Goiter

The enlargement and swelling of the thyroid gland, located in the lower front part of the neck around the windpipe, is called “goiter”. It is especially common in people with iodine deficiency and occurs frequently in Turkey as well. In terms of sex distribution, women are at 5 times higher risk than men.

In goiter, the thyroid gland enlarges with or without nodules. Nodules are monitored by the doctor using various imaging methods, and although rare, surgery may be required if they are suspected to be malignant. Radioactive iodine (“atomic”) therapy is also used in goiter today.

As long as it functions normally, no matter how much the thyroid gland enlarges, it does not cause problems for the patient unless it presses on the esophagus or windpipe. However, if it leads to hyperthyroidism, in which thyroid hormones are secreted in excess, radioactive iodine (“atomic”) therapy or surgery may be applied. This condition is also called “toxic goiter”.

Goiter usually does not cause pain, but when it becomes very large it can cause coughing and difficulty swallowing and breathing. Treatment depends on the size of the goiter, your complaints and the factors causing the disease. Small enlargements that are not noticeable and do not cause problems usually do not require treatment.

Causes

The most common cause of goiter worldwide is iodine deficiency in the diet. Other causes are as follows:

1. Graves’ disease
2. Inflammatory diseases of the thyroid, such as Hashimoto’s disease
3. A nodule or swelling on one side of the thyroid gland
4. Presence of more than one nodule and swelling in the thyroid gland (multinodular goiter)
5. Thyroid cancer (very rare compared with benign thyroid nodules)
6. Pregnancy (the hormone hCG secreted during pregnancy can cause slight enlargement of the thyroid gland)
7. Cysts
8. People exposed to radiation in the neck region
9. People with a family history of nodules.

People living in regions with few iodine-containing foods, the female sex, those with various autoimmune diseases, those using medications such as amiodarone, interferon and lithium, women in pregnancy or menopause, and people over 40 are at risk for goiter.

Types

The enlargement of the thyroid gland to the point of becoming visible is commonly called ‘goiter’. However, many thyroid gland disorders with very different causes, diagnostic methods and treatments fall under the name goiter.

There are two types of goiter: with and without nodules.

1. If the gland enlarges entirely in volume, it is called ‘non-nodular’ or ‘diffuse goiter’.
2. If nodules are present, it is called ‘nodular goiter’. If there is more than one nodule, it is called “multinodular goiter”.

However, the development of goiter gives no indication of the function of the thyroid gland, that is, the amount of hormone secreted.

Symptoms

Not every case of goiter causes symptoms. When it does, the following complaints are seen.

1. Swelling in the neck. It can be clearly seen especially while shaving or applying makeup. When it grows large, it can be noticed even from the outside.
2. Difficulty swallowing
3. Difficulty breathing
4. Coughing

Goiters caused by other conditions such as hypothyroidism or hyperthyroidism can lead to a range of symptoms, from fatigue and weight gain to unintended weight loss, nervousness and insomnia.

Diagnostic Methods

In the presence of nodular goiter, the likelihood of the nodules being malignant, the presence of excess hormone production and the pressure of large nodules on the windpipe need to be evaluated together. First, the physician examines the neck by hand. Then a blood test is requested, and TSH, T3, T4 and, if necessary, thyroid autoantibodies are checked.

The diagnosis can be made by checking hormone levels with a blood test called the thyroid function test.

Thyroid scintigraphy and ultrasonography are performed to examine the nodules. In this way, the structure of the nodule can be seen in detail. A needle biopsy can be performed for detailed examination of the nodules.

Treatment Methods

In people with symptoms of thyroid gland disease, after the necessary evaluations are made, treatment is determined according to the level of thyroid hormones and the characteristics of the thyroid gland. The most suitable option among follow-up, medication, radioactive iodine or surgery is decided on.

In people for whom medication is decided on, the duration of treatment and the dose of the drug are adjusted according to the severity of the disease. In hyperthyroidism, called toxic goiter, radioactive iodine therapy and surgery come into question after drug treatment.

When Radioactive Therapy, When Surgery?

If permanent treatment of hyperthyroidism is needed after medication, which treatment will be applied is determined according to the patient’s sex, age and the condition of the thyroid. Both methods are safe. Radioactive iodine therapy is performed in nuclear medicine departments, while surgical treatment is performed by doctors specialized in Endocrine Surgery.

How much of the thyroid tissue will be removed during surgery is again decided according to the patient’s condition, age and some other factors. In a group of diseases (for example Graves’ disease), the tissue needs to be removed completely. If hyperthyroidism is due to a single overactive nodule, removing only that area is sufficient for treatment. The remaining tissue continues to produce enough thyroid hormone for the patient.

If all of the tissue has been removed and the patient has no tissue left that can produce thyroid hormone, thyroid hormone is given externally as medication after surgery. Because the thyroid gland does not work, the patient has to take thyroid hormone externally for life. Since these medications are in the same form as the thyroid hormone the body secretes, the patient can live their whole life as if they had thyroid tissue.