Goitre

What is goitre?

Goitre is an enlarged thyroid gland. The thyroid gland is a butterfly-shaped gland at the base of your neck. It secretes thyroid hormones, which are needed for:

• normal brain growth in children
• controlling many aspects of your metabolism

Goitre is a sign that there is something wrong with your thyroid gland. It is more common in females than males.

What are the symptoms of goitre?

Goitre can show as an obvious lump or swelling at the bottom of your neck. Goitres are usually painless, but it can feel sore or tender around your thyroid area.

In some people, goitre causes no symptoms.

A large goitre can press on your windpipe or your oesophagus (food pipe, or ‘gullet’). This can:

• cause cough
• cause a hoarse voice
• make it hard to swallow
• cause breathing problems

If you have goitre, you might also have too much thyroid hormone (hyperthyroidism) or too little thyroid hormone (hypothyroidism).

What causes goitre?

The main causes of goitre are:

• nodules or lumps in your thyroid gland
• hormone changes during puberty, pregnancy or menopause
• an inflamed thyroid gland (thyroiditis)
• autoimmune diseases such as Hashimoto’s disease or Grave’s disease
• a lack of iodine in your diet
• a tumour or thyroid cancer

Iodine is a mineral. Your body uses iodine to make thyroid hormones. In Australia, not having enough iodine is not that common. This is because iodine is added to most breads as iodised salt. But iodine deficiency can still occur. Breastfeeding and pregnant people have a greater need for iodine.

When should I see my doctor?

See a doctor if you see or feel a lump at the base of your neck, or if you have any of the other symptoms of goitre.

How is goitre diagnosed?

If you have goitre, your doctor will ask about your symptoms and examine you. They’ll look at your thyroid gland. They will feel its shape, size, and check for lumps.

You will have blood tests to see how well your thyroid gland is functioning. An ultrasound may be recommended to check the structure of your thyroid gland.

If you need more testing your doctor may order a:

• computed tomography (CT) scan
• an imaging test called a radionuclide thyroid scan

You may also need a biopsy. This is when a doctor takes a sample of your thyroid gland. This sample is tested for disease.

How is goitre treated?

Your treatment will depend on the cause of your goitre.

If your goitre is small and your thyroid function is normal, you might not need treatment. This is often true during puberty and pregnancy.

If your goitre is due to your thyroid gland being overactive or underactive you will be given medicines.

If you have breathing or swallowing problems, you may need to have surgery.

Medication

You might be given medicine if your thyroid gland is producing either too much or too little thyroid hormone.

If you have painful swelling of your thyroid, your doctor may recommend pain relievers or corticosteroids.

Radiation or surgery

Radioactive iodine treatment (radioiodine) is another treatment choice. It’s usually given to people with thyroid cancer after they have had their thyroid gland removed. It can also be given to some people with Graves’ disease or nodules or lumps in the thyroid.

Radioactive iodine comes as a tablet. The radioactive iodine spreads through your body. It is absorbed only by your thyroid cells, killing them. It doesn’t affect your other (healthy) cells.

People with a large goitre that is causing difficulty breathing or swallowing might need surgery. People with nodules or lumps in the thyroid may also have surgery as part of their treatment.

Can goitre be prevented?

Only goitre caused by a lack of iodine in your diet can be prevented.

Iodine is in many foods, but the actual amount of iodine will vary. It depends on where the food is grown and how it is made.

Iodine occurs naturally in seawater and coastal soils. Oysters, sushi (with seaweed) and tinned salmon are all good sources of iodine. Eggs and milk also contain iodine.

In Australia, all bread contains iodised salt, except for organic bread. Eating bread regularly should help keep up your iodine levels. Ensure that any table salt you used is iodised salt.

Women who are pregnant, considering becoming pregnant or breastfeeding should take a 150 micrograms of iodine each day.

What are the complications of goitre?

A large goitre can make it hard to breathe or swallow. Goitres can also affect the amount of thyroid hormones that you make.