Goitre (enlarged thyroid gland) Tenga
A goitre is a swelling or enlargement of the thyroid gland at the front of your neck. Goitres are often harmless and do always need treatment. But it may be caused by another condition which will need to be treated.
Causes of a goitre
Your thyroid gland is in the lower front of your neck. It produces thyroid hormones, which are carried in your blood through your body. Thyroid hormones are important because they:
- help your body use energy
- help you stay warm
- keep your brain, heart, muscles and other organs working as they should.
There are several common causes of an enlarged thyroid gland.
- Graves' disease or Hashimoto's disease — these are autoimmune diseases where your body's own immune system affects your thyroid gland. In Graves' disease it makes too much thyroid hormone. Hashimoto's disease can result in the thyroid gland not making enough hormone, or cause a goitre even when you have normal levels of thyroid hormone.
- Multinodular goitre — A few solid or fluid‑filled lumps called nodules develop in both sides of your thyroid gland. Most of these nodules are benign (not cancer).
- Thyroid cancer.
- Iodine deficiency — your body needs iodine to produce thyroid hormone. If you are not eating enough iodine‑rich food, your thyroid gland can enlarge. This is uncommon in Aotearoa New Zealand where iodine is routinely added to salt and most bread. Fish, seaweed and dairy products are rich in iodine.
Goitre is more common in women, people older than 40 and those with a family history of goitre.
Symptoms of a goitre
In most cases, the only symptom of a goitre is the appearance that your neck is swelling. The size of the swelling may vary from a single small lump to a large swelling (mass) at the front of your neck.
Sometimes an enlarged thyroid can place pressure on your food pipe (oesophagus) and windpipe. This can lead to symptoms such as:
- a tight feeling in your throat
- difficulty swallowing food, especially solid food
- a cough
- a change of voice or hoarseness
- difficulty breathing, especially when lying flat on your back
- pain in the area of your thyroid.
Depending on the cause of the goitre, some people may also have the symptoms of an overactive thyroid or underactive thyroid.
Diagnosing a goitre
You may notice a goitre if you feel a swelling in your neck or see it in a mirror. Sometimes your healthcare provider may notice the swelling during a routine examination.
They may also perform other tests, including:
- blood tests
- a thyroid scan
- a biopsy (removal of sample tissue or cells).
Treating a goitre
The treatment for a goitre depends on:
- the cause
- how large your thyroid has grown
- your symptoms.
If your goitre is small and is not bothering you, you and your healthcare provider may decide that it does not need to be treated. But the goitre will be closely watched for any changes.
The 3 main treatment options are:
- medicines
- radioactive iodine treatment
- surgery.
Medicines
The appropriate medicine for you to treat your goitre depends on the cause. If the cause is:
- a lack of iodine, your healthcare provider may prescribe small doses of iodine supplements
- an underactive thyroid (hypothyroidism), your healthcare provider may prescribe a thyroxine tablet, which is identical to the thyroid hormone produced naturally by your body (this is called thyroid replacement therapy)
- an overactive thyroid (hyperthyroidism), then your healthcare provider may prescribe medications such as carbimazole.
Radioiodine treatment
In some cases, if your goitre is caused by an overactive thyroid gland, your healthcare provider may prescribe radioiodine. You take this orally as a liquid or capsule.
The aim is to treat the thyroid overactivity but it is also common for the goitre to shrink after radio iodine. The iodine goes to your thyroid gland and kills thyroid cells.
After radio iodine treatment, you may be prescribed thyroid hormone replacement therapy as ongoing treatment.
Surgery
You may need an operation to remove part or all of your thyroid gland. It is an option if:
- your goitre is large and causes problems with breathing and swallowing
- there is cancer.
Depending on the amount of thyroid gland removed, your healthcare provider may prescribe thyroid hormone replacement therapy as ongoing treatment.