Goiter

A goiter is often discovered during a routine physical exam. By touching your neck, your health care provider may detect an enlargement of the thyroid, an individual nodule or multiple nodules. Sometimes a goiter is found when you are undergoing an imaging test for another condition.

Additional tests are then ordered to do the following:

• Measure the size of the thyroid
• Detect any nodules
• Assess whether the thyroid may be overactive or underactive
• Determine the cause of the goiter

Tests may include:

• Thyroid function tests. A blood sample can be used to measure the amount of thyroid-stimulating hormone (TSH) produced by the pituitary gland and how much thyroxine (T-4) and triiodothyronine (T-3) is produced by the thyroid. These tests can show whether the goiter is associated with an increase or decrease in thyroid function.
• Antibody test. Depending on the results of the thyroid function test, your health care provider may order a blood test to detect an antibody linked to an autoimmune disorder, such as Hashimoto's disease or Graves' disease.
• Ultrasonography. Ultrasonography uses sound waves to create a computerized image of tissues in your neck. The technician uses a wand-like device (transducer) over your neck to do the test. This imaging technique can reveal the size of your thyroid gland and detect nodules.
• Radioactive iodine uptake. If your health care provider orders this test, you are given a small amount of radioactive iodine. Using a special scanning device, a technician can measure the amount and rate at which your thyroid takes it in. This test may be combined with a radioactive iodine scan to show a visual image of the uptake pattern. The results may help determine function and cause of the goiter.
• Biopsy. During a fine-needle aspiration biopsy, ultrasound is used to guide a very small needle into your thyroid to obtain a tissue or fluid sample from nodules. The samples are tested for the presence of cancerous cells.

Goiter treatment depends on the size of the goiter, your signs and symptoms, and the underlying cause. If your goiter is small and your thyroid function is healthy, your health care provider may suggest a wait-and-see approach with regular checkups.

Medications

Medications for goiters may include one of the following:

• For increasing hormone production. An underactive thyroid is treated with a thyroid hormone replacement. The drug levothyroxine (Levoxyl, Thyquidity, others) replaces T-4 and results in the pituitary gland releasing less TSH. The drug liothyronine (Cytomel) may be prescribed as a T-3 replacement. These treatments may decrease the size of the goiter.
• For reducing hormone production. An overactive thyroid may be treated with an anti-thyroid drug that disrupts hormone production. The most commonly used drug, methimazole (Tapazole), may also reduce the size of the goiter.
• For blocking hormone activities. Your health care provider may prescribe a drug called a beta blocker for managing symptoms of hyperthyroidism. These drugs — including atenolol (Tenormin), metoprolol (Lopressor) and others — can disrupt the excess thyroid hormones and lower symptoms.
• For managing pain. If inflammation of the thyroid results in pain, it's usually treated with aspirin, naproxen sodium (Aleve), ibuprofen (Advil, Motrin IB, others) or related pain relievers. Severe pain may be treated with a steroid.

Surgery

You may need surgery to remove all or part of your thyroid gland (total or partial thyroidectomy) may be used to treat goiter with the following complications:

• Difficulty breathing or swallowing
• Thyroid nodules that cause hyperthyroidism
• Thyroid cancer

You may need to take thyroid hormone replacement, depending on the amount of thyroid removed.

Radioactive iodine treatment

Radioactive iodine is a treatment for an overactive thyroid gland. The dose of radioactive iodine is taken orally. The thyroid takes up the radioactive iodine, which destroys cells in the thyroid. The treatment lowers or eliminates hormone production and may decrease the size of the goiter.

As with surgery, you may need to take thyroid hormone replacement to maintain the appropriate levels of hormones.

Your body gets iodine from your food. The recommended daily allowance is 150 micrograms. A teaspoon of iodized salt has about 250 micrograms of iodine.

Foods that contain iodine include:

• Saltwater fish and shellfish
• Seaweed
• Dairy products
• Soy products

Most people in the United States get enough iodine in a healthy diet. Too much iodine in the diet, however, can cause thyroid dysfunction.

If you've been diagnosed with a goiter, you're likely to have further tests to determine the cause. You might find it helpful to make a list of questions to ask your health care provider, such as:

• What caused this goiter to develop?
• Is it serious?
• What can be done to treat the underlying cause?
• I have other health conditions. How can I best manage them together?
• What are the alternatives to the main treatment that you're proposing?
• What will happen if I choose to do nothing?
• Will the goiter continue to get larger?
• How often should I have follow-up appointments?
• Will the treatment you're suggesting improve the appearance of the goiter?
• Will I have to take medication? For how long?