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Goitre

A goitre is an enlargement of the thyroid gland that is NOT associated with inflammation or cancer.

Causes, incidence, and risk factors Return to top

There are different kinds of goitres. A simple goitre usually occurs when the thyroid gland is not able to produce enough thyroid hormone to meet the body's requirements. The thyroid gland compensates by enlarging, which usually overcomes mild deficiencies of thyroid hormone.

A simple goitre may be classified as either an endemic (colloid) goitre or a
sporadic (nontoxic) goitre.

Endemic goitres occur within groups of people living in geographical areas with iodine-depleted soil, usually regions away from the sea coast. People in these communities might not get
enough iodine in their diet. (Iodine is vital to the formation of thyroid hormone.) The modern
use of iodized table salt prevents this deficiency; however, it is still common in central Asia
and central Africa. Certain areas of Australia, including Tasmania and areas along the Great Dividing Range (for example, the Australian Capital Territory), have low iodine levels in the
soil.

In most cases of sporadic goitre the cause is unknown. Occasionally, certain medications such as lithium or aminoglutethimide can cause a nontoxic goitre.

Hereditary factors may cause goitres. Risk factors for the development of a goitre include female sex, age over 40 years, inadequate dietary intake of iodine, residence in an endemic area, and a family history of goitre.

Symptoms

thyroid enlargement varying from a single small nodule to massive enlargement (neck lump)
breathing difficulties, cough, or wheezing due to compression of the trachea swallowing difficulties due to compression of the esophagus neck vein distention and dizziness when
the arms are raised above the head Signs and tests Return to top

measurement of thyroid stimulating hormone (TSH) and free thyroxine (T4) in the blood
thyroid scan and uptake ultrasound of thyroid -- if nodules are present, a biopsy should be
done to evaluate for thyroid cancer

Treatment

A goitre only needs to be treated if it is causing symptoms. The enlarged thyroid can be
treated with radioactive iodine to shrink the gland or with surgical removal of part or all of
the gland (thyroidectomy). Small doses of iodine (Lugol's or potassium iodine solution) may
help when the goitre is due to iodine deficiency.

Expectations (prognosis)

A goitre is a benign (harmless) process. Simple goitres may disappear spontaneously, or
may become large. Over time, hypothyroidism may develop due to destruction of the normal thyroid tissue. This can be treated with medications to replace the thyroid hormone.

Occasionally, a goitre may progress to a toxic nodular goitre when a nodule is making thyroid hormone on its own. This can cause hyperthyroidism and can be treated with radioactive iodine to destroy the nodule.

Complications

Progressive thyroid enlargement and/or the development of hardened nodules may indicate thyroid malignancy. All thyroid nodules should be biopsied to evaluate for malignancy.
A simple goitre may progress to a toxic nodular goitre.
Hypothyroidism may occur after treatment of a large goitre with radioactive iodine or surgery.
Calling your health care provider

Call your health care provider if you experience any swelling or enlargement in the front of
your neck, increased resting pulse rate, palpitations, diarrhea, nausea, vomiting, sweating without exercise or increased room temperature, tremors, agitation, shortness of breath, or signs of hypothyroidism such as fatigue, constipation, or dry skin.

Prevention

The use of iodized table salt prevents endemic goitre.