Grade III goiter is an enlargement of the thyroid gland visible to the naked eye. On physical examination, the thyroid gland exceeds the posterior border of the sternocleidomastoid muscle, and the swelling in the neck is very obvious, causing local compression symptoms and mild vague pain and swelling in the front of the neck. The swelling of the thyroid gland may compress the trachea and esophagus, causing a choking sensation when eating, and may cause panic attacks and shortness of breath after strenuous activities. If the enlarged thyroid gland is of degree III caused by hyperthyroidism, the patient will have systemic symptoms, such as increased heart rate, panic attacks, chest tightness, and protrusion of the eyes.