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Senior Correspondent

Q. I saw a woman with what looked like a small tire around her neck. Do you know what that could be?

It could be a goiter, which is a benign enlargement of the thyroid gland. The thyroid is a small gland made up of two halves that lie along the windpipe just below the voicebox.

When the thyroid can’t produce enough hormone to meet the body's needs, the gland compensates by enlarging. Iodine, a chemical element, is needed to produce thyroid hormone. Therefore, an iodine deficiency can lead to goiter and hypothyroidism — deficient activity of the thyroid.

The body does not make iodine, so you have to consume it. Iodized table salt is the primary food source of iodine.

The Recommended Dietary Allowance (RDA) for iodine in adults is 150 micrograms a day. A microgram is one-millionth of a gram. One teaspoon of iodized salt contains approximately 400 micrograms of iodine.

Seafood is naturally rich in iodine. A six-ounce portion of ocean fish provides 650 micrograms of iodine. Seaweed, a seafood vegetable, is a rich source of iodine. Dairy products also contain iodine. Other good sources are plants grown in iodine-rich soil.

About half of the multivitamin formulas in the U.S. contain iodine—usually 150 micrograms.

Treatment of iodine deficiency by the introduction of iodized salt has almost eliminated goiter in the United States. However, about 40 percent of the world’s population is at risk for iodine deficiency.

Deficiency happens more often in women than in men, and is more common in pregnant women and older children. Getting enough iodine in the diet may prevent a form of physical and mental retardation called cretinism. Cretinism is very rare in the U.S. because iodine deficiency is generally not a problem.

A goiter can cause problematic symptoms such as difficulty breathing or swallowing.Treatment depends on the size of the goiter, your symptoms and the underlying cause.

The following are treatments for an enlarged thyroid:

  • If the goiter is small and doesn't cause problems, and the thyroid is functioning normally, your doctor may suggest waiting and observation.
  • Removing all or part of your thyroid gland surgically is an option if you have a large goiter that is uncomfortable or causes difficulty breathing or swallowing
  • If you have hypothyroidism, thyroid hormone replacement will resolve the symptoms of hypothyroidism and often decrease the size of the goiter.
  • Radioactive iodine is used to shrink the thyroid. The radioactive iodine is taken orally and reaches your thyroid gland through your bloodstream.
  • Small doses of iodine solutions are often used.

A goiter may disappear on its own, or may become large. Occasionally, a goiter may become toxic and produce thyroid hormone on its own. This can cause high levels of thyroid hormone, a condition known as hyperthyroidism.

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