Goitre

Introduction

A goitre (sometimes spelt "goiter") is a swelling of the thyroid gland that causes a lump to form in the front of the neck. The lump will move up and down when you swallow.

The thyroid gland is a small butterfly-shaped gland in the neck, just in front of the windpipe (trachea). It produces thyroid hormones, which help regulate the body's metabolism, the chemical processes that occur in the body.

The size of a goitre can vary from person to person. In most cases, the swelling is small and doesn't cause any symptoms.

In more severe cases, the symptoms may include:

coughing
a tight feeling in your throat
changes to your voice, such as hoarsenes
difficulty swallowing (dysphagia)
difficulty breathing – there may be a high-pitched sound when you breathe (stridor)

Diagnosing a goitre

If you think you have a goitre, see your GP. They'll examine your neck to see whether your thyroid gland is swollen, and may request a thyroid function test to see how well your thyroid gland is working.

A thyroid function test measures the level of certain hormones (chemicals produced by the body) in your blood.

It can show whether you have an underactive or overactive thyroid, both of which are associated with goitre.

If necessary, you may be referred to a specialist in hospital for further tests or treatment.

Read more about how a goitre is diagnosed.

Treating a goitre

The treatment for a goitre depends on the underlying cause. If the goitre is small and isn't causing any problems, a wait-and-see approach is usually recommended.

Other possible treatments include radioiodine treatment and thyroid surgery.

Although most goitres are usually non-cancerous (benign), it's estimated that in 1 in 20 cases they may be a sign of thyroid cancer.

Causes of a goitre

A goitre can have several possible causes, including:

an overactive thyroid gland (hyperthyroidism)
an underactive thyroid gland (hypothyroidism)
hormone changes during puberty, pregnancy or the menopause
not enough iodine (a trace mineral found in fish and plant foods) in your diet
taking some types of medication – such as lithium, a medication often used to treat a number of mental health conditions
an inflamed thyroid gland (thyroiditis)
having radiation treatment to your neck or chest area – such as radiotherapy for neck cancer
nodules or cysts within the thyroid – most are benign, but should be assessed
thyroid cancer – a rare type of cancer in the UK

Anyone can develop a goitre, but the chances increase with age. Women are also more likely to develop a goitre.

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 develop within the thyroid and make the thyroid gland feel lumpy to touch; the nodules can be single or multiple and may contain fluid (cysts)

Thyroid gland: The thyroid gland is found in the neck. It produces hormones that are released into the bloodstream to control the body's growth and metabolism (the process that turns food into energy).

Diagnosis

If you think you have a goitre, see your GP. They can examine your neck to see if there's any evidence of thyroid gland swelling and may request blood tests to check the function of your thyroid gland.

Thyroid function test

A thyroid function test is a type of blood test. A sample of your blood is taken and measured for levels of:

thyroid-stimulating hormone (TSH)
thyroxine and triiodothyronine (the thyroid hormones)

If you have lower or higher-than-average levels of these hormones, it could mean you have a thyroid condition or are at risk of developing one in the future.

Referral to a specialist

Your GP may refer you to a specialist thyroid clinic or a specialist in hormone-related conditions (an endocrinologist) if you have a thyroid swelling and:

it's getting bigger
you have a family history of thyroid cancer
you've had radiation treatment to your neck
you have swollen lymph nodes in your neck
you're a child or teenager
you're 65 or over
your voice has changed
you're making a high-pitched noise as you breathe (stridor)
you're having difficulty breathing or swallowing

If you're referred to a specialist, you may have further tests in hospital. These are described in more detail below.

Radioactive iodine scan

This involves a small amount of radioactive iodine being injected into your vein. The iodine builds up in your thyroid gland, which can then be studied using a special camera.

The scan can provide useful information about the structure and function of your thyroid gland. As the amount of radiation used is very small, it's perfectly safe for most people. However, it may not be suitable if you're pregnant.

Ultrasound scan

An ultrasound scan uses high-frequency sound waves to create an image of part of the inside of your body. It can be used to:

build up a picture of the inside of your thyroid gland
assess the size of your thyroid gland
check whether there are any enlarged nodules in your thyroid gland not found during the physical examination

Fine-needle aspiration

Fine-needle aspiration is a procedure where a sample of the goitre is extracted so the cells inside it can be tested. This procedure is often known as a biopsy.

During the procedure, a fine needle on the end of a syringe is inserted into the goitre in your throat. A sample of the fluid or tissue inside the goitre is sucked through the needle into the syringe.

The sample can be examined under a microscope to determine what kind of cells are inside the goitre.

Autoimmune condition: An autoimmune condition is when your immune system (the body’s defence system) produces antibodies (proteins) that should fight infections, but instead attack your body's healthy tissues.
Hormones: Hormones are groups of powerful chemicals produced by the body and have a wide range of effects.
Thyroid gland: The thyroid gland is found in the neck. It produces hormones that are released into the bloodstream to control the body's growth and metabolism (the process that turns food into energy).

Treatment

Treatment for a goitre can include medication, hormone therapy and surgery.

The treatment you receive will depend on:

the size of the goitre
the symptoms the goitre is causing
whether you have any underlying thyroid condition

Your condition may just be monitored if tests reveal your thyroid gland is working normally and the goitre is small.

If your goitre is interfering with your breathing or swallowing and it hasn't responded to other forms of treatment, you may need surgery to remove part or all of your thyroid gland. This procedure is known as a thyroidectomy.

Treating thyroid gland problems

If tests reveal a problem with your thyroid gland, you may receive treatment for:

an overactive thyroid gland (hyperthyroidism) – which may include taking a type of medication known as thionamides or a type of radiotherapy called radioiodine treatment
an underactive thyroid gland (hypothyroidism) – which usually involves taking a synthetic hormone called levothyroxine to replicate your normal thyroid function (hormone therapy)

Iodine supplements

A well-balanced diet usually provides all the iodine your body needs, and iodine supplements aren't usually required in developed countries like the UK. Your GP can give more advice about extra supplements, if needed.

Iodine supplements are available in many health food shops without a prescription. However, always consult your GP before taking them as the amount of iodine needed varies from person to person.

Taking too much iodine may cause other health problems, and it could also have toxic effects.

Thyroidectomy

Before a thyroidectomy, you'll be given a general anaesthetic so you're unconscious and unable to feel anything.

During surgery, the surgeon makes a cut (incision) in the front of your neck so they can see your thyroid gland.

How much of the thyroid gland is removed depends on the underlying condition causing the goitre. The procedure reduces the size of your goitre and the amount of thyroid hormones being produced.

The surgeon will attempt to remove enough of your thyroid gland to relieve your symptoms, while leaving enough so normal thyroid hormone production can continue.

However, if this isn't possible, you may require hormone therapy after surgery.

Surgery to remove the thyroid gland is usually safe, but as with all surgical procedures there's a risk of complications, such as postoperative infection.

Complications of a thyroidectomy

The risks of complications occurring after thyroid gland surgery are estimated to be 1-2%. Before having the procedure, you should discuss the risks with your surgeon.

Nerve damage and parathyroid gland damage are two other possible complications of thyroid gland surgery. These are briefly described below.

Nerve damage

The thyroid gland is very close to the two laryngeal nerves, which control your vocal cords. If these are accidentally damaged during surgery, your voice and breathing could be affected.

Permanent damage to the laryngeal nerves affects 1-2 people in every 100 who have this type of surgery. Temporary damage may affect up to 5 people in every 100.

Parathyroid gland damage

The parathyroid glands help regulate the amount of calcium in your body. If the parathyroid glands are damaged, you'll probably need to take calcium supplements for the rest of your life.

Hormones: Hormones are groups of powerful chemicals that are produced by the body and have a wide range of effects.
Incision: An incision is a cut made in the body with a surgical instrument during an operation.
Thyroid gland: The thyroid gland is found in the neck. It produces hormones that are released into the bloodstream to control the body's growth and metabolism (the process that turns food into energy).
White blood cells: White blood cells are the part of blood that fight infection and disease.

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