Goiter: treatment and symptoms

Goiter, also known as a goitre, is an enlargement of the thyroid gland. The cause of such a swelling of the thyroid gland is often an iodine deficiency, which can lead to lumps in the thyroid gland. It is estimated that every third German has a goitre – often without even knowing it. Because, especially in the beginning, the goitre is usually not accompanied by a noticeable or visible swelling in the neck, many sufferers do not notice any signs. Learn more about the symptoms and treatment of such an enlarged thyroid gland.

symptoms of goitre

Goiter usually initially causes no symptoms or hardly any complaints and is therefore often discovered late or only by chance. The first signs can be swallowing difficulties or feeling pressure and tightness in the throat (“lump in the throat”). A thick neck, reflected in a shirt collar that has become tight, can also be a sign of goitre.

Because the thyroid is close to the trachea, it can press on it when enlarged. In some people, this causes shortness of breath or wheezing. The swollen thyroid gland can also affect vocal cord nerves or blood vessels, causing hoarseness or blood congestion in the head. These symptoms worsen as the thyroid gland swells.

Goiter can affect hormone production in the thyroid gland. If it is accompanied by an overactive thyroid gland (hyperthyroidism) or an underactive thyroid gland (hypothyroidism), the typical symptoms can occur.

 

Identify thyroid swelling with a self-test

To recognize at an early stage whether the thyroid gland is swollen, doctors recommend doing a “level test” regularly. To do this, the head is tilted back, and the area below the larynx is observed with a hand mirror while you drink water.

When swallowing, you should consult a doctor if swelling occurs below the larynx. The same applies to sudden swallowing difficulties or feeling pressure in the throat. With a palpation examination, the doctor can determine the size and condition of the thyroid gland and thus determine whether goitre exists.

Goitre: diagnosis and examinations

If the palpation indicates a swelling of the thyroid gland, an exact diagnosis can be made with the help of further examinations:

• A blood test shows whether the thyroid gland is overactive or underactive.
• The blood’s TSH level  (thyroid-stimulating hormone) also allows conclusions on whether a tumour causes the goitre.
• An ultrasound examination can be used to examine the size and structure of the thyroid gland. This can be used to determine whether goitre nodules are present.
• If there are nodules, the iodine accumulation in the thyroid gland can be measured with a thyroid scintigraphy, and whether the nodules are so-called hot or cold nodules can be checked.
• A tissue sample  (biopsy) from the thyroid provides clarity if a malignant nodule is suspected.
• For example, X-rays can show whether the goitre is pressing on the trachea or oesophagus.

The examinations can also rule out other diseases, such as Hashimoto’s thyroiditis.

 

forms of goitre

There are different forms of goitre. The classification is based on various criteria, including the structure: In most cases, one or more nodules form in the thyroid gland (“struma nodosa”). Depending on the number of nodes, a distinction is made between “Goiter uninodosa” and “Goiter multinodosa”. If the entire thyroid gland is swollen, this is called “struma diffusa”.

Another classification is based on the production of thyroid hormones. In more than 90 per cent of cases, this hormone production is not impaired, which means that “euthyroid goitre”  or “euthyroidism” is present. If increased hormones are produced, this is called “hyperthyroid goitre”. Reduced hormone production is called “hypothyroid goitre. “

Goitre: classification into grades

In addition, goitre is divided into different degrees, also called stages, based on its size:

• Grade 0: Neither visible nor palpable, detectable only on ultrasound
• Grade Ia: Palpable but not visible
• Grade Ib: Palpable but only visible when the head is tilted back
• Grade II: Visible with normal head position
• Grade III: Significantly enlarged thyroid gland, also visible from afar

In addition, there are other distinctions, for example, about the anatomical location of a goitre. A “goitre” is the name for a goitre on the neck.

Hot knots and cold knots

In some people, part of the thyroid tissue turns into a nodule. Depending on their activity, cold and hot nodes are distinguished.

A hot lump is an almost always benign lesion in the thyroid gland that increases the uptake of iodine and the production of hormones. Often, the result of a hot lump is an overactive thyroid.

 Tissue in the thyroid gland that does not absorb iodine and does not release hormones is called a cold nodule. This can be, for example, scar tissue, a (usually benign) tumour or a cyst.

 

Treatment for goitre

Treatment for goitre depends on its size, whether thyroid function is impaired, and whether nodules are present. There are three forms of therapy available.

• The drug treatment is carried out, for example, with iodide tablets, thyroid hormones or – in the case of hyperthyroidism – thyroid blockers (antithyroid drugs).
• During radioiodine therapy, the affected person swallows radioactive iodine, the radiation from which destroys the thyroid cells.
• During an operation, the diseased tissue parts (on one or both sides) or, if necessary, the entire thyroid gland is removed.

Therapy for goitre often requires taking iodine or hormone tablets over a long time. This is often necessary as a result of an operation or radioiodine treatment.

In homoeopathy, iodine-containing remedies are often used to treat goitre, which can be used as a support in consultation with a doctor.

Goitre: course and consequences

If a goitre continues to grow during the disease, the symptoms also increase. In addition, the risk of hyperthyroidism (“functional autonomy”) increases. Another possible consequence is the formation of a malignant tumour. However, the risk of developing thyroid cancer  (“goitre malignant”) as a result of goitre is shallow.

In the case of goitre with normal hormone formation, treatment with iodine, often in combination with thyroid hormones, is usually sufficient for the goitre to recede within several months. If the thyroid gland is overactive, however, iodine should not be administered: Excessive iodine intake threatens a “thyrotoxic crisis” (thyroid poisoning), which can lead to death.

Iodine deficiency as a cause of goitre

The cause of goitre is usually insufficient iodine intake over an extended period. Since the body cannot produce iodine, the trace element must be supplied through food. If the thyroid gland does not receive enough iodine, it cannot produce enough hormones and enlarges to use it even better.

In some phases of life, the need for iodine is exceptionally high due to hormonal changes, so greater attention must be paid to adequate iodine intake. These include menopause and puberty, but also pregnancy and breastfeeding because iodine deficiency can lead to pregnant women or newborns developing goitre.

 

Other causes of goitre

In addition to iodine deficiency, there are other possible causes of goitre, for example:

• Diseases such as the autoimmune diseases Graves ‘ disease or Hashimoto’s thyroiditis, but also an overactive or underactive thyroid gland
• thyroid inflammation
• Thyroid injuries
• Thyroid cancer or other tumours and metastases, as well as cysts
• Medicines that contain certain substances, for example, lithium
• peripheral hormone resistance
• excess iodine

Stress is also suspected to be a possible trigger of thyroid disease.

Goiter is not hereditary. Nevertheless, an accumulation of the disease can be observed in some families, which may be because iodine is used poorly for genetic reasons.

Prevent goitre

The best prevention against goitre is an adequate supply of iodine. About 180 to 200 micrograms of iodine per day are recommended. This is found in iodized salt and sea fish (pollock).

If you are pregnant or breastfeeding or if you have a goitre in your family, you should take additional iodide tablets after consulting a doctor. In addition, older people are recommended to ask their doctor for a regular palpation examination to detect goitre at an early stage.