The word “goiter” means enlarged thyroid. It is usually asymptomatic. It can be caused by genetics, iodine deficiency, several nodules, and thyroiditis. Rarely it may need surgery of it causes symptoms of problems swallowing or breathing due to pressure on the esophagus or windpipe or if it is visible on the front of the neck. Sometimes extra thyroid hormone can be given to patients to try to shrink the gland. It can help if the TSH levels are on the high side. Only about half of patients treated respond and you have to worry about osteoporosis (low calcium in the bones) and heart rhythm problems with prolonged use.