Thyroid Goiter Treatments
Enlargement of the Thyroid
The term non-toxic goiter refers to enlargement of the thyroid that is not associated with overproduction of thyroid hormone or malignancy. The thyroid can become very large so that it can easily be seen as a mass in the neck. This picture depicts the outline of a normal size thyroid in black and the greatly enlarged goiter in pink. There are a number of factors that may cause the thyroid gland to become enlarged. A diet deficient in iodine can cause a goiter, but this is rarely the cause because of the readily available iodine in our diets. A more common cause of goiter in America is an increase in thyroid stimulating hormone (TSH) in response to a defect in normal hormone synthesis within the thyroid gland. The thyroid stimulating hormone comes from the pituitary and causes the thyroid to enlarge. This enlargement usually takes many years to become manifest.
What do thyroid goiters look like and how do you treat them? Find out in our thyroid goiter basics slideshow.
Learn More about Thyroid Goiters
Thyroid Goiter Picture
This picture depicts the typical appearance of a goiter in a middle-aged woman. Note how her entire neck looks swollen because of the large thyroid.
This mass will compress the trachea (windpipe) and esophagus (swallowing tube) leading to symptoms, such as coughing, waking up from sleep feeling like you can't breathe, and the sensation that food is getting stuck in the upper throat. Once a goiter gets this big, surgical removal is the only means to relieve the symptoms. Yes, sometimes they can get a lot bigger than this!
Thyroid Goiter Treatments
Most small- to moderate-sized goiters can be treated with thyroid hormone in the form of a pill. By supplying thyroid hormone in this fashion, the pituitary will make less TSH, which should result in stabilization in size of the gland.
This technique often will not cause the size of the goiter to decrease but will usually keep it from growing any larger. Patients who do not respond to thyroid hormone therapy are often referred for surgery if it continues to grow.
A more common indication for surgical removal of an enlarged thyroid is to remove those glands that are large enough to cause compression on other structures in the neck, such as the trachea and esophagus.
These patients will typically complain of a cough, a slight change in voice, or nighttime choking episodes because of the way that the gland compresses the trachea while sleeping.
The x-ray on the right shows how an enlarged right thyroid lobe has moved the trachea to the patient's left. The trachea (outlined in light yellow) should be straight from the mouth down to the lungs. But in this patient, it is compressed and displaced far to the left.
The enlarged gland can even compress the blood vessels of the neck, which is also an indication for its removal. You may read more about this on our page examining sub-sternal thyroids.
As always, the suspicion of malignancy in an enlarged thyroid is an indication for removal of the thyroid. There is often a dominant nodule within a multinodular goiter that can cause concern for cancer. Remember, the incidence of malignancy within a multinodular goiter is usually significantly less than 5%. If the nodule is cold on thyroid scanning, then it may be slightly higher than this. For the vast majority of patients, surgical removal of a goiter for fear of cancer is not warranted.
Another reason (although not a very common one) to remove a goiter is for cosmetic reasons. Often, a goiter gets large enough that it can be seen as a mass in the neck. When other people begin to notice the mass, it is usually big enough to begin causing compression of other vital neck structures—but not always. Sometimes, the large goiter causes no symptoms other than being a cosmetic problem. But if it's big enough to be seen by your neighbors, you will need medications or surgery, or it will most likely continue to get bigger.