Goiter
What Is a Goitre?
A goitre is an enlargement of the thyroid gland. The thyroid gland is located at the front of the neck, in front of the windpipe. The enlargement may affect the entire gland or appear as one or more nodules.
The presence of a goitre alone does not indicate whether the thyroid gland is overactive or underactive. Thyroid hormone levels may be normal, high or low. Therefore, thyroid function and the cause of the enlargement are assessed alongside the size and structure of the goitre.
What causes a goitre?
The causes of a goitre may vary depending on iodine intake and regional factors. Possible causes include:
- Iodine deficiency
- Autoimmune thyroid diseases such as Hashimoto's thyroiditis or Graves' disease
- A single nodule or multiple nodules
- Thyroiditis
- Certain medications and, less commonly, other thyroid diseases
Most nodules are benign; however, a nodule is assessed based on its ultrasound features, size, clinical risk factors and, when necessary, biopsy results.
What are the types of goitre?
- Diffuse goitre: The entire thyroid gland is enlarged; there may be no distinct nodules.
- Nodular goitre: The gland contains one or more nodules.
- Multinodular goitre: There are multiple nodules in the thyroid.
The term “toxic goitre” is used to describe a condition in which the thyroid produces excess hormones, rather than the goitre itself. A goitre can also occur with normal hormone levels or with hypothyroidism.
What are the symptoms?
Small goitres often cause no symptoms. When the thyroid gland becomes significantly enlarged, symptoms may include swelling in the neck, a feeling of pressure, difficulty swallowing, coughing or difficulty breathing.
If hormone levels have changed, symptoms such as palpitations, tremor, sweating, weight changes, feeling cold, fatigue or constipation may also occur. These symptoms may result from underlying thyroid dysfunction rather than the goitre itself. Medical assessment should be sought if the swelling in the neck is growing rapidly, or if there is hoarseness or difficulty breathing/swallowing.
How is a goitre assessed?
Assessment usually begins with a medical examination and blood tests. TSH measurement is the primary test for assessing thyroid function; depending on the result and the clinical situation, free T4 (FT4), T3 and thyroid antibody tests may be requested.
Thyroid ultrasound examines the size of the gland and the structural features of any nodules. Not every nodule requires a biopsy; the decision to perform a fine-needle aspiration biopsy is based on the nodule's ultrasound risk features, size and clinical assessment. Thyroid scintigraphy may be used particularly when TSH is low or a hormone-producing nodule is suspected; it is not routinely performed for every goitre or nodule.
A blood sample for TSH and thyroid hormone tests can be provided at Wellcare Laboratories. Your doctor determines which tests are needed based on your clinical findings.
How is a goitre treated?
Treatment is selected according to the cause and size of the goitre, hormone levels, symptoms and the results of nodule assessment. Small goitres that cause no symptoms and are found to be low-risk during investigations can sometimes be monitored without starting treatment.
Depending on the cause, treatment or monitoring options may include medications for thyroid dysfunction, radioactive iodine, surgery or regular ultrasound monitoring. Radioactive iodine and surgery are not suitable for every type of goitre. Levothyroxine may be needed if the entire thyroid gland has been surgically removed. Treatment decisions are made in consultation with endocrinologists and, when necessary, thyroid surgery specialists.