Goitre

Introduction

A goitre is a swelling of the front of the neck due to enlargement of the thyroid gland. It may affect persons of any age. Not all neck swellings are goitres.
Goitres are usually benign but may occasionally be malignant. They could be associated with normal, reduced or excessive function of the thyroid gland.
A reduction in production of thyroid hormones results in hypothyroidism while an excess results in hyperthyroidism or thyrotoxicosis.
Abnormalities of thyroid hormone production may also occur in the absence of goitre.
Proper diagnosis and selection of appropriate surgical or non-surgical treatment of benign and malignant goitres is by full clinical assessment and investigations.
Treatment is not necessarily by increasing iodine intake e.g. in iodated salt. Excess iodine intake may actually be harmful in some cases.

Causes of goitre

  • Simple non-toxic goitre or endemic goitre
  • Hypothyroidism (SeeĀ  ‘Hypothyroidism’)
  • Hyperthyroidism or Thyrotoxicosis (See ‘Hyperthyroidism’)
  • Thyroid neoplasm – benign or malignant

Symptoms of goitre

  • Swelling in the neck
  • Breathing and swallowing difficulty, if large
  • Symptoms of hypothyroidism
  • Symptoms of hyperthyroidism

Signs of goitre

  • Diffuse (smooth) or nodular (irregular) thyroid swelling
  • Signs of hypothyroidism
  • Signs of hyperthyroidism

Investigations

  • Thyroid function tests – free T3, free T4, TSH
  • Thyroid ultrasound scan
  • Thyroid autoantibodies (if necessary)
  • Radioisotope scan of thyroid (if necessary)
  • Fine needle aspiration cytology (if necessary)
  • X-ray of the neck including thoracic inlet view for large

Treatment for goitre

Treatment objectives

  • To assess and correct level of thyroid hormone production
  • To reduce symptoms associated with thyrotoxicosis
  • To reduce or prevent obstructive symptoms
  • To identify thyroid neoplasms and manage appropriately

Non-pharmacological treatment

  • Subtotal thyroidectomy where indicated

Pharmacological treatment

  • Appropriate treatment of hypothyroidism or hyperthyroidism (See ‘Hypothyroidism’ and ‘Hyperthyroidism’)

Referral Criteria

  • Refer patients to a physician or surgical specialist where complications (e.g. hypothyroidism, hyperthyroidism, breathing difficulty etc.) or malignancy are suspected or if full clinical assessment and investigations are not possible.