A goiter is simply an enlarged  thyroid gland. Symptoms can occur when the thyroid increases  in size and compresses other structures in the  neck like the esophagus  and windpipe. According to the American Association of Clinical Endocrinologists, compressive symptoms are rare and usually found in elderly patients who have had a goiter for a long time. Compressive symptoms include difficulty swallowing, voice changes, cough and obstruction of blood flow. 

Difficulty Swallowing 

Difficulty swallowing occurs when a goiter puts pressure on the esophagus. This may make it hard to swallow large pills or solid foods. Patients report feeling as if they have a lump in their throat that never goes away. 

Difficulty Breathing 

When  the goiter presses on  the trachea or windpipe, it causes  a narrowing that creates problems with airflow. Patients may have trouble breathing, particularly with exercise or  when lying down. 

Voice Hoarseness 

In some patients,  the goiter will press on  the nerve leading to the voice box. This can lead to voice changes, particularly in people who speak frequently, such  as teachers. 

Restricted Blood Flow  to the Neck 

If the goiter becomes large enough, it can compress blood vessels in the neck. Patients raising their arms notice enlarged veins in the neck, redness in the face and difficulty breathing. This is  known as Pemberton's sign. 

Pain in  the Goiter 

A goiter may contain  a cyst that is filled with fluid. Bleeding may occur in the cyst which can cause pain  in the thyroid, sudden enlargement  of the goiter or difficulty breathing.