Goitre (Thyroid Swelling)

What is a goitre?

A goitre is an enlarged thyroid gland. A goitre can mean that all the thyroid gland is swollen or enlarged, or one or more swellings or lumps develop in a part or parts of the thyroid.The thyroid gland is in the lower part of the front of the neck. It lies just in front of the trachea (windpipe). It has a right and left lobe which are connected together by a narrower band of thyroid tissue. (It is roughly the shape of a butterfly.) You cannot usually see or feel a normal thyroid gland. If the thyroid enlarges it causes a swelling in the neck which you can see - a goitre.The thyroid gland makes thyroid hormones - called thyroxine (T4) and triiodothyronine (T3). These hormones are carried round the body in the bloodstream. Thyroxine and T3 help to keep the body's functions (the metabolism) working at the correct pace. Many cells and tissues in the body need thyroxine and T3 to keep them working correctly.

Goitres and thyroid function (production of thyroid hormones)
In many people with a goitre the goitre does not affect the amount of thyroxine or T3 that you make. You are then 'euthyroid' which means you make the correct amount of these hormones.
In some people, the goitre is associated with an abnormality of thyroid function. You may make too much thyroxine or T3 (hyperthyroidism or overactive thyroid) or too little thyroxine or T3 (hypothyroidism or underactive thyroid). See separate leaflets called about these conditions.
Note: you can also develop an overactive or underactive thyroid without having a goitre.

What are the symptoms of a goitre
In many cases there are no symptoms apart from the appearance of a swelling in the neck. The size of a goitre can range from very small and barely noticeable, to very large.
Most goitres are painless. However, an inflamed thyroid (thyroiditis) can be painful.
If your thyroid makes too much or too little thyroxine or T3, this can cause a range of symptoms. See separate leaflets called 'Hyperthyroidism (Overactive Thyroid)' and 'Hypothyroidism (Underactive Thyroid)' for more detail.
A large goitre may press on the trachea (windpipe) or even the oesophagus (gullet) behind the trachea. This may cause difficulty with breathing or swallowing.
Assessing the situation
When you have a goitre a doctor will usually do some blood tests to check if you are making too much or too little thyroxine or T3. Blood tests may also help to find out the cause of some goitres. Other tests may be done to find out the cause of the goitre. For example:
An ultrasound scan of the thyroid. This may be done if you have a single nodule. An ultrasound scan is a safe and painless test which uses sound waves to create images of organs and structures inside your body. It can tell if a nodule is a cyst or a solid lump.
A small piece of tissue (a biopsy) may be taken from a nodule to look at under the microscope. The biopsy is done by inserting a thin needle into the nodule. (It is a bit like taking a blood sample but the needle is smaller.) It is a simple and safe procedure.
A radioactive iodine scan or similar test. This may be done to see if any nodules are making too much thyroxine or T3. (The radioiodine concentrates in tissue that makes thyroid hormones.) See separate leaflet called 'Radionuclide (Isotope) Scan' for more detail.
In some situations a chest X-ray is done if it is suspected that a goitre extends downwards into the chest.

What is the treatment for a goitre?
Treatment depends on the cause, the size of the goitre, and whether it is causing symptoms. For example:
If you have a small goitre that is not due to a cancerous nodule, and your thyroid is making the correct amount of thyroxine and T3, then you may not need any treatment.
You will need treatment if you make too much or too little thyroxine or T3.
An operation to remove some or all of the thyroid may be an option in some cases.
Radioactive iodine treatment may be an option for a goitre causing an overactive thyroid. This involves taking a drink, or swallowing a capsule, which contains radioactive iodine. The radioactive iodine builds up in the thyroid gland. As the radioactivity is concentrated in the thyroid gland, it destroys some thyroid tissue. You may need to take thyroxine tablets after having radioactive iodine if too much of the thyroid is destroyed.
If you have cancer of the thyroid, you will probably need an operation to remove the cancer and some of the thyroid gland.
Iodine replacement, if the goitre is due to lack of iodine in the diet.