A goiter refers to an enlargement of the thyroid. It is caused by overproduction of the the thyroid hormone or from a lack of iodine in the diet. A goiter takes many years to develop and can become so large that it becomes visible. Some people who have larger goiters complain of pain, coughing or a choking sensation, especially at night because the enlarged goiter compresses the esophagus (the swallowing tube) or the trachea (the windpipe). Many small goiters can be treated with a hormone pill. However, larger goiters can be surgically removed if they are causing a lot of problems for the patient. Some goiters can be cancerous, and in this case surgical removal is essential. However, if there is no sign of cancer in the goiter, it maybe removed to avoid compressing vital organs in the neck or for cosmetic reasons. If the thyroid and the goiter are removed, then the patient will have to take hormone therapy for the remainder of their lives because there will be no gland to produce the needed hormones.