Goitre (Thyroid Swelling)

What is a goitre?

There are different types of goitre, each with various causes

Diffuse smooth goitre

This means that the entire thyroid gland is larger than normal. The thyroid feels smooth but large. There are a number of causes. For example:

• Grave's disease - an auto-immune disease which causes the thyroid to swell and make too much thyroxine. (See leaflet called 'Hyperthyroidism (Overactive Thyroid)'.)
• Thyroiditis (inflammation of the thyroid) - which can be due to various causes. For example a viral infection can cause 'viral thyroiditis'.
• Iodine deficiency. The thyroid gland needs iodine to make thyroxine and T3. If you lack iodine in your diet the thyroid swells as it tries to make enough thyroxine and T3.
• Some medicines can cause the thyroid to swell as a side-effect. For example, lithium.
• Hereditary factors - some people inherit a tendency for a thyroid to swell. In particular, it may swell at times of life when you may make more thyroxine and T3. For example, when you are pregnant, or during puberty.
• Various other problems with making thyroxine or T3 may cause the thyroid to swell.

Nodular goitres

A thyroid nodule is a small lump which develops in the thyroid. There are two types:

• A multinodular goitre. This means the thyroid gland has developed many lumps or 'nodules'. The thyroid gland feels generally lumpy.
• A single nodule. Causes include:
  • a cyst (a fluid-filled benign tumour)
  • an adenoma (a solid benign tumour)
  • a cancerous tumour (rare)
  • other rare causes.

Goitres and thyroid function (production of thyroid hormones)

• In many people with a goitre the goitre does not affect the amount of thyroxine or T3 that you make. You are then 'euthyroid' which means you make the correct amount of these hormones.
• In some people, the goitre is associated with an abnormality of thyroid function. You may make too much thyroxine or T3 (hyperthyroidism or overactive thyroid) or too little thyroxine or T3 (hypothyroidism or underactive thyroid). See separate leaflets called about these conditions.

Note: you can also develop an overactive or underactive thyroid without having a goitre.

What are the symptoms of a goitre

• In many cases there are no symptoms apart from the appearance of a swelling in the neck. The size of a goitre can range from very small and barely noticeable, to very large.
• Most goitres are painless. However, an inflamed thyroid (thyroiditis) can be painful.
• If your thyroid makes too much or too little thyroxine or T3, this can cause a range of symptoms. See separate leaflets called 'Hyperthyroidism (Overactive Thyroid)' and 'Hypothyroidism (Underactive Thyroid)' for more detail.
• A large goitre may press on the trachea (windpipe) or even the oesophagus (gullet) behind the trachea. This may cause difficulty with breathing or swallowing.

Assessing the situation

When you have a goitre a doctor will usually do some blood tests to check if you are making too much or too little thyroxine or T3. Blood tests may also help to find out the cause of some goitres. Other tests may be done to find out the cause of the goitre. For example:

• An ultrasound scan of the thyroid. This may be done if you have a single nodule. An ultrasound scan is a safe and painless test which uses sound waves to create images of organs and structures inside your body. It can tell if a nodule is a cyst or a solid lump.
• A small piece of tissue (a biopsy) may be taken from a nodule to look at under the microscope. The biopsy is done by inserting a thin needle into the nodule. (It is a bit like taking a blood sample but the needle is smaller.) It is a simple and safe procedure.
• A radioactive iodine scan or similar test. This may be done to see if any nodules are making too much thyroxine or T3. (The radioiodine concentrates in tissue that makes thyroid hormones.) See separate leaflet called 'Radionuclide (Isotope) Scan' for more detail.
• In some situations a chest X-ray is done if it is suspected that a goitre extends downwards into the chest.

What is the treatment for a goitre?

Treatment depends on the cause, the size of the goitre, and whether it is causing symptoms. For example:

• If you have a small goitre that is not due to a cancerous nodule, and your thyroid is making the correct amount of thyroxine and T3, then you may not need any treatment.
• You will need treatment if you make too much or too little thyroxine or T3.
• An operation to remove some or all of the thyroid may be an option in some cases.
• Radioactive iodine treatment may be an option for a goitre causing an overactive thyroid. This involves taking a drink, or swallowing a capsule, which contains radioactive iodine. The radioactive iodine builds up in the thyroid gland. As the radioactivity is concentrated in the thyroid gland, it destroys some thyroid tissue. You may need to take thyroxine tablets after having radioactive iodine if too much of the thyroid is destroyed.
• If you have cancer of the thyroid, you will probably need an operation to remove the cancer and some of the thyroid gland.
• Iodine replacement, if the goitre is due to lack of iodine in the diet.

Further help and advice

British Thyroid Foundation

PO Box 97, Clifford, Wetherby, West Yorkshire, LS23 6XD
Tel: 01423 709 707 Web: www.btf-thyroid.org