If your goiter is not causing any symptoms, your doctor may recommend close observation to monitor for any changes or growth over time. Medication to normalize abnormal thyroid hormone levels may be helpful in decreasing the size of the goiter. A portion of the enlarged thyroid, if possible, or all of the thyroid, may need to be removed in a surgical procedure known as a thyroidectomy.
When the goiter is caused by a noncancerous thyroid nodule s , a new technique, called radiofrequency ablation RFA , may be used to shrink the goiter, and alleviate pressure-related symptoms, without the need for surgery. If you require surgery to remove the goiter, your surgeon will determine the best approach for removal. Some or all of thyroid may be removed via a scarless technique. If a neck incision must be made, the smallest incision possible will be used to allow for a safe removal of the affected thyroid gland.
If the goiter extends underneath the breastbone significantly, a small cut in your breastbone may need to be made to safely remove it. The thyroid gland is a butterfly-shaped endocrine gland that is normally located in the lower front of the neck. Thyroid hormone helps the body use energy, stay warm and keep the brain, heart, muscles, and other organs working as they should. For the first weeks of pregnancy, the baby is completely dependent on the mother for the production of thyroid hormone.
The baby, however, remains dependent on the mother for ingestion of adequate amounts of iodine, which is essential to make the thyroid hormones. Because iodine intakes in pregnancy are currently low in the United States, the ATA recommends that US women who are planning pregnancy, pregnant, or breastfeeding should take a daily supplement containing mcg of iodine.
In addition to other usual causes of hyperthyroidism see Hyperthyroidism brochure , very high levels of hCG, seen in severe forms of morning sickness hyperemesis gravidarum , may cause transient hyperthyroidism in early pregnancy. The correct diagnosis is based on a careful review of history, physical exam and laboratory testing. In addition to the classic symptoms associated with hyperthyroidism, inadequately treated maternal hyperthyroidism can result in early labor and a serious complication known as pre-eclampsia.
Mild hyperthyroidism slightly elevated thyroid hormone levels, minimal symptoms often is monitored closely without therapy as long as both the mother and the baby are doing well. When hyperthyroidism is severe enough to require therapy, anti-thyroid medications are the treatment of choice, with PTU being preferred in the first trimester.
Targeting this range of free hormone levels will minimize the risk to the baby of developing hypothyroidism or goiter. Maternal hypothyroidism should be avoided. Therapy should be closely monitored during pregnancy.
This is typically done by following thyroid function tests TSH and thyroid hormone levels monthly. Answering these three important questions begins with collecting certain facts about the person's medical history and any recent symptoms.
Table 2. Goiter and nodules are more common in women and older people, but nodules in men and younger are somewhat more likely to be cancer. Swelling or pain in the front of the neck Hoarseness that is new and persistent Cough that is new and persistent Coughing up blood Shortness of breath.
Weight loss, heat intolerance, trembling hands, palpitations, insomnia, anxiety, increased bowel movement frequency - especially if the symptoms are new or persistent. Weight gain, cold intolerance, constipation, very dry skin, slowed thinking, depressed mood, muscle cramps - especially if the symptoms are new or persistent. Childhood neck radiation Family history of thyroid cancer Family history of colon polyps Family history of parathyroid or adrenal tumors.
A doctor will look on physical examination for signs related to the thyroid enlargement: the entire gland or nodule size; its firmness, mobility, and tenderness; and whether there is any nearby lymph node enlargement. The doctor will also look for signs of thyroid hormone excess or deficiency.
Although the history and physical examination sometimes provide important clues, it is almost always necessary to perform additional diagnostic tests to answer the key clinical questions with certainty. A thyroid sonogram beams inaudible sound waves into the neck and the returning echoes depict thyroid and surrounding tissues; this can confirm that a lump in the neck is in the thyroid gland, show whether it is cystic or solid, and precisely measure its size.
A blood test for TSH can rule in or out all of the common causes of hyperthyroidism and hypothyroidism. If the TSH is low, then there is a possibility the person has a benign, but hyperfunctioning thyroid adenoma; so the next step for these individuals is often a radionuclide thyroid scan to see if the gland enlargement is, in fact, a "hot" nodule.
This is important, because almost all cancerous thyroid nodules are "cold" on radionuclide scanning; unfortunately, so are many benign thyroid nodules, so the test is not very helpful in people who do not already have a low TSH blood test suggesting hyperthyroidism. If the TSH is elevated, the person probably has an underactive thyroid gland, and its enlargement may be a sign of autoimmune thyroiditis.
If the TSH is normal or high, then most individuals with a thyroid nodule larger than 1. Thyroid biopsy results fall into four categories. First is an inadequate specimen in which there simply is not enough thyroid tissue to make a diagnosis.
People with this finding need another biopsy. Second, and fortunately, most often, the biopsy report is benign.
People with this category of nodule usually need no surgery and can be seen by their doctor periodically to sure their goiter or nodule is not progressively enlarging.
Third, the biopsy can strongly suggest the presence of thyroid cancer. The fourth category of thyroid biopsy finding is uncertain or indeterminate. One in five biopsies fall into this group, in which adequate tissue has been obtained, but the features of the cells seen just are not characteristic enough of a benign or malignant nodule to be sure.
Whether a goiter needs treatment depends on the answers to the three key clinical questions. If the thyroid is so large as to cause symptoms by stretching or compressing adjacent structures, or if it is so big as to be unsightly, surgical removal of the thyroid gland thyroidectomy may be required. If the goiter is related to a condition causing hyperthyroidism, as in Graves disease or toxic nodular goiter, treatment with radioactive iodine may be effective in both controlling gland overactivity and decreasing its size.
Some normally functioning nontoxic nodular goiters can also be shrunk with radioactive iodine therapy. If the thyroid is enlarged as the result of autoimmune Hashimoto thyroiditis and the gland is also underactive with a high blood TSH level, then starting thyroid hormone medication L-thyroxine may both treat the hypothyroidism and partially shrink the gland. Similarly, thyroid nodules may also require surgical removal or radioactive iodine based on their size and whether they are causing hyperthyroidism.
In addition, thyroid nodules that are found to be suspicious for malignancy must be removed along with the remainder of the thyroid gland to prevent the spread of thyroid cancer.
Most people with a cytologically uncertain finding are also advised to have at least the half of their thyroid gland with the nodule removed because one in seven of these individuals will be found to have thyroid cancer. The use of thyroid hormone to put the thyroid gland to rest and shrink thyroid nodules-often prescribed in the past-has now been found to be relatively ineffective.
Thyroid surgery can remove one-half thyroid lobectomy or hemi-thyroidectomy or all of the thyroid gland total thyroidectomy to establish with certainty whether a goiter or nodule is cancer or not. Surgery to remove an enlarged thyroid can relieve compression of nearby structures and improve symptoms in patients with related difficulty swallowing, cough, or shortness of breath. Thyroid surgery can also cure certain forms of thyroid gland overactivity associated with goiter or nodules.
Thyroid surgery almost always requires hospitalization and anesthesia. The incision causes pain for a day or two after surgery, and it leaves a scar, which is usually relatively inapparent after a year. As with any operation, bleeding and infection can complicate thyroid surgery. Behind the thyroid gland, there are two sets of important structures that can be accidentally injured during the course of a thyroid operation.
The recurrent laryngeal nerves run along side the windpipe on their way to the voicebox larynx , where they control the muscles that move the vocal cords. If one of these nerves is cut, smashed, or has its blood supply cut off, then a person will suffer some degree of voice loss.
This vocal cord paralysis can lead to a range of voice changes, ranging from losing a high octave or two while singing to the inability to shout to a severely disabling whisper of a voice. If both recurrent laryngeal nerves are injured, then a person may have difficulty breathing and require that a hole be created connecting the windpipe with the front of the neck tracheostomy.
Four parathyroid glands are also located behind the thyroid: two on each side. If the parathyroids are accidentally removed or injured, then the patient's blood calcium levels drops-resulting in tingling, numbness, and muscle cramps. Rarely, a severely low calcium level can lead to throat spasm or a seizure.
Fortunately, these complications are unusual in the hands of an experienced thyroid surgeon; mild injuries often resolve spontaneously over days or weeks after surgery; and there are treatments that can improve matters. Radioactive iodine is mainly used for treated of a goiter or nodule when it is the cause of an overactive thyroid gland. Radioactive iodine is also sometimes used to shrink a goiter that is not overactive.
UCSF is a major referral center for endocrine surgery. Endocrine surgeons at UCSF perform a high volume of thyroid procedures with generally excellent results.
Content on this page was derived or reproduced directly from Paul W. Ladenson, M.
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