Enlargement of the thyroid, usually associated with malfunction of the gland. If the thyroid is functioning normally the condition is usually caused by iodine deficiency. This occurs particularly in countries a long way from the sea (endemic goitre). If a person’s diet contains too little iodine, the thyroid has to overwork to produce enough thyroid hormone. The condition can also occur in periods when the body requires additonal thyroid hormone: in puberty, pregnancy and the period after it, when a baby is being breast-fed. Table salt containing iodine, sea salt and fish products can provide enough iodine and prevent this form of goitre. If the thyroid is enlarged it is important to establish whether the swelling is even (diffuse) or whether certain areas feel abnormal (thyroid nodules). In the latter case it is possible that a malignant growth is developing, and extensive examination is necessary. Before a diffuse goitre is treated artificial thyroid hormones are usually administered. The swollen gland is thus rested, and may return to its normal size, but if the condition has been present for a long time it is less likely to react well to such treatment. If the enlarged gland causes difficulty in swallowing or breathing through pressure on the oesophagus or windpipe it may be necessary to remove

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