Symptoms of Goiter
Patients with goiter can experience a range of symptoms including dyspnea, orthopnea, obstructive sleep apnea, dysphagia, and dysphonia due to compression of surrounding structures such as the trachea and esophagus. 1, 2
Common Symptoms
Respiratory Symptoms
- Dyspnea (difficulty breathing), especially when lying flat 1, 2
- Orthopnea (shortness of breath when lying down) 1, 2
- Obstructive sleep apnea 1, 2
- Stridor (high-pitched wheezing sound) 1
- Coughing 3
Swallowing and Voice Symptoms
- Dysphagia (difficulty swallowing) 1, 2, 3
- Dysphonia (voice changes) 4, 5
- Hoarseness, which may occur due to nerve injury in some cases 4
- Throat discomfort and subjective neck discomfort 5
Compressive Symptoms
- Neck swelling or visible enlargement of the thyroid gland 6
- Sensation of pressure or choking 3, 7
- Vascular compression symptoms 8
Symptoms Related to Specific Types of Goiter
Substernal/Intrathoracic Goiter
- More severe respiratory distress due to tracheal compression 1, 8
- Potential for sudden and unpredictable respiratory distress 8
- Vascular compression symptoms 8
- Risk of vocal cord paralysis due to recurrent laryngeal nerve involvement 8
Multinodular Goiter
- Similar compressive symptoms but may be more localized depending on nodule location 7
- Symptoms may worsen as the goiter increases in size 7
Associated Thyroid Function Symptoms
- Patients may be asymptomatic from a thyroid function perspective (euthyroid) 6
- Some patients may present with symptoms of hypothyroidism or hyperthyroidism if the goiter affects thyroid function 6
Complications
- Vocal cord paralysis due to recurrent laryngeal nerve injury (rare but serious) 4, 8
- Nodule rupture (rare, 0.08% to 0.21%) presenting with neck discomfort and swelling 4
- In severe cases, untreated large goiters can lead to significant airway obstruction and even sudden death in rare cases 8
Important Clinical Considerations
- Symptoms may be absent despite significant goiter, especially in slowly growing goiters where adaptation occurs 6, 7
- The severity of symptoms doesn't always correlate with the size of the goiter 2
- CT imaging is superior to ultrasound for evaluating the degree of tracheal compression when respiratory symptoms are present 4, 2
- Laryngopharyngeal reflux disease may coexist with goiter and contribute to throat symptoms, which can persist even after thyroidectomy 5