Endocrine conditions

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Goitre

Print Print | Email  Email article to a friend | Last updated: January 08, 2015

Goitre is a general term for an enlarged thyroid gland. Depending on the type of swelling, location, how it affects gland function and how long it has been present, goitre has various effects and is treated in a variety of different ways.
Swollen neck of a patient with goitre.

Swollen neck of a patient with goitre.

Alternative names for goitre

Goiter; thyroid cyst; colloid goitre; colloid goiter; Plummer disease; Plummer’s disease; follicular adenoma.

What is goitre?

The thyroid gland is a butterfly-shaped gland found in the neck. A normal thyroid is usually not felt if finger pressure is applied to the neck. Any increase in size of the thyroid gland is called goitre.

Goitre can be due to enlargement of the whole thyroid gland, known as ‘smooth goitre’, or part of the gland, called a ‘nodular’ or ‘cystic’ goitre. Many people with goitre have normal thyroid hormone levels but some can have an underactive (hypothyroidism) or an overactive thyroid (hyperthyroidism).

What causes goitre?

There are a number of different causes for goitre including:

  • Iodine deficiency - Iodine is an essential trace element which helps the thyroid gland function properly and make thyroid hormones. There are two main hormones called thyroxine and triiodothyronine. Approximately 2.2 billion people worldwide have this type of deficiency and roughly 29% of the world's population live in an iodine deficient area. 

In the UK, our diet is supplemented with iodine and most areas have enough iodine. Goitres may be due to one of the following:

  • Thyroiditis - This means inflammation of the thyroid gland. A number of causes can lead to swelling of the thyroid. The most common cause worldwide is Hashimoto's thyroiditis which is due to the body reacting against itself and forming antibodies (known as the autoimmune process), which attack the thyroid gland. Thyroiditis can also occur for other reasons eg, due to a viral infection.
  • Graves' disease – This is an autoimmune disease where the body produces antibodies causing the thyroid to be overactive. 

  • Benign growths - These can take a number of different forms but follicular adenomas are most common. There may be more than one growth and they can be fluid or blood-filled, but they are usually single cyst-type or solid growths.
     
  • Goitrogens - These are external factors that may cause the formation of goitre.  They include drugs (eg, lithium, which is used in the treatment of mental health problems) and certain foods such as vegetables from the cabbage family, cassava or kelp, although only excessively high consumption of these could lead to goitre formation. Additionally, a lack of micronutrients such as iron, selenium, and vitamin A could also cause goitre formation.
     
  • Physiological causes – These include increased demands for hormone production during pregnancy and puberty.
     
  • Inherited causes – There are a number of genetic conditions that can increase the possibility of goitre formation.
     
  • Toxic nodular goitre (Plummer’s disease) – This is where a nodule is associated with overactivity of the thyroid gland.

What are the signs and symptoms of goitre?

It is common to have small nodules within the thyroid gland, which cannot be felt by finger pressure, but these may be picked up by chance when scans or examinations are conducted for other reasons. In these cases, there have usually been no symptoms to indicate the presence of goitre. Larger goitres simply present as a lump in the neck. 

How common is goitre?

Worldwide, goitre is estimated by the World Health Organization to affect around 12% of people, although the rate of goitre in Europe as a whole is slightly lower. Goitre affecting a particular area (endemic) occurs in areas where there is iodine deficiency and is defined when more than one in ten people have goitre.

Is goitre inherited?

Some forms of goitre can be inherited. There is some evidence that the presence of goitre in one family member increases the chances of other family members having goitre.

How is goitre diagnosed?

Goitre is diagnosed when the thyroid gland is enlarged enough to be felt by external touch or is clearly visible without a scan. Usually a GP will undertake thyroid function tests to measure the levels of thyroid related hormones and thyroid antibodies in the bloodstream. They may also arrange an ultrasound scan or make a referral to an endocrinologist for outpatient assessment. Where more complex tests are required, they may include:

  1. Fine needle aspiration’ of the thyroid gland. A needle is carefully guided to remove a small amount of thyroid tissue which is studied under a microscope to determine the cell type(s) that are present. This procedure may need to be repeated more than once to get an adequate result.
     
  2. A thyroid 'uptake' scan, which is conducted by a radiologist. This will pick up differences in the absorption of special chemicals such as radioiodine as well as the activity of different areas of the thyroid.  

How is goitre treated?

Treatment depends on the underlying cause of the goitre. ‘Simple’ goitre, where there is no thyroid hormone imbalance and no problems arising from the size of the thyroid, can usually just be regularly monitored and is unlikely to cause problems. Where treatment is requested for cosmetic reasons, surgery (a thyroidectomy) is occasionally suggested, although totoal removal of the thyroid gland will result in the patient requiring lifelong thyroxine replacement.

Treatment of overactive and underactive thyroid is explained in articles on hyperthyroidism and hypothyroidism respectively.

Are there any side-effects to the treatment?

The majority of patients respond well to treatment and do not experience any side-effects.

A fine needle aspiration is usually conducted without any problems and only causes minor discomfort to the patient.

Surgery carries the normal risks of any operation (the risks from anaesthetic, post-operative infection, haemorrhage, bleeding and scar formation), and may lead to an underactive thyroid. It can rarely cause specific complications with damage to the recurrent laryngeal nerve (controlling the voice box) resulting in a hoarse voice, or damage to the glands around the thyroid (parathyroid glands) which control calcium. This may result in a low calcium level (hypocalcaemia) in the blood requiring medication.

What are the longer-term implications of goitre?

Occasionally, a large goitre will press on nearby structures, for instance making it difficult to swallow. If that happens, it may be appropriate to consider surgery. Usually there are no long-term implications of goitre, and the safest thing is to avoid unnecessary surgery once medical assessment has been made.

 

 

Reviewed: January 2015

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