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A goiter is a thyroid condition that is characterized by an increase in the size of the thyroid gland, which is located slightly below the Adam's apple. Sometimes hereditary, this disease occurs more commonly in women than men and its frequency increases with age. It affects people who live in mountainous regions more because of iodine deficiency in the soil (an essential component of thyroid hormones). However, in Switzerland, as in other developed countries, dietary salt enriched with iodine has reduced the occurrence of goiters. Congenital factors and certain conditions can also cause goiters.
Though unsightly, most goiters are benign and generally do not interfere with the normal function of the thyroid. However, enlargement of this gland may lead to compression of neighboring organs and interfere with swallowing (dysphagia), speech (dysphonia) or breathing (dyspnea).
The treatment varies depending on the cause and severity of the goiter. It may remain small and have no impact on the secretion of hormones or create any compression. In this case, regular endocrinology monitoring is recommended, including palpation, ultrasounds and blood work. Surgical treatment is indicated when a goiters are very unsightly or if they cause problems in the neck, resulting in hyperthyroidism. The goal of the operation is complete or partial removal of the gland (thyroidectomy).
When a goiter descends along the trachea and invades the chest because of its volume, it is called an intrathoracic (or diving) goiter. Surgery is then recommended, most often through an incision in the neck (cervicotomy) or, if necessary, an opening of the sternum (sternotomy). The Thoracic and Endocrine Surgery Division at the HUG is the only facility in Switzerland with expertise in both of these specializations.