GOITER

The symptoms of a goiter include:

• Swelling at the front side of the base of the neck, ranging from a small lump to a general enlargement.
• If you have hyperthyroidism (an overactive thyroid gland), symptoms may also include weight loss despite an increased appetite, an increased heart rate, elevated blood pressure, nervousness, diarrhea, muscle weakness, and hand tremors.
• If you have hypothyroidism (an underactive thyroid gland), your symptoms may include lethargy, slowed physical and mental functions, depression, a lower heart rate, an intolerance to cold, constipation, easy weight gain, and tingling or numbness in your hands.

DIAGNOSIS

Your doctor may discover an enlarged thyroid gland simply by feeling your neck and having you swallow during a routine physical exam. In some cases, your doctor may also be able to feel the presence of nodules.

Diagnosing goiter may also involve:

• A hormone test. Blood tests can determine the amount of hormones produced by your thyroid and pituitary glands.
• An antibody test. Some causes of goiter involve production of abnormal antibodies. A blood test may confirm the presence of these antibodies.
• Ultrasonography. The images reveal the size of your thyroid gland and whether the gland contains nodules that your doctor may not have been able to feel.
• A thyroid scan. Thyroid scans provide information about the nature and size of your thyroid, but they’re more invasive, time-consuming and expensive than are ultrasound tests.
• A biopsy. During a fine-needle aspiration biopsy, ultrasound is used to guide a needle into your thyroid to obtain a tissue or fluid sample for testing.

RECOMMENDED MEDICATIONS

Goiter treatment depends on the size of the goiter, your signs and symptoms, and the underlying cause. Your doctor may recommend:

• Observation. If your goiter is small and doesn’t cause problems, and your thyroid is functioning normally, your doctor may suggest a wait-and-see approach.
• Medications. If you have hypothyroidism, thyroid hormone replacement with levothyroxine (Levothroid, Synthroid) will resolve the symptoms of hypothyroidism as well as slow the release of thyroid-stimulating hormone from your pituitary gland, often decreasing the size of the goiter. For inflammation of your thyroid gland, your doctor may suggest aspirin or a corticosteroid medication to treat the inflammation. For goiters associated with hyperthyroidism, you may need medications to normalize hormone levels.
• Surgery. Removing all or part of your thyroid gland (total or partial thyroidectomy) is an option if you have a large goiter that is uncomfortable or causes difficulty breathing or swallowing, or in some cases, if you have nodular goiter causing hyperthyroidism. Surgery is also the treatment for thyroid cancer. You may need to take levothyroxine after surgery, depending on the amount of thyroid removed.
• Radioactive iodine. In some cases, radioactive iodine is used to treat an overactive thyroid gland. The radioactive iodine is taken orally and reaches your thyroid gland through your bloodstream, destroying thyroid cells. The treatment results in diminished size of the goiter, but eventually may also cause an underactive thyroid gland.