What is Goitre?
When the thyroid gland becomes big it is called goitre, whatever may be the reason. There is no direct relation between the size of the gland with the function that is the amount of thyroid hormone coming out of the gland.
So a goitre can produce normal thyroid hormone, can be hypothyroid or hyperthyroid.
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 the 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 the salt and water iodinization programme, we do not see iodine deficiency goitre these days. A benign nodule is a common cause in the elderly.
Otherwise, autoimmune thyroid disease is also a 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 a physiological goitre. There is nothing to worry about these.
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 and functioning normally. Usually 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). 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 the thyroid gland or whole of it and see under a microscope.
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 a cosmetic reason; in that case, you must remember you will have a scar in front of your neck.
Is there no medical treatment for goiter?
Sometimes we give a 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, the big goitre may be very uncomfortable for day-to-day life where most of the time people prefer operation.
What are the warning signs?
A sudden increase in size is not a good sign. In the same way, sudden onset pain in the goitre, the appearance of small lumps near the goitre (lymph gland), a recent change in the voice (an indication of involvement of the laryngeal nerve) are the warning signs