Goitre or swollen thyroid

Goitre is a swelling of the thyroid gland and is often noticed by accident. The swelling is in the centre of the neck, under the Adam’s apple and moves up and down as you swallow. It is usually painless but can cause a feeling of pressure on the windpipe or difficulty swallowing. 

The volume of the thyroid gland is determined by a person’s age, sex and pubertal development and the iodine content in the diet.  

Thyroid swelling is 5 to 10 times more common in girls/women than in boys/men. It often starts during puberty. It may be a harmless swelling that often remains stable and is accompanied by normal thyroid function. It may also be an emerging thyroid disease that will eventually cause too slow or too thyroid activity (i.e. hypothyroidism or hyperthyroidism, respectively). 

Thyroid swelling can result from: 

• The growth of the thyroid gland itself due to a high concentration of thyroid stimulating hormone (TSH) in the blood. 
• The growth of the thyroid gland due to the presence of growth-stimulating antibodies in the blood (Graves’ disease) 
• Growth due to the infiltration of immune cells in the thyroid gland (Hashimoto’s thyroiditis) 
• Iodine deficiency 
• Genetic form of a goitre 

The doctor may discover a goitre during a physical exam by simply feeling it. However, your doctor will usually need to order one or more of the following tests: 

• Blood test: This test checks the levels of hormones secreted by the thyroid gland as well as antibodies that can be related to thyroid inflammation (thyroiditis) 
• Urine analysis: This test checks your iodine levels (iodine/creatinine) 
• Thyroid ultrasound: This test uses sound waves to determine if a nodule is solid or a fluid-filled cyst.  

The swelling is located in the centre of the neck, under the Adam’s apple, and moves up and down as you swallow. It is usually painless but can cause a feeling of pressure on the windpipe or difficulty swallowing. 

Gland swelling in children due to iodine deficiency can easily be treated by taking extra iodine with food or in tablets. 

If the patient has thyroiditis or elevated TSH levels, treatment with thyroid hormone can be administered. 

If Graves’ disease is diagnosed, thyroid-blocking agents are used. 

Both a deficiency (hypothyroidism) and an excess of thyroid hormone (hyperthyroidism) must be treated.