When the thyroid gland becomes big it is called goitre, whatever may be the reason. There is no direct relation between sizes of the gland with the function that is the amount of thyroid hormone coming out of the gland.

Goiter (Enlarged thyroid gland)

How do I know that I have goitre?

In thin individual, if you stand in front of the mirror you can see your thyroid in stretched or extended neck, this is normal. If you have goitre you can easily see this in front of your neck in the midline, sometime others will notice this. By ultrasound examination also we can measure the exact size of the gland.

What are the causes of Goitre?

Iodine deficiency used to be the commonest cause before but after salt and water iodinisation programme we do not see iodine deficiency goitre these days. Benign nodule is a common cause in the elderly. Otherwise autoimmune thyroid disease is a very common cause. Thyroid cancer is a rare cause of goitre.

Can we have Goitre in good health?

There are a few times in life when we normally have an enlargement of the thyroid gland. At the time of puberty (maturation) we see enlargement of thyroid gland, it usually settles on its own. Pregnancy is another cause of goitre what is called physiological goitre. There is nothing to worry about this.

What should I do if have a goitre?

There is no point in panicking; most of the cases goitres are benign. Best is to see doctor who will suggest simple measures to find whether it is benign or functioning normally, Normally we do not need many investigations.

How do I know it is not cancer?

The best way to know is by a simple needle test called FNAC (Fine Needle Aspiration Cytology), when using a small needle and syringe we draw little fluid from the thyroid and see under microscope. FNAC is simple and cheap although may not be full proof. If the clinical suspicion of cancer is high we suggest excision biopsy that is to remove the big portion of thyroid gland or whole of it and see under microscope.

Will my thyroid be overactive if I have goitre?

Not necessarily, the function and structure of thyroid gland does not go hand in hand in most of the cases. Your thyroid can be underactive while you have goitre.

Is surgery a must?

If the cause of the goitre is cancer, surgery is a must followed by radioiodine ablation of the remaining tissue. The other reason for operation is pressure of the goitre on the surrounding neck structures such as air pipe, food pipe, voice cartilage or its nerve. Some people prefer operation for cosmetic reason; in that case you must remember you will have a scar in front of your neck.

Is there no medical treatment?

Sometime we give higher dose of thyroid hormone for reducing the size of the gland called suppressive therapy. This is usually successful in young persons and if you size of the goitre is not already very big. We continue the treatment for around 18 to 24 months.

What happen if I leave like that?

It depends on the cause. If it is benign, as it is in most of the cases, nothing happens other than you see everyday a lump in front of your neck. Very slowly it can grow bigger, but it is very difficult to tell which will and which won’t.

What happens if goitre becomes very big?

A big goitre can put pressure on the surrounding important structures in the neck such as blood vessels, air pipe, voice cartilage (larynx), food pipe, etc. Also big goitre may be very uncomfortable for day-to-day life where most of the time people prefer operation.

What are the warning signs?

Sudden increase in size is not a good sign. In the same way sudden onset pain in the goitre, appearance of small lumps near the goitre (lymph gland), recent change in the voice (indication of involvement of the laryngeal nerve) are the warning signs.