Got A Goiter

Overview

A goiter is simply an enlarged thyroid gland. Your thyroid is a small, butterfly-shaped gland that sits at the front of your neck, just below your Adam's apple. It makes hormones that control how fast your body uses energy (your metabolism). When the gland grows bigger than normal, the swelling is called a goiter. Some people with a goiter have a thyroid that works normally, some have a thyroid that is underactive (hypothyroidism), and some have one that is overactive (hyperthyroidism). Having a goiter does not mean you have cancer — the great majority of goiters are not cancer.

Yes. Goiters are common around the world and are one of the most frequent reasons people are referred to a thyroid clinic. In many parts of the world, the most common cause is not getting enough iodine from food. In countries where iodine is added to salt or occurs naturally in the diet, goiters are less common but still seen, usually because of thyroid nodules (lumps in the gland) or an autoimmune thyroid condition.

Anyone can develop a goiter, including children. It is more common in women than in men, becomes more common with age, and often runs in families. You may be more likely to get one if you live somewhere with low iodine in the soil and food supply, have an autoimmune thyroid condition, have thyroid nodules, are pregnant or going through the menopause, or take certain long-term prescription medicines.

Symptoms

Common symptoms

• A visible swelling or fullness at the base of the front of your neck
• A lump you can feel in the neck, which may be smooth and even or bumpy
• A feeling of tightness or pressure in the throat
• A tickly cough or a feeling of needing to clear your throat
• Difficulty swallowing solid food, or a feeling that food sticks
• A hoarse or changing voice
• A tight collar or necklace feeling uncomfortable
• Symptoms of a slow thyroid, such as tiredness, weight gain, feeling cold, dry skin and constipation
• Symptoms of an overactive thyroid, such as weight loss, a fast or pounding heartbeat, sweating, shaky hands, anxiety and trouble sleeping

Symptoms in children

• A swelling in the neck, often first noticed by a parent, teacher or during a swim or school photo
• Trouble swallowing or a hoarse voice
• A slow thyroid can affect growth, so a child may be shorter than expected or go through puberty later
• An overactive thyroid can cause poor concentration, restlessness, behaviour changes or falling school performance
• Tiredness, weight change or a change in energy levels that lasts weeks

Symptoms in older adults

• Often no symptoms at all — the goiter may be found during a routine check or a scan done for another reason
• A neck lump that grows slowly over months or years
• An overactive thyroid may show up mainly as an irregular heartbeat, breathlessness or unexplained weight loss
• A slow thyroid may show up as low energy, low mood, confusion or constipation rather than the classic picture
• Pressure symptoms, such as trouble swallowing, can feel worse if the goiter is large

Causes

Main causes

• Not getting enough iodine from food — the single most common cause worldwide, because the thyroid needs iodine to make its hormones
• Multinodular goiter — several lumps (nodules) growing in an otherwise normal gland, very common in older adults
• A single thyroid nodule that has enlarged the gland
• Hashimoto's thyroiditis — an autoimmune condition where the body's immune system slowly damages the thyroid, often causing an underactive thyroid
• Graves' disease — an autoimmune condition that makes the thyroid overactive and enlarged
• Pregnancy and the years around the menopause, when hormone changes can enlarge the gland
• Some long-term prescription medicines, including certain medicines used for mood and heart conditions
• Thyroiditis — inflammation of the thyroid after a viral illness or after childbirth
• In rare cases, thyroid cancer or a lymphoma in the thyroid

Risk factors

• Being female
• A family history of goiter, thyroid nodules or autoimmune thyroid disease
• Living in a region where the soil and food contain little iodine
• Smoking — smoking can make the thyroid enlarge and can worsen thyroid eye problems
• Having another autoimmune condition, such as type 1 diabetes or coeliac disease
• Pregnancy and the first year after childbirth
• Increasing age, especially over 50
• Past radiotherapy to the neck, or a strong family history of thyroid cancer

When to see a doctor

See a doctor urgently if:

• You cannot breathe comfortably, or your breathing is noisy
• The swelling is getting bigger fast or is painful with a fever
• Your voice has been hoarse for more than three weeks
• You are struggling to swallow, or food feels stuck
• You have a fast, irregular heartbeat along with sweating, shaking and weight loss

Book a routine appointment if:

• You have noticed a swelling or lump in the front of your neck that was not there before
• A lump has been there a while and seems to be slowly changing
• You have goiter symptoms plus tiredness, weight change, feeling cold or feeling hot
• You have a family history of thyroid problems and want a check-up
• You are pregnant or planning a pregnancy and have a known thyroid condition

Diagnosis

Your doctor will start by asking about your symptoms, your family history, your diet and any medicines you take. They will look at and gently feel your neck while you swallow, and check your pulse. A simple blood test then shows whether your thyroid is working normally, too slowly or too fast. If the gland is enlarged or lumpy, an ultrasound scan of the neck is often used to look at its size and shape and to check any nodules. Depending on the results, you may be offered a small sample (biopsy) taken with a fine needle, or a scan that shows how actively the gland is taking up iodine. None of these tests are unusual, and your doctor will explain why each one is being suggested.

Tests that may be done

• A physical examination of the neck
• Blood tests to measure thyroid hormone levels and thyroid-stimulating hormone (TSH), the signal from the brain that tells the thyroid what to do
• Antibody blood tests, to look for autoimmune thyroid conditions
• An ultrasound scan of the thyroid — painless, using sound waves, no radiation
• Fine needle aspiration — a thin needle takes a few cells from a nodule so they can be checked under a microscope
• A radioactive iodine uptake scan or a thyroid scan, in some cases, to see how active the gland is
• Sometimes a scan of the windpipe or a swallowing assessment if the goiter is large

What to expect at your appointment

Most people need only a blood test and an ultrasound, and get their results within a week or two. A fine needle biopsy is done in the clinic, takes a few minutes and feels like a quick sting; you can usually go home straight afterwards. Your GP may manage everything, or may refer you to a thyroid or endocrine specialist if the goiter is large, lumpy, pressing on nearby structures, or if your hormone levels are abnormal.

Treatment

Treatment depends entirely on the cause, the size of the goiter, whether it is pressing on anything, and whether your thyroid hormone levels are normal. Many small goiters with normal hormone levels need no treatment at all — just a check-up every so often to make sure nothing is changing. If the thyroid is not working properly, or the goiter is causing symptoms, there are several effective options and your doctor will discuss which suits you.

Self-care at home

• Keep taking any prescribed thyroid medicine exactly as directed, and do not stop it on your own
• Attend your follow-up appointments and blood tests, even when you feel well
• Eat a balanced diet; if you live somewhere with low iodine, use iodised salt as part of normal cooking
• Avoid taking high-dose iodine supplements or kelp supplements unless your doctor advises them — too much iodine can make things worse
• If you smoke, try to stop; ask your GP or pharmacist for support
• Wear looser collars and scarves if your neck feels tight
• Note any change in the size of the swelling, your voice or your swallowing, and mention it at your next visit
• Tell any doctor, dentist or surgeon that you have a goiter before neck procedures or imaging

Medical treatments

If your thyroid is underactive, the usual approach is daily thyroid hormone replacement in tablet form, which replaces what your body is not making; the dose is adjusted using blood tests until it suits you. If your thyroid is overactive, treatment aims to slow it down — this can include medicines that reduce hormone production, treatment with radioactive iodine to shrink an overactive gland, or sometimes surgery. If the goiter is simply large but your hormones are normal, the focus is on watching it and managing pressure symptoms. Painful inflammation of the thyroid is usually treated with anti-inflammatory pain relief and time. Your doctor will explain the choices, the pros and cons, and how each option might affect you — never start, stop or change any medicine without speaking to them first.

When is surgery considered?

Surgery to remove part or all of the thyroid may be suggested if the goiter is large and pressing on your windpipe or food pipe, if it is causing serious trouble breathing or swallowing, if one or more nodules look suspicious on testing, if you have an overactive thyroid that is not settling with other treatments, or if the size of the goiter is causing you significant distress. Surgery is usually straightforward and safe, but like any operation it has risks, including changes to your voice and, if the whole gland is removed, a lifelong need for thyroid hormone tablets. Your surgical team will talk these through with you in detail.

Living with this condition

For most people a goiter is a background issue rather than a daily problem. You may simply need a blood test and a check-up once a year, and many goiters stay the same size for years. If you are on thyroid hormone treatment, the main task is remembering your tablet each day and having your levels checked when your doctor asks. Some people feel self-conscious about how their neck looks; that is very understandable, and it is worth mentioning to your doctor, because there are options.

Lifestyle tips

• Take your thyroid medicine at the same time each day, and ask your pharmacist how to take it so it is absorbed well
• Keep a simple symptom diary if you are having treatment changes, so you can see patterns
• Get regular sleep and gentle activity — both help with energy levels and mood
• Avoid smoking, and limit alcohol
• Tell your doctor if you are planning a pregnancy, as thyroid needs change
• Ask about a medical alert card or note on your phone if you take thyroid hormone for a completely removed or non-working gland

Diet and exercise

A normal, balanced diet is all most people need. If you live in an area where iodine is low in the food supply, using iodised salt in everyday cooking is a simple way to meet your needs. Avoid taking kelp, seaweed or high-dose iodine supplements without medical advice, as excess iodine can trigger or worsen thyroid problems. Cruciferous vegetables like cabbage and broccoli are fine in normal amounts — you would have to eat enormous quantities for them to matter. Regular moderate exercise such as walking, swimming or cycling is good for your heart, weight and mood, and is safe with a goiter. If your thyroid is overactive, your heart may race with exercise, so build up gently and check with your doctor first.

Mental health and emotional wellbeing

A swelling in the neck can be genuinely worrying, and many people find themselves checking it in the mirror or thinking about it a lot while they wait for tests. Both an overactive and an underactive thyroid can also affect mood directly — anxiety, low mood, irritability and poor sleep are common. These feelings are real and treatable, not a sign of weakness. If low mood, anxiety or worry about your health is affecting your sleep, work or relationships, please tell your doctor. If you ever have thoughts of harming yourself, contact your local emergency number or a crisis line in your country straight away — you deserve immediate support.

Prevention

Not all goiters can be prevented, especially those caused by autoimmune conditions or nodules, which are largely down to genetics. But the single biggest preventable cause worldwide is iodine deficiency, and getting enough iodine from food prevents many goiters. Public health programmes that add iodine to salt have dramatically reduced goiters in many countries. Not smoking also lowers your risk, and avoiding unnecessary high-dose iodine supplements is sensible.

Vaccines

There is no vaccine that prevents a goiter. Keeping up with routine vaccinations is still good general health advice, and flu and other vaccines are safe for people with thyroid conditions.

Screening programmes

There is no general screening programme for goiter in most countries. Testing is offered when you have symptoms or a noticeable swelling. Thyroid blood tests may be offered in certain situations — for example during pregnancy or when planning a pregnancy if you have a thyroid condition or family history, when you have symptoms of a thyroid problem, or when you take a medicine that can affect the thyroid. If you are unsure whether you should be tested, ask your GP.

Complications

If left untreated

• An underactive thyroid left untreated can cause ongoing tiredness, weight gain, low mood, high cholesterol and heart problems
• An overactive thyroid left untreated can cause heart rhythm problems, bone thinning, muscle weakness and, rarely, a dangerous sudden worsening of symptoms
• A large goiter can press on the windpipe, causing shortness of breath, or on the food pipe, causing difficulty swallowing
• Pressure on the nerve to the voice box can cause a hoarse voice
• Bleeding into a nodule can cause sudden painful swelling
• Some nodules can, in a small number of cases, be cancerous — which is why lumps are checked
• Cosmetic concerns and worry about appearance can affect confidence and wellbeing

Long-term outlook

The outlook is good for most people. The great majority of goiters are not cancer, many stay the same for years and need only occasional check-ups, and the treatments available for an underactive or overactive thyroid work very well. If surgery is needed, most people recover well and get back to normal life. The important thing is to have it checked, keep your follow-up appointments, and tell your doctor if anything changes — that way any problem is caught early, when it is easiest to deal with.

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