Goitre (Enlarged Thyroid)

A goitre is an enlarged thyroid gland, seen or felt as a swelling at the front of the neck. The gland may be enlarged evenly, called a diffuse goitre, or contain several lumps, called a multinodular goitre. The thyroid may be producing normal, too much or too little hormone.

Most goitres are benign, grow slowly and need nothing more than monitoring. Treatment becomes necessary when the goitre presses on the windpipe or gullet, when it is overactive, when a nodule within it looks suspicious, or when its appearance troubles you.

Symptome

• A visible swelling at the base of the neck
• A feeling of tightness, especially with collars or scarves
• Difficulty swallowing solid food
• Breathlessness or noisy breathing when lying flat or raising the arms
• A cough or a hoarse voice
• Palpitations, weight loss, tremor and intolerance of heat if the goitre is overactive
• Tiredness, weight gain and feeling cold if it is underactive

Ursachen und Risikofaktoren

Worldwide the leading cause is a lack of iodine in the diet. Where salt is iodised, the usual causes are multinodular change with age, which often runs in families, Hashimoto's thyroiditis, Graves' disease, pregnancy and certain medicines such as lithium and amiodarone. Women are affected several times more often than men. Multinodular goitres grow slowly over decades and may gradually become overactive. A large goitre can extend downwards behind the breastbone, where it is not visible but can narrow the windpipe.

Wie es diagnostiziert wird

• Neck examination: Assesses the size of the gland, any nodules, the lower edge of the gland and the lymph nodes.
• Thyroid blood tests: TSH first, followed by free T4 and T3 and thyroid antibodies as required.
• Thyroid ultrasound: Measures the gland and grades each nodule with a risk score such as TI-RADS.
• Fine needle aspiration: For nodules that meet size and appearance criteria, to exclude cancer.
• Thyroid uptake scan: When the TSH is low, to find overactive hot nodules.
• CT of the neck and chest without iodine contrast, and breathing tests: For goitres that extend behind the breastbone or cause symptoms of airway narrowing.

Behandlungsmöglichkeiten

• Observation: A yearly examination, TSH and periodic ultrasound for small goitres that function normally.
• Correction of iodine intake: Where a deficiency exists. Excess iodine and kelp supplements can do harm.
• Thyroidectomy: Removal of the whole gland or one half for compressive symptoms, extension behind the breastbone, suspicious cytology, overactivity or cosmetic concern. Lifelong levothyroxine is needed after total removal.
• Radioactive iodine: Shrinks an overactive or large multinodular goitre by about 30 to 50 percent over a year or two. It is an alternative for people who should avoid surgery.
• Antithyroid medicines: Used to control overactivity before definitive treatment.
• Radiofrequency ablation of nodules: Shrinks a single dominant benign nodule without surgery. It is less suitable for a goitre made up of many nodules.
• Levothyroxine to shrink the gland: No longer recommended as routine, since the benefit is small and carries risks for the heart and bones.

Wenn es dringend ist

Rapid enlargement of the neck, noisy breathing, difficulty breathing when lying down, or sudden pain and swelling from bleeding into a nodule need urgent hospital assessment nearby. High fever, severe agitation and a racing heart in someone with an overactive thyroid may indicate a thyroid storm, which is an emergency.

Reisen nach Türkiye zur Behandlung

Thyroidectomy for a goitre is a planned operation that fits a visit of about 7 to 10 days, and the volume of operations performed by the surgeon is closely linked to lower rates of voice and calcium complications. Do your blood tests, ultrasound and any needle sampling before booking, so that the need for surgery is clear, and ensure overactivity is controlled beforehand. Adjustment of the levothyroxine dose and calcium checks continue at home in the following weeks. Radioactive iodine involves radiation safety rules that make flying soon afterwards impractical.

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