Goitre/Toxic Nodular Goitre

Question 1

How common is it?

Answer 1

Most common in women over 40

Question 2

What causes it?

Answer 2

A goitre is an enlarged thyroid gland. A goitre can mean that all the thyroid gland is swollen or enlarged, or one or more swellings or lumps develop in a part or parts of the thyroid.

Diffuse smooth goitre
This means that the entire thyroid gland is larger than normal. The thyroid feels smooth but is larger than normal.
• Graves’ disease
• Thyroiditis - which can be due to various causes. Hashimoto’s thyroiditis, infections, radiotherapy treatment to the neck.
• Iodine deficiency. The thyroid needs iodine to make thyroxine and T3. If you lack iodine in your diet, the thyroid swells as it tries to make enough thyroxine and T3.
• Drugs - lithium and amiodarone can cause the thyroid to swell.
• Hereditary factors
• Any other disorder which causes problems in the making of thyroxine or T3 may cause the thyroid to swell.

Nodular goitres
A thyroid nodule is a small lump which develops in the thyroid. There are two types: 
•	A multinodular goitre. This means the thyroid gland has developed many lumps or nodules. The thyroid gland feels generally lumpy. 
•	A single nodule. Causes include: 
o	A cyst.
o	An adenoma.
o	A carcinoma.
o	Other rare causes.

Question 3

Risk factors?

Answer 3

• Sex – women are more likely to have thyroid problems and develop a goitre
• Age – the risk of developing a goitre increases with age
• Iodine deficiency
• pregnancy and menopause – the risk of having thyroid problems increases during pregnancy and the menopause
• medication – lithium and immunosuppressants, increase your risk
• exposure to radiation – radiotherapy to the neck or chest area, or being exposed to radiation, increases risk

Question 4

How does it present?

Answer 4

• In many cases there are no symptoms apart from the appearance of a swelling in the neck. The size of a goitre can range from very small and barely noticeable, to very large.
• Most goitres are painless. However, thyroiditis can be painful.
• Most goitres come in conjunction with hyper/hypothyroidism, which have a range of symptoms.
• A large goitre may press on the trachea or the oesophagus. This may cause difficulty with breathing or with swallowing.

Question 5

How would you investigate the patient?

Answer 5

• Bloods (TFTs)
• Ultrasound
• Ultrasound guided biopsy

Question 6

Treatments?

Answer 6

• Treatment depends on underlying cause. Wait-and-see approach often taken.
• Other possible treatments include radioiodine treatment and thyroid surgery.
• 1 in 20 goitres are a sign of thyroid cancer.