Overview
A goitre (sometimes spelt “goiter”) is when your thyroid gland swells, resulting in a lump in the front of the neck. The thyroid gland is a small butter-fly-shaped gland at the base of the neck just in front of the windpipe (trachea). It is responsible for producing the hormones that regulate metabolism, body temperature, mood and excitability, pulse and heart rate and digestion.
Thyroid growth can result in a varying amount of thyroid hormone in the body (hyperthyroidism or hypothyroidism).
Treatment for goitre is dependent on its cause and type. Small goitres cause no symptoms, are not noticeable and do not need treatment.
Types of goitre
There are two main types of goitre:
- Diffuse goitre – where the entire thyroid gland swells and feels smooth to the touch
- Nodular goitre – where solid or fluid-filled lumps called nodules to develop within the thyroid and make the thyroid gland feel lumpy to touch; the nodules can be single or multiple and may contain fluid.
Key facts
- A goitre is a swelling of the thyroid gland that causes a lump in the front of the neck.
- There are two types of goitre, diffuse and nodular goitre
- The size of the goitre can vary from person to person.
- An overactive thyroid gland can cause goitre
- Treatment depends on size and symptoms
Symptoms and Diagnosis
The goitre size can vary, from very small and barely noticeable to large. Goitre is usually painless, but if you have thyroiditis (an inflamed thyroid gland), you might experience some pain.
Other symptoms may include:
- Coughing
- A tight feeling in your throat
- Changes to your voice, such as hoarseness
- Difficulty swallowing
- Difficulty breathing – there might be a cranking or high-pitched sound when you breathe
Signs and symptoms of hypothyroidism (underactive thyroid) include:
- Constipation
- Muscle weakness
- Problems with memory or concentration
- Fatigue
- Increased sensitivity to cold
- Increased sleepiness
- Dry skin
Signs of overactive thyroid (hyperthyroidism) include;
- Fatigue
- Increased sensitivity to cold
- Increased sleepiness
- Dry skin
- Weight loss
- Rapid heartbeat (tachycardia)
- Increased sensitivity to heat
- Excess sweating
- Tremors
- Irritability and nervousness
- Muscle weakness
- Frequent bowel movements
- Changes in menstrual patterns
- Sleep difficulty
- High blood pressure
- Increased appetite
Diagnosis
See your doctor if you think or notice your goitre is growing. They will perform a physical examination and check your neck for thyroid gland swelling.
Your healthcare provider may also request one or more of these tests;
- The thyroid function test is conducted to check if your thyroid hormones are functioning correctly. A blood sample will be collected to investigate if the goitre is associated with an increase or decrease in thyroid function.
- Antibody test: Depending on the thyroid test result, your doctor may order an antibody test to check for antibodies linked to auto-immune diseases like Graves or Hashimoto’s.
- Thyroid ultrasound: The ultrasound procedure uses high-frequency sound waves to check for abnormalities in tissues in your neck and thyroid. The echoes of the sound waves are recorded, and then photos and videos are produced from them. Your healthcare giver can detect through the images and videos if your thyroid is larger than usual and has nodules.
- Radioactive iodine uptake. If your healthcare provider orders this test, you will be given a small amount of iodine. The lab technician will use a unique device to measure the rate at which your thyroid takes it in. It can also be combined with a radioactive iodine scan to visually represent the iodine uptake pattern.
- Biopsy. An ultrasound guides a very tiny needle into your thyroid to take a small piece of tissue or fluid sample from nodules. These samples are tested in a lab for cancerous cells.
- CT scan or MRI of your thyroid: This test is usually ordered when the goitre is vast or has spread to your chest. A CT scan or MRI measures the size and spread of the goitre.
Causes
A goitre can have several possible causes, including:
- An underactive thyroid gland (hypothyroidism)
- An overactive thyroid gland (hyperthyroidism)
- Hormone changes during puberty, pregnancy, and menopause
- Iodine deficiency
- Some medications, such as lithium, a drug used to treat some mental health conditions
- An inflamed thyroid gland (thyroiditis)
- Radiation treatment to your neck or chest area, such as radiotherapy for neck cancer
- Presence of nodules or cysts in the thyroid. While most nodules or cysts are harmless, they should be medically evaluated.
- Thyroid cancer
Prevention
The only goitre you can prevent is the one caused by iodine deficiency. A diet rich in fish, dairy, and a healthy amount of iodized table salt can prevent these goitres. It is not advised to take iodine supplements as they can do more harm. While anyone can develop a goitre, the chances increase with age. Additionally, women are more at risk of developing goitres.
Treatment
The treatment administered or prescribed by your healthcare provider will depend on the size of the goitre, the symptoms it presents, and whether you have any underlying thyroid condition.
These treatments include;
- No treatment/”watchful waiting”: Your healthcare provider might not administer any treatment if the goitre is minor and unnoticeable. However, it will be monitored for any changes in the thyroid.
- No treatment: If the goitre is minor and unnoticeable, your healthcare provider may decide not to administer any treatment. However, they will monitor it for changes in your thyroid.
- Radioactive iodine treatment: This treatment, used in cases of overactive thyroid, involves orally taking radioactive iodine. The iodine goes into the thyroid cells to shrink the glands and reduce the goitre swelling. After radioactive treatment, you might need to take iodine replacement therapy for the rest of your life.
- Medications: Levothyroxine will be prescribed if the cause of the goitre is an underactive thyroid (hypothyroidism). This is also called thyroid hormone replacement therapy. Other medications will be prescribed if an overactive thyroid causes the goitre. These drugs include methimazole (Tapazole®) and propylthiouracil. Your healthcare provider might also prescribe aspirin or a corticosteroid medication if the goitre is caused by inflammation.
- Surgery: Your healthcare provider may recommend surgery to some part or all of your thyroid gland if the goitre has become large and is causing swallowing and breathing problems. Surgery is also done if there’s the presence of nodules in the thyroid. In cases of cancerous goitre, surgery must be performed.
Conclusion
The thyroid gland is a crucial part of the endocrine system. It affects many functions of the body. Goitre development can be a sign of thyroid disease and other abnormalities. The good news is it’s treatable. Some goitres are also too small to cause any problems. Speak with your healthcare provider if you notice any growth in front of your neck. They can determine if it’s goitre and the underlying cause and administer treatment if necessary.
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