CONDITIONS
Goitre
A goitre is an enlargement of your thyroid gland. This enlargement of the thyroid may be because of irregular cell growth forming one or more lumps (nodules) in the thyroid. A goitre may or may not be associated with a change in thyroid function or thyroid hormones. The most common cause of goitres worldwide is a lack of iodine in the diet. Indians are prone to goitre owing to high iodine deficiency. The prevalence of goitre is around 11% in India.
What are the symptoms of goitre?
Apart from swelling at the base of the neck, most people with goitres have no signs or symptoms. In many cases, the goitre may be discovered during a routine medical exam or while undergoing tests for another condition. Other signs and symptoms depend on the functional change in the thyroid gland (hypo or hyper–thyroid), and on how quickly it grows.
The signs and symptoms of hypothyroidism include:
- Fatigue (tiredness)
- Increased cold sensitivity.
- Increased sleepiness
- Dry skin
- Constipation
- Muscle weakness
- Irregular period
- Tingling in hands
- Weight gain
Problems with memory or concentration
Signs and symptoms of hyperthyroidism include:
- Weight loss despite increased appetite
- Rapid heartbeat (tachycardia)
- Increased sensitivity to heat
- Excess sweating
- Tremors
- Irritability and nervousness
- Muscle weakness
- Frequent bowel movements
- Changes in menstrual patterns
- Sleep difficulty
- High blood pressure
- Nausea
Sometimes, a goitre may obstruct the airway and voice box by its size or position. The signs and symptoms of obstructive goitre may include:
- Difficulty swallowing
- Difficulty breathing with exertion.
- Cough
- Hoarseness (voice changes)
- Snoring
What are the causes of goitre?
A deficiency of iodine is the main cause of goitres. India has the largest number of children vulnerable to iodine deficiency at birth. Iodine, a vital element of thyroid hormone production, is trapped by the thyroid gland to produce the hormone. In case of insufficient iodine, the process of hormone production is hampered.
Autoimmune disorders (Hashimoto’s disease) and multinodular goitre are also major causes of goitre.
Goitre is also caused by an inflammation of the thyroid, called thyroiditis.
- Risk factors for goitres include:
- People above the age of 40.
- Women – they are more likely to have goitres and overall thyroid disorders
- Pregnancy or menopause, since they are linked to thyroid
- History of autoimmune disease
- Medications, such as lithium (used for mood disorders) and amiodarone (for irregular heartbeat)
- Exposure to radiation by cancer treatments
- Areas with iodine deficiency
How is Goitre diagnosed?
A simple neck examination by the doctor may result in a diagnosis of goitre. The doctor may suggest tests to further know the cause for a proper treatment approach. These tests include:
- An ultrasound is conducted to detect the size of the thyroid and for the presence of nodules
- Blood tests – For measuring thyroid hormone levels.
- A biopsy (Using a thin needle to obtain a sample for tissue or fluid testing) – to rule out cancer.
- A thyroid scan (Creating an image of the thyroid by injecting a little radioactive material) – for the doctor to assess the size and functioning of the thyroid
- A CT scan or MRI – to check if the goitre is large or has spread to the chest
How is Goitre treated?
Treatment is focused on getting the thyroid hormone levels back to normal. In cases where the goitre is small or thyroid hormone levels are normal, treatment may not be necessary. In other cases where levels are on extreme ends, the following treatment options are available:
Medications: A thyroid hormone replacement medication may be prescribed by the doctor to attain normal thyroid levels. Post-effect, the thyroid may return to its normal size. Additional medications may be given for goitres caused by inflammation.
Surgery: In cases of –
- uncomfortable goitre,
- over-productive thyroid hormone producing goitre nonresponsive to medications,
- large-sized, symptom-causing goitre, or
- cancerous, a part or the entire thyroid gland may be surgically removed.
Post-surgery, the patient would have to take thyroid hormone medicine for the rest of their life.
Radioactive iodine: Treating an overactive thyroid with radioactive iodine kills the cells to shrink the thyroid gland. Hormone drugs would be prescribed continually after this treatment.
Regular checks to ensure that the goitre isn’t growing larger or developing nodules could be suggested by the doctor.
References
1. Goiter. (November 2023). Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/goiter/symptoms-causes/syc-20351829
2. Carol DerSarkissian, MD. Goiter. (November 2023). WebMD. https://www.webmd.com/women/understanding-goiter-basics
3. Pandav CS, Yadav K, Srivastava R, Pandav R, Karmarkar MG. Iodine deficiency disorders (IDD) control in India. Indian J Med Res. 2013 Sep;138(3):418-33.