Thyroid Goitre: All You Need To Know!

Thyroid goitre, commonly referred to as goitre, is an irregular enlargement of the thyroid gland situated below the Adam’s apple of the neck. In this condition, the entire thyroid gland enlarges, or one or multiple thyroid nodules (lumps) develop in the gland.

Goitre is not a disease but a sign of an underlying condition affecting thyroid function. If not treated properly, it can lead to various health complications. Keep reading to learn about the symptoms of goitre, its types, causes, treatment options, and more for effective management and medical care.

Symptoms and Signs of Thyroid Goitre

In most cases, goitres are unnoticeable due to their small size and painless nature. However, for individuals with thyroiditis(thyroid gland inflammation), goitre can be painful. Below are the common symptoms that can help identify thyroid goitre in individuals:

• Swelling of neck veins
• Scratchy or hoarse voice
• Coughing
• Breathing difficulties
• A tightness around the throat
• A lump below the Adam’s apple
• Wheezing due to windpipe squeezing
• Feeling dizzy while raising arms above the head
• Swallowing issues as the oesophagus gets squeezed due to goitre

What are the Different Types of Thyroid Goitres?

Based on different ways of classification (enlargement and thyroid hormone level), goitre is of 5 types:

• Nodular Goitre: The development of a fluid-filled or solid lump in an individual’s thyroid gland indicates nodular goitre.
• Multinodular Goitre: Multiple nodules or lumps within the thyroid gland cause a multinodular goitre in individuals. These nodules are not visible without a scan or test.
• Diffuse (Simple) Goitre: Swelling of the entire thyroid gland that feels smooth upon touching is diffuse or simple goitre.
• Non-toxic Goitre: It happens when an individual’s thyroid gland swells or enlarges despite normal thyroid levels.
  Toxic Goitre: When excessive thyroid hormone is produced, and the gland enlarges, it is called a toxic goitre.

What Causes Thyroid Goitre?

Several factors cause swelling of the thyroid gland, leading to goitre. Here are some of them:

• Hashimoto’s Disease

This autoimmune disease occurs when an individual’s immune system attacks the healthy tissues. Due to damage and inflammation, thyroid tissues fail to produce adequate hormones, causing hypothyroidism. The pituitary gland, upon detecting this, prompts the thyroid gland to produce more hormones, causing thyroid enlargement. 

• Thyroid Cancer

Though treatable, it is one of the uncommon cancer types caused due to thyroid nodules. Thyroid nodules (irregular growth or lumps in thyroid cells) are mostly non-cancerous, except for a 5% chance of being cancerous.

• Iodine Deficiency

Adequate iodine in an individual’s blood is necessary for producing thyroid hormones. Deficiency of dietary iodine can affect hormone production. It causes the pituitary gland to signal the thyroid gland for more hormone production, causing thyroid growth.

• Pregnancy

During pregnancy, females produce hCG (human chorionic gonadotropin) hormone, which may result in an overactive or enlarged thyroid gland.

• Grave’s Disease

It is an autoimmune disorder caused by the immune system producing a protein that resembles TSH (thyroid-stimulating hormone). Hyperthyroidism develops when this protein causes an overproduction of hormones, leading to thyroid growth.

Diagnosis of Thyroid Goitre

In most cases, physical examination (touching the neck) helps detect the thyroid growth or nodules in this gland. However, sometimes, it may go unnoticed unless the patient undergoes an imaging test. Here are some of the diagnostic procedures that can help detect goitre:

• Ultrasonography

In this process, a transducer (wand-like device) is waved over an individual’s neck. This device uses sound waves to produce a digital image of neck tissues and the thyroid gland. Ultrasonography can detect abnormal growth in the size of the thyroid gland and the presence of nodules.

• Thyroid Function Test

In this test, the pathologist collects blood samples to measure the amount of TSH (thyroid stimulating hormone), T3 (triiodothyronine), and T4 (thyroxine) in an individual’s body. It detects if the goitre is caused due to an increase or decrease in the function of these hormones.

• Antibody Test

Healthcare providers suggest an antibody test based on the results of thyroid function tests. This helps detect antibodies associated with autoimmune disorders like Grave’s disease or Hashimoto’s disease.

• Fine Needle Aspiration Cytology (FNAC)

In this process, the pathologist obtains fluid or tissue from the patient’s thyroid nodules using a small needle. A biopsy of these samples helps detect cancerous cells.

• Radioactive Iodine Uptake

In this test, the healthcare provider provides radioactive iodine in small amounts to evaluate the thyroid's iodine uptake and rate of absorption. This generates a visual image of the iodine distribution and helps detect the cause and function of goitre.

How to Treat Thyroid Goitre?

The treatment of thyroid goitre mostly depends on its size, symptoms, and cause. Depending on these factors, doctors can suggest medications or surgery for goitre treatments:

Medications

Here are some of the medications to treat thyroid goitre:

• Beta Blockers

Drugs like beta blockers can treat hyperthyroidism (overactive thyroid), one of the major causes of goitre. Drugs containing metoprolol, atenolol, etc., can reduce hormone production.

• Thyroid Hormone Replacement

Individuals with goitre due to an underactive thyroid can take thyroid hormone replacement to increase hormone production. Drugs containing levothyroxine can replace T4 and cause the pituitary gland to release less TSH.

 Doctors may suggest liothyronine-containing drugs to replace the T3 hormones.

• Anti-thyroid Drugs

These drugs reduce hormone production and are used to treat overactive thyroid. Health providers may prescribe drugs containing methimazole to treat this condition and reduce the goitre size.

• Pain Relievers

Thyroid inflammation can cause unbearable pain. To relieve such pain, doctors prescribe medicines containing aspirin, ibuprofen, naproxen sodium, etc.

Surgery

In the following conditions, individuals need to undergo a partial or thyroidectomy surgery (whole or partial thyroid removal):

• Swallowing or breathing difficulties
• Thyroid cancer
• Hyperthyroidism due to thyroid nodules, etc.

Prognosis and Complications of Thyroid Goitre

The prognosis of thyroid goitre mainly depends on its cause and type. For example, simple goitre has a better prognosis, as thyroid enlargement compresses surrounding structures, causing breathing and swallowing difficulties.

However, when goitre is caused due to another thyroid disease, prognosis solely depends on the reason behind thyroid enlargement.  

Complications in goitres are not quite common, except for the large goitres that obstruct the voice box and airway. Thyroid hormone production disorders associated with goitre may cause complications in various body systems.

Prevention of Thyroid Goitre

You cannot prevent goitres in most cases, except for the types caused by iodine deficiency. However, dietary iodine, such as dairy products, fish, iodised table salts, etc., can help prevent goitres caused by iodine deficiency.

Conclusion

Thyroid goitre is an important indicator of underlying health conditions related to thyroid function. Understanding its symptoms, types, causes, etc., helps individuals seek timely medical attention and manage their health effectively.

Though most cases are manageable with appropriate interventions, awareness and education about this condition are crucial to prevent potential complications associated with untreated thyroid disorders.