The term goitre refers to an increase in the volume of the thyroid gland. It is common, especially in women.
Goiter is not in itself a disease. It can be present in a variety of diseases.
Goitre can cause problems by its volume but especially by its association with an abnormality of the functioning of the thyroid gland: thyroid insufficiency (hypothyroidism) or hyperactivity thyroid (hyperthyroidism), or by its cause, thyroid cancer for example. Thyroid cancer, however, rarely manifests as goiter.
Goitre is an increase in the volume of the thyroid gland, a gland located at the base of the neck and consisting of two lobes connected to each other by an isthmus. In the normal state, the thyroid weighs 20 to 30 grams.
The thyroid makes the thyroid hormones, essential for the proper functioning of the body.
Under the influence of various factors, it can increase in volume and form goitre:
– either homogeneously: the increase in volume is then regular and affects only one or both lobes.
– either in a heterogeneous way: only one or more areas of the thyroid are larger, constituting one or more nodules, hence the term nodular or multi-nodular goitre (see the sheet thyroid nodules).
What are the signs of goiter?
Goitre can be manifested either by the appearance of a swelling at the base of the neck , painful or uncomfortable size, rapid or progressive, or by manifestations of malfunction of the thyroid. Attention may be drawn to an impaction at the base of the neck, noticed by the person or discovered by the doctor during a palpation examination of the base of the neck.
It is rare nowadays and in our countries that goitre reaches such a volume that it causes difficulties in feeding , breathing difficulties or changes of the voice . But this could have happened in the past when people do not get treatment quickly.
In some cases, palpation of a goiter can lead to pain in palpation .
When it is associated with hyperthyroidism (excessive production of thyroid hormones), it can cause weight loss, tachycardia (hard heart rate acceleration), tremors, anxiety or nervousness, excessive sweating, feeling too hot, diarrhea …
Conversely, when there is hypothyroidism (lack of thyroid hormones), the face can be swollen, with weight gain, nervousness, intellectual slowdown or depression, fatigue, constipation, slowing of the pulse …
When should you consult if you have goiter?
The presence of swelling of the base of the neck, pain on palpation of this area, unexplained change in weight, a change in behavior should lead to consultation with your doctor. After a medical check-up, this doctor can then refer the person suffering from goiter to an endocrinologist (specialist in hormonal function), an ENT or even a surgeon if necessary.
What are the causes of goiter?
The causes of goitre are numerous, different according to whether it is homogeneous or heterogeneous, with or without abnormality of the thyroid function. It can be linked to:
– Nutritional and genetic factors (hence the highest frequency among women);
– tobacco that promotes goitre by competing with iodine;
– exposure to radiation, cervical irradiation in childhood or environmental exposure.
These are goitres in which the thyroid gland is swollen in all its volume homogeneously.
A homogeneous goiter with normal thyroid function is found in 80% of cases in women. It is painless, of variable size, and does not require special care.
Goiter with hyperthyroidism or Graves’ disease: more common in women than in men, and often of familial origin, it is accompanied by a loss of weight, irritation, febrility, hypersudation, and tremor . In some cases there is an exophthalmia, ie bulky eyeballs, giving an appearance of globular eyes, projecting out of the orbit.
Homogenous goitre with hypothyroidism is also more common in women. It can be caused by drugs such as lithium, or iodine deficiency in some areas of France such as the Alps, the Pyrenees, etc. Goiter was very common before the use of iodine-enriched cooking salt. It can also be of familial origin or caused by an autoimmune disease (Hashimoto’s thyroiditis) in which the body makes antibodies against its own thyroid.
Goitres with iodized overload after radiography with contrast agents or treatment with amiodarone (treatment to treat heart rhythm disorders) can lead to hypo- or hyperthyroidism. They regress spontaneously in the first case or after stopping amiodarone.
Painful goitres associated with fever may correspond to subacute Quervain thyroiditis leading to hypothyroidism and often hyperthyroidism. It usually heals spontaneously in a few weeks or months. The doctor may prescribe aspirin, corticosteroids and treatments to slow the heart in case of tachycardia
Heterogeneous or nodular goiter.
Palpation or ultrasound shows the presence of one or more nodules, associated or not with an abnormality of the thyroid function. The nodule may be “neutral” with normal hormonal function, “cold” or hypoactive with decreased thyroid hormone production or “hot” or hyperactive with increased secretion of thyroid hormones. Hot nodules are exceptionally cancerous. But cold solid, liquid or mixed nodules can in 10 to 20% of cases correspond to a malignant tumor, so cancerous.
Which doctor to consult when you have a goiter?
In front of goitre, therefore an increase of the volume of the thyroid gland at the base of the neck, one can consult his general practitioner who according to the examination and the first elements of the balance will direct towards an endocrinologist (specialist of the hormonal functioning) or an ENT.
The clinical examination.
Examination of the neck by the doctor makes it possible to observe whether the swelling of the base of the neck is or is not related to the thyroid. It also allows to see if it is painful or not, homogeneous or not, if the swelling affects a lobe or both, its consistency hard, firm or soft. Examination by the doctor can also find the presence of ganglions in the neck.
During the general medical examination, the doctor’s questions associated with a body exam look for signs of abnormal thyroid function.
The doctor will also ask what the treatments are usually taken by the person, if there were thyroid problems in the family, radiation of the neck in childhood, the geographical origin, the contributing factors (tobacco, lack of iodine, pregnancy).
They analyze the function of the thyroid by the dosage of thyroid hormones (T3 and T4) and TSH (hormone manufactured by the pituitary that controls the secretion of thyroid hormones). In practice it is especially TSH that is dosed for a first assessment. If it is increased, it means that the thyroid does not work enough, if it is low, that the secretion of thyroid hormones is excessive.
The doctor can also prescribe a biological examination to find the presence of antithyroid antibodies.
The essential examination is the ultrasound which specifies the size, the heterogeneous or non heterogeneous character of the goiter, the characteristics of the nodule or nodules (fluid, solid or mixed), its exact situation and in particular the extension of the goitre towards the thorax ( what is called a diving goitre). She is also looking for ganglia on the neck.
The thyroid scan . It consists in giving to the person who will pass the examination of the radioactive markers containing a substance which will be fixed on the thyroid gland (of iodine or technetium). As these markers are radioactive, it is easy to get an image of the marker binding areas. This examination specifies the overall functioning of the thyroid gland. It can reveal nodules not perceived on palpation and shows
– if the nodules are “cold”: they fix very little radioactive marker, and this shows a decrease of the thyroid hyperfunction,
– if the nodules are “hot”, they set a lot of radioactive markers, which shows excessive manufacturing
– if the nodules are neutral, they fix an average of radioactive markers, which objectifies a normal hormonal functioning.
The puncture of a nodule makes it possible to search for the presence of malignant cells or to evacuate a cyst. It is systematically performed for all cold nodules
The single ray may show calcifications of goitre and its extension to the chest
MRI is interesting for specifying the extension of the thyroid to neighboring structures and in particular the existence of a goiter plunging to the thorax, looking for lymph nodes.
What are the risks if you do not consult for a goiter?
A small goitre, without modification of hormonal function or nodule on ultrasound does not require treatment but a monitoring of its volume.
The complications of goiter can be related to its volume: voice modification with paralysis of a vocal cord, swallowing or breathing disorder, venous compression
Complications linked to hormonal dysfunction, if it is not corrected, can lead to general manifestations:
– in case of hyperthyroidism, weight loss, tachycardia, tremors, anxiety, irritability, excessive perspiration, intolerance to the heat, diarrhea …
– in case of hypothyroidism, weight gain, cautiousness, intellectual slowdown, depression, fatigue, constipation, slowing of the pulse …
Complications of a malignant thyroid tumor are related to its extension to neighboring organs (larynx, pharynx, skin, lymph nodes) or to distant dissemination (metastases)
What treatments for goiter?
Several types of treatment are possible depending on the cause of goiter.
The treatment is medical and / or surgical, but some goitre require only a simple monitoring.
Thyroid hormone treatment corrects hypothyroidism.
Antithyroid drugs are prescribed in simple goiters that produce too much thyroid hormone. Their goal is to reduce the hormonal secretion and normalize the volume of goiter.
Iodine 131 treatments (radioactive iodine) is used to reduce the size of a large, compressive goitre. The radioactive iodine is captured by the thyroid cells and then destroyed by the action of its radioactivity.
Partial or total thyroidectomy: the thyroid can be removed surgically in part (a single lobe with or without the isthmus) or totally. A completely removed thyroid causes the need for thyroid hormones for life to compensate for hormones that can no longer be made by the body. This operation is indicated when there is a compression of the neighboring organs, in case of suspicion of a thyroid cancer in front of a cold nodule.
Goitre can be prevented in some cases. Compensation for iodine deficiency in tap water in some areas should be by consuming iodized salt or even taking iodine tablets.
Treatments that may interfere with the thyroid should be monitored for goiter or abnormal thyroid hormones.