A goitre is an enlarged thyroid gland for whatever reason. It is common in the UK (up to 20% of the population) and half have palpable nodules. Some cases are physiological (puberty, pregnancy) whilst others are pathological (iodine deficiency, underactive or overactive or rarely cancer). It is important to remember that most cases are benign (non-cancer).
The gland can be uniformly enlarged (a diffuse swelling) or often there is a nodule (lump) present which is either single or multiple (a multinodular goitre). However, most thyroid nodules are benign. All swellings usually require further investigation with blood tests (for thyroid function) and a needle biopsy.
Benign swellings can usually be treated conservatively (without an operation). Some may require an operation (either a partial or a total thyroidectomy) when the gland is of a significant size and causing symptoms of obstruction or if there is any doubt about the diagnosis (cancer versus non-cancer).
Sometimes the gland is underactive and this is treated with thyroxine replacement. Rarely the gland is overactive (thyrotoxicosis) which can cause symptoms such as palpitations, weight loss and protruding eyes. Patients are usually treated medically (tablets or radioiodine) but occasionally require surgery (total thyroidectomy).
Whilst thyroid disease is common, thyroid cancer is uncommon and the commonest way for it to present is as a solitary thyroid nodule (usually in a young woman) when the incidence of malignancy is between 10 20%. Most of these cases are differentiated thyroid cancer (papillary or follicular) and the majority are treated with total thyroidectomy and radioactive iodine therapy. Sometimes the disease spreads to the neck and requires a neck dissection. The outlook is excellent with most patients having a normal life span.
Further information regarding investigations of the thyroid gland, surgery and the treatment of differentiated thyroid cancer with radioactive iodine are available in the patient information leaflets below. Alternatively, the following websites maybe contacted for further information.
John Watkinson has a major interest in thyroid surgery and does weekly thyroid clinics for both benign and malignant disease with the Professors of Medicine. He carries out between 150 and 200 thyroidectomies a year.
- www.endocrinesurgeon.co.uk – John Lynn – Thyroid Surgeon
- www.baes.info – British Association of Endocrine Surgeons
- www.bahno.org.uk – British Association of Head & Neck Oncologists
- www.british-thyroid-association.org – British Thyroid Assocation
- www.thyroidcancer.org.uk – Ruth Fawcett – Thyroid Patient
- www.nice.org.uk – National Institute for Health and Clinical Excellence