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Goiter- causes and treatment

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Svetla BankovaA goiter is an abnormal swelling of the thyroid gland and it usually presents as a palpable lump in the neck. 

Most patients present having noticed a lump in the neck, either themselves or it’s been pointed out by others. Occasionally a patient might present with a sore throat, an alteration in their voice quality or, more rarely, difficulty swallowing or breathing. The voice also can become hoarse, or the patient may feel pressure in the neck and tenderness when touched.

There are several possible underlying causes for enlargement of the thyroid gland. One would be an overactive thyroid gland, also called hyperthyroidism, an underactive thyroid gland, known as hypothyroidism, and the presence of one or more thyroid nodules. Another reason could be thyroiditis, which is an inflammation of the thyroid gland. Worldwide the commonest cause is a deficiency of iodine in the diet. The thyroid can also become enlarged during or after pregnancy.

Of patients who present with thyroid nodules, less than one in 20 of those nodules will prove to be cancerous. The sort of situation where one might find it to be more likely to be a cancer is if a nodule is solitary, i.e. there is just one, and if it is growing more rapidly. If, as a patient, you notice a lump in the neck, it is important that you are assessed by your general practitioner, who will be able to determine whether that swelling is coming from the thyroid. Your GP will then be able to arrange blood tests and thyroid scans and can then refer you on to an endocrinologist for further treatment.

A further scan which may be organized is called a thyroid uptake scan, which aims to determine whether the thyroid shows areas of overactivity or underactivity. Needle aspiration  оr needle biopsy, as well as thyroid ultrasound are the other methods to determine whether or not the goiter is caused by hypo or hyper function of the thyroid gland, or a nodule. 

The nodules could be benign (not cancerous) and this pertains to the majority of the nodules. If the nodule is found to be malignant, that means that it is cancerous. In such cases the most recommended procedure is surgery. In cases where the diagnosis is not conclusive due to various reasons, the nodule is considered to be suspicious for cancer. Finally, when the biopsy is not correctly performed or the ultrasound  is not clear the diagnosis is inconclusive and the thyroid tests should be repeated.

Worldwide the commonest cause of goiter is a lack of iodine in the diet. However, recently this would be a relatively rare cause and therefore it is unlikely that a patient would be advised to change their diet. The treatment plan will depend upon the underlying cause of the goiter. The majority of goiters are small and do not cause any specific symptoms and therefore a wait-and-see policy may be appropriate.

For goiters which are caused by an underactive thyroid, treatment would include thyroid hormone replacement (L-thyroxine). For those caused by an overactive thyroid, treatment might include medication, radioactive iodine or surgery. If the goiter is causing serious symptoms, with difficulty swallowing and/or breathing, then surgery may be recommended. test

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