What Is Goitre?

Overview

A goitre is a medical condition that occurs due to abnormal enlargement of the thyroid gland. It indicates that the thyroid gland is abnormal, either due to hyperthyroidism (too much hormone production), or hypothyroidism (which is the production of too little hormone). The thyroid is a small endocrine, butterfly-shaped gland located at the base of the neck just below the Adam’s apple. The thyroid gland produces thyroid hormones thyroxine (T4) and triiodothyronine (T3), both having an essential role in metabolism, regulating body temperature, heart rate, blood pressure, and growth during childhood.⁷

Causes of goitre

Several factors may cause goitres and influence abnormal thyroid function: 

• Iodine deficiency

One of the most common causes of goitre formation is iodine deficiency. Iodine is essential for the production of thyroid hormone by the thyroid gland. If the amount of iodine is not enough, there will be a deficiency in thyroid hormone production (hypothyroidism)¹

• Grave's disease

This is an autoimmune disease where the immune system produces a protein called thyroid stimulating immunoglobulin (TSI) that stimulates the thyroid gland to produce too much thyroid hormone causing hyperthyroidism and goitre^1,8 

• Thyroid nodules 

Abnormal growth and lumps in the thyroid gland leading to enlarged thyroid gland⁸

• Hashimoto's thyroiditis

Autoimmune disorder where there is a destruction of the thyroid gland by one’s immune system. As a result of the damage, the thyroid gland is unable to produce sufficient amounts of thyroid hormone causing hypothyroidism¹

• Medications 

Goitre may be a side effect of certain medications such as lithium⁸

• Hormonal changes

During pregnancy and due to hormonal disturbance, the thyroid gland may be enlarged

• Radiation 

Exposure to radiation, either due to medical treatment or a nuclear accident

Signs and symptoms of goitre

Goitres are characterised by signs of an enlarged thyroid gland mainly where:⁸

• There is swelling at the lower front of the neck - it may be on one side
• The swelling may be either smooth or lumpy
• It is painless
• Hoarseness of the voice (scratchy voice)
• Wheezing noise when you breathe
• Difficulty swallowing or breathing, and feeling like something is stuck in the throat

Goitres may be associated with hyperthyroidism and characterised by:⁹

• Tachycardia (rapid heart rate)
• Weight loss
• Diarrhoea
• Agitation
• Unexplained sweating even without exercising

 Goitres may also be associated with hypothyroidism, symptoms of which are:⁹

• Fatigue
• Constipation
• Dry skin
• Weight gain
• Abnormal menstrual cycle

Management and treatment for goitres 

Treatment of goitres depend on the following factors:¹

1. The size of the goitre: if the goitre is small and doesn't cause any problems, it doesn't require treatment. However, regular monitoring is necessary to ensure that it doesn't increase in size and requires surgical removal

2. The cause of the goitre: 
   • If the goitre was due to iodine deficiency in the diet, iodine supplements will be given
   • If the goitre is due to Hashimoto's thyroiditis, thyroid hormone supplements will be given to restore thyroid hormone levels to normal and the goitre may get smaller
   • When a goitre is due to hypothyroidism, medication such as levothyroxine is prescribed to restore normal thyroid function and reduce the size of the goitre
   • If the goitre is due to hyperthyroidism, radioactive iodine therapy is used which concentrates in the gland and destroys the overactive cells causing the goitre
   • Surgery is an option when the goitre is large and causes difficulty breathing and swallowing, whereby removal of part or all the thyroid gland is necessary
   • In the case of thyroid cancer, surgery is the appropriate treatment option

It is important to consult a healthcare professional to determine the most appropriate treatment option suitable for the patient’s condition.

FAQs

How is a goitre diagnosed?¹³

It’s diagnosis requires a combination of physical examination and diagnostic tests:

1. Physical examination includes examining the neck for any swelling or enlargement of the thyroid gland. If the gland is enlarged, the doctor will check for any signs or symptoms of hyperthyroidism or hypothyroidism

2. Blood tests measure the levels of thyroid hormones (T3, T4) and thyroid stimulating hormone (TSH) in the blood. Abnormal levels indicate thyroid problems

3. Thyroid ultrasound uses high-frequency sound waves to detect any abnormalities in the thyroid gland such as nodules, enlargement, or cysts

4. Antibody tests to detect antibodies linked to an autoimmune disorder such as Hashimoto’s or Grave’s disease

5. Radioactive iodine uptake where a small amount of radioactive iodine is given and a scanning device is used to measure the amount and rate at which the thyroid takes it up. This test determines the function and cause of the goitre

6. Fine-needle aspiration biopsy is when a small needle is used to obtain a tissue or fluid sample from the thyroid gland. This sample is important to indicate the presence of cancerous cells

How can I prevent a goitre?

Goitre caused by iodine deficiency (simple goitre) is the only type of goitre that can be prevented. This is done by consuming a diet that includes a healthy amount of iodised table salt.

What are the different types of goitres?

There are different ways of classifying a goitre - it may be classified according to thyroid hormone levels or the way it grows. 

Classification of goitre depending on how it grows and enlarge includes:

• Simple (diffuse) goitre : when the entire thyroid gland swells and is smooth to the touch
• Nodular goitre: solid or fluid-filled lump (nodule) develops within the thyroid gland and feels lumpy
• Multinodular goitre: occurs when there are many nodules or lumps within your thyroid gland. The nodules are either visible or discovered during examination and scanning

Classification of goitre according to hormone levels: 

• Toxic goitre: occurs when the thyroid is enlarged and produces too much thyroid hormone

• Non-toxic goitre: when the thyroid gland is enlarged but thyroid hormone levels are normal (euthyroid)

Who is at risk of a goitre?

Risk of goitre development increases:

• If there is a lack in dietary iodine¹² 
• Being female - women are six times more likely to have hyperthyroidism than men¹³
• Pregnancy and menopause: thyroid problems in women are more common to occur during pregnancy and menopause. 25% of women aged between 50 and 69 have the risk of developing thyroid issues and have high TSH levels¹³
• Older age - goitres are more common to develop after age 40¹²
• Family history of goitre disease or other thyroid disorder¹²
• Medications including heart drugs like amiodarone (pacerone), and psychiatric drug lithium (lithobid)
• Radiation exposure: goitre's risk increases if you have had radiation treatment to your neck or chest¹²

How common is a goitre ?

It is relatively common - 15% of the UK population suffers from thyroid enlargement. One in 50 women in the UK live with an overactive thyroid gland (hyperthyroidism) and the prevalence of underactive thyroid (hypothyroidism) is 2% in the UK.^10,11

When should I see a doctor?

Should you start developing signs and symptoms that may indicate thyroid problems, please seek professional help immediately. If you have been diagnosed with a goitre, it is important to see your healthcare provider at least once annually to monitor the condition.

Summary

Goitres  are  a relatively common condition that may be dangerous if the underlying cause is thyroid cancer; otherwise, it is not dangerous but characterised by a wide range of symptoms that may develop into difficulty in swallowing and breathing. Treatment varies according to the type and the cause of the condition - it ranges from close observation, medical treatment, or surgical removal of the thyroid gland. However, by implementing healthy dietary habits and keep up a healthy lifestyle, prevention of some types of goitre may be possible.