of the thyroid gland.

The function of your thyroid gland is very important because it relates to how well your thyroid is able to produce thyroid hormone.

Any change to the ability of your gland to produce thyroid hormone will result in very specific symptoms that are too big to be ignored and these symptoms will often drive people into the Doctors office for evaluation.

Fortunately, many conditions that result in thyroid gland enlargement (such as thyroid nodules) usually do not interfere with thyroid hormone production.

Some conditions, such as Hashimoto’s thyroiditis, cause both thyroid gland enlargement AND thyroid hormone issues.

Because of this, each and every patient with a known or suspected thyroid gland issue should undergo thyroid function testing with blood tests.

To test your thyroid function you will need the following tests:

TSH (Thyroid Stimulating Hormone) (9) – This will help you understand if your brain is talking to your thyroid gland.
Free T3 (10) – This is the most important thyroid hormone in your body and is responsible for the majority of thyroid cellular activity.
Free T4 (11) – This is the most abundant thyroid hormone in your body and is important because it acts as a reservoir for T3 thyroid hormone.
Thyroid Antibodies – The presence or absence of thyroid antibodies can help you understand if you have an autoimmune disease or if your body is attacking your own thyroid gland.

These lab tests represent the most basic tests necessary to evaluate your thyroid but they are NOT the only lab tests you can use.

You can find a complete list of lab tests that can be used to assess your thyroid function here.

Your Next Steps + Treating your Thyroid

If you suspect (or know) that you have an enlarged or swollen thyroid gland then you may be wondering what are you supposed to do next.

The world of thyroid management can be difficult to navigate, but I’ve created a list of steps below that you can check off to ensure that you are on the right track.

Following this list will help you with proper diagnosis and treatment (if necessary).

[Always necessary] Get a full physical exam and history from your physician (12). This will include feeling your thyroid gland in your neck and asking about any other symptoms you may be dealing with.
[Always necessary] If your thyroid is enlarged then your next step is to get ultrasound imaging (13). Ultrasound will help determine if you need a biopsy or if you can simply monitor your thyroid gland every few months.
[Not always necessary] If necessary get a biopsy via FNA (14).
[Not always necessary] If necessary get thyroid blood tests (see above).
[Always necessary] Obtain a diagnosis as to what is CAUSING your enlarged or swollen thyroid. You need to NAME the issue you are dealing with. Potential diagnoses include Hashimoto’s thyroiditis, thyroid cancer, thyroid nodule, thyroid cyst, thyroiditis, etc.
[Do no matter what] Ensure that you are eating a healthy diet that is high in fruits and vegetables but also low in processed and refined foods.
[Do no matter what] Ensure that you are not deficient in any critical thyroid nutrients (such as Iodine). If necessary you may need to use supplementation to optimize these levels.

Final Thoughts

Your thyroid gland is a very important hormone-secreting organ in your body.

Because of its importance, you should always evaluate any suspected problems of this gland including enlargement.

Testing your thyroid can be done easily with blood tests and ultrasound testing.

These basic tests can give you a solid starting point and help point you in the right direction.

Remember:

Many causes of an enlarged thyroid do not necessarily require treatment, but some may cause permanent damage if not identified and treated.

Now I want to hear from you:

Are you having issues with your thyroid gland?

Is your thyroid gland enlarged or swollen?

Are you also experiencing symptoms?

Have you been assessed by a Doctor yet? Do you have a diagnosis?

Leave your comments below!

Scientific References

#1. https://www.ncbi.nlm.nih.gov/pubmed/23145396

#2. https://academic.oup.com/jcem/article/94/3/833/2596420

#3. https://www.ncbi.nlm.nih.gov/pubmed/25591468

#4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2571803/

#5. https://www.ncbi.nlm.nih.gov/pubmed/16079218

#6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3683194/

#7. https://www.ncbi.nlm.nih.gov/pubmed/21866043

#8. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3575959/

#9. https://www.ncbi.nlm.nih.gov/books/NBK249/

#10. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4699302/

#11. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4274666/

#12. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2379312/

#13. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4322035/

#14. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC121968/

Signs and Symptoms

Comments

29 responses to “Swollen & Enlarged Thyroid: What it Means & What Causes it”

Kiesha Renee Trahan

May 8, 2018

Hi, I am a 41 yr caucasian female. I was diagnosed with hypothyroidism in 2008 during 2 back to back pregnancies. I was put on levothyroxine 75mcg. I had a small nodule on ultrasound. Fast forward to 2018. Over the past 10 years increasing fatigue, unexplained joint pain, shoulder (?frozen shoulder),? TMJ, painful finger joints. Recently facial pain with shooting nerve pain, chronic ear and face pain, weight gain at now is 200. Sciatic back pain and extreme fatigue to the point of dr. Suggesting narcolepsy dx and being prescribed Provigil. Labs show Tsh at 4.9, platelet count at 499. Vit d deficiency, thyroid ultrasound shows inflammation of the thyroid, multiple nodules in r lobe. Ultrasound tech comment difficult to scan and heterogeneous appearance. Family dr increased levothyroxine to 88mcg and referral to an endocrinologist. Any advice on how to improve things on my own.?
I am an RRT, POLYSOMNOGRAPHER AND ULTRASOUND TECH. Desperately seeking help!!

Reply
1. Westin Childs
  
  May 9, 2018
  
  Hi Kiesha,
  
  Sorry to hear about your struggle! One way to potentially improve thyroid function is through the use of certain supplements (usually alongside lifestyle changes). You can read more about this idea here: https://restartmed.stagemarketingdemo.com/thyroid-support/
  
  Reply
Voula

May 9, 2018

Hello Dr. Child’s. I did a vitamin d3 on September it was 44 iu, told extremely low and was put at 1000 iu a day, checked it after 8 months went to 55 iu, doctor put me on 2000 iu and want to check my levels after 3 months. He doesn’t know why my body is not absorbing vitamin d3. My thyroid is normal, did ultrasound in Greece, slightly enlarged, was told that I might have Hashimotos thyroiditis. The doctor also want to check iron, magnesium, calcium. He thinks I might have celiac disease, but is not necessary to check it, wants to see me after 3 months. I also have hormone issues, low testosterone and high bioavailable testosterone and my body produces lots of hair.
Let me know what you think is the cause of my vitamin d3 deficiency and why my body is not absorbing vitamin d3. Thanks. I am otherwise healthy female 34 years old.
Thanks for your blogs, Voula

Reply
Maria

March 15, 2019

24-year-old athlete- good health- in the last 5 months having symptoms of a swollen neck -burning -chills- fatigue. went to the Doctor- all blood work was normal- Cat scan- normal -ultrasound normal- The final diagnosis- my Thyroid is enlarged but it’s functioning properly. But because I am having symptoms the only solution given to me is to take out my Thyroid.- I say no and want to weigh out my options. I have an appointment with the Endocrinologist and will get more information. Your thoughts.

Reply
1. Westin Childs
  
  March 19, 2019
  
  Hi Maria,
  
  Removing your thyroid should be your last option because it’s possible that you may not be a high-level athlete afterward.
  
  Reply
Isabelle Samson

May 29, 2019

I have been done in some lab test like, Xray, ECG and Ultrasound, and their impression is I have Enlarged Thyroid gland with a nodule on the left…but I have not yet met my doctor for some diagnoses on how I cure my disease…Please give some advice..regarding my illness…Thank you so much…Godbless!

Reply
Gladys

July 4, 2019

I have been diagnosed with an enlarged thyroid with nodules in an area where I previously had cancer in 1990. My right parotid gland was removed. I started feeling a radiating in the area, like electricity running through it. Currently, I am awaiting a biopsy, scheduled August 21, four months after diagnosis. In the meantime I am experiencing all the symptoms of thyroid problems with intense pain when area is stressed by movement or pressure, resulting in difficulty using my right hand and arm. Trying not to become overanxious and to learn and do what I can to improve my thyroid while waiting on the doctors to make their next move.

Reply
Chelsea

September 4, 2019

Hi, I have been on levo for at least 5 years now. One thing I was wondering, almost every doctor I’ve seen for various things comments on my thyroid looking enlarged and suggests I get an ultrasound. Even friends sometimes comment on my pictures (who also have thyroid issues) and point it out, but every time I get a scan (which I have at least 4 times) they say it’s normal. Why do people keep pointing it out but then the test shows normal? Could it be fluctuating? Thanks!

Reply
Brenda Theobald

October 29, 2019

I have an enlarged thyroid and I am having it out because the doctor says I am past the stage of any medication helping. My question is there a good chance they will find cancer? I do not have pain, but they found mine because the swelling has caused my airway is getting narrow between my windpipe and thyroid and I am wheezing and I am also starting to have problems with taking pills.

Reply
Herman L Coulter

November 25, 2019

I have a enlarged thyroid gland it eight inches at the right side of my neck and four inches on the left side I will be surgery on the right side of my neck but I am afraid because it is near my vocal chords.

Reply
Susan Bonnet

July 13, 2020

I have an enlarged thyroid with a nodule. This right side is 7cm with a 2 cm nodule. This was all found by ultra sound. They did a needle biopsies and found abnormal follicular cells but were unsure of exactly what type they were for sure at our local hospital. They sent the slide to the Mayo Clinic and they could not determine what they were. I then was sent to a surgeon to have one side of my thyroid removed and possibly both sides removed depending on what they find. the surgery is this week. My voice is changing and it is pressing on my throat making it difficult to swallow at times. I have been on levothyroxine for about 20 yrs now. Is there something I could of some to of prevented my current situation?

Reply
Rushel

August 15, 2020

Hi Dr
My name is rushel livan
I live in Guyana and I have an enlarged thyroid on my right side. I already did a by biopsy it not cancer but they say I have low active thyroid. Can u help me with some home remedies cause i am taking levothyroxine one a day 50g

Reply
Annette

February 1, 2021

I have enlarged thyroid. Please what test preliminary to decide I have a problem. Please list all. F3 f4?

Reply
V

June 12, 2021

My name is Wayne and I’ve got 2 nodules dx by CT scan. Referral made to see a endocrinologist I’m assuming labs were ok because md said was not concerned. No bx as of yet but always have dry mouth & sore throat. Am 75 and was wondering if by chance could be cancer. I have recently had vascular surgery aortic arch graft placement due to stenosis & aneurysm and have had to set this problem aside for a while as I’m still healing. Wondering what could be done once I can start addressing this problem or could it be something else? Thanks

Reply
Ben

April 29, 2022

Hi, I’ve got an enlarged thyroid and I’ve been suffering with anxiety episodes, could they be related ?

Reply
1. Dr. Westin Childs
  
  May 2, 2022
  
  Hi Ben,
  
  It could be, yes, but anxiety can also be caused by many other things.
  
  Reply
Sue Dickens

May 3, 2022

Hi my name is Sue. I have been diagnosed with enlarged thyroid. Doctor said Ultrasound is next. I’m really nervous since cancer runs in my family. Thank you so much for all the information.

Reply
1. Dr. Westin Childs
  
  May 3, 2022
  
  Hi Sue,
  
  No need to get worried until you have something to worry about! Just wait and see what the ultrasound says. Most of the time, thyroid enlargement is not due to thyroid cancer.
  
  Reply
Joni

June 4, 2022

I have been dx with Hashimoto’s since 1986. I am taking Levothyroxine 137mcg, and Liothyronine 5mcg. My lab levels have been normal, but because of my symptoms including weight gain, psych diagnoses, neuropathy, I asked my doctor to do an antibody test, which was elevated. In January my new endocrinologist added the liothyronine. Two days ago, I went for my routine checkup, and my neck was large. My endocrinologist did an ultrasound and said that the entire gland was black on sonogram, with one white knight. He said I have a grossly enlarged, angry thyroid. He told me that the Hashimoto’s has taken over my entire thyroid and told me that if I begin having trouble swallowing or breathing, they can remove the thyroid. I am having swallowing issues. Is there anything else I can do besides removing it?

Reply
1. Dr. Westin Childs
  
  June 7, 2022
  
  Hi Joni,
  
  Yes! You should do whatever you can to treat it naturally to try and prevent thyroid removal. Almost everyone who gets their thyroid removed wishes that they didn’t: https://restartmed.stagemarketingdemo.com/natural-remedies-for-hashimotos-thyroiditis/
  
  Reply
Elizabeth

October 21, 2022

Hi, I just had a thyroid ultrasound yesterday. They said they found no nodules. I had an ultrasound 10 years ago and they said I had an enlarged thyroid. My new dimensions are Right lobe: 6.0 x 2.1 x 2.0 cm and Left lobe: 4.9 x 1.7 x 1.4 cm. Do those numbers mean I still have an enlarged thyroid? Thank you for your help!

Reply
1. Dr. Westin Childs
  
  October 21, 2022
  
  Hi Elizabeth,
  
  If the thyroid gland size was abnormal then the radiologist would have mentioned it in the assessment portion of your ultrasound.
  
  Reply
Catherine M Kuntz

November 15, 2022

Hi I am a 63 year old woman, I just had a physical and the Dr. noticed an enlarged thyroid. My last labs a few years ago were normal. I researched symptoms of an enlarged thyroid and I do have all most all of them. I am chokeing on drinks and food quite often. I also have gained 20 pounds, don’t sleep well and have some memory issues. My question is if my blood work comes back fine is it still possible I have an issue. Also what is the treatment if my hormones are fine but I still have the issue of chokeing. I also have rapid heartbeat and difficulty breathing.

Reply
1. Dr. Westin Childs
  
  November 16, 2022
  
  Hi Catherine,
  
  Yes, please see this article which outlines the difference between optimal and normal thyroid lab tests: https://restartmed.stagemarketingdemo.com/normal-thyroid-levels/
  
  Reply
Dawn Cox

April 25, 2023

My thyroid is swollen! Saw my Primary who ordered blood work & ultrasound. Told thyroid levels were in normal range but did not include all necessary ones. Ultrasound revealed Hashimoto’s Thyroiditis. My Mom has Hypothyroidism & I am experiencing most of the symptoms besides the swollen Thyroid. I’m going strict on my diet, Dairy free, Gluten-free, sugar free or very little and also taking supplements: Liquid Turmeric, liquid B-complex, zinc, D3, vitamin C! What else can I do, especially to get the swelling down? It’s uncomfortable! Need to get it down before a surgery I’m having soon!

Reply
Marcus Robert

July 14, 2023

Hey Dr. I am a 27 year old male who is very active with zero allergies to any medication. No drug use and I am very healthy. I have had no thyroid swelling or issues prior. After sleeping in high air conditioning one night on my back (which I sleep stomach down) my girlfriend said I was snoring. The next day my neck was sore. By the evening my left thyroid was swollen and sore to the touch. No other symptoms other than the swollen thyroid, trouble swallowing, and soreness up my neck to my ear. It has been about a week and its staying the same. Any ideas? I really need some insight! Thank you!

Reply
Fran Genis

October 27, 2023

Dear Dr. Childs,
A friend of mine (59 yr old, non-smoker) has had an very swollen thyreiod on the right side of his neck for a couple of months now. Bloodwork was normal, so was biopsy.
He has lost weight (but cycles a lot now) and his left hand trembles a couple of times a day. Other than that, he feels OK.
What could help him? Iodine maybe?
Thanks!!!!

Reply
Judy Keller

November 12, 2024

My thyroid appears swollen on the outside, but the ultrasound is clean, and I’m told it is within normal range. The initial tests have come back within normal range. I’m waiting now for the autoimmune tests. If my thyroid is in normal range, why does it appear to be swollen on the outside. My voice is being affected, as well as, my breathing and swallowing. I don’t know what to think.

Reply
1. Dr. Westin Childs
  
  November 12, 2024
  
  Hi Judy,
  
  You may have something going on behind your thyroid that is pushing your thyroid outward. If your ultrasound showed there wasn’t swelling then that’s a good indicator that the problem is not with your thyroid but some other structure in your neck.
  
  Reply