Goiter – Diagnosis and Treatment
Diagnosis
Doctors usually find a goiter during a regular checkup by feeling the patient’s neck for thyroid changes. Sometimes, a thyroid problem first appears when a person gets a scan or imaging for another health issue.
After doctors find a possible goiter, they use different methods to learn more and decide what type of thyroid problem may be causing it. These steps help them choose the right treatment.
Examination Methods and Tests
Doctors use a mix of physical checks and medical tests. Here are several common approaches:
| Diagnostic Tool | What It Checks For |
|---|---|
| TSH Test | Thyroid function (overactive/underactive) |
| Thyroid Antibody Tests | Autoimmune disorders |
| Thyroid Ultrasound | Nodules, cysts, gland size |
| Radioactive Iodine Uptake Scan | Thyroid activity and structure |
| Fine Needle Biopsy | Cancer and nodule analysis |
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Blood Tests: Doctors check thyroid function and measure hormone levels.
- TSH Test: This test measures thyroid-stimulating hormone (TSH) to see if the thyroid works normally.
- Tests for thyroid hormones (T-3, T-4) and thyroid antibodies help doctors find thyroid dysfunction and autoimmune diseases like Hashimoto thyroiditis and Graves disease.
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Imaging Studies:
- Thyroid Ultrasound: Sound waves create detailed images, so doctors can spot thyroid nodules, cysts, multinodular goiter, or an enlarged thyroid gland. This helps them check any lumps or nodules.
- Radioactive Iodine Uptake Scan: This scan shows if the thyroid absorbs iodine at a healthy rate. It also shows whether the thyroid works too much (hyperthyroidism) or too little (hypothyroidism), and whether the shape and size are normal.
Fine-Needle Aspiration Biopsy: Doctors guide a thin needle into the thyroid, usually with ultrasound, to take a small tissue or fluid sample. They check the sample for cancer or other problems, such as benign nodules or signs of autoimmune disorders.
Signs and Symptoms to Watch
Some people notice visible swelling in the neck, trouble swallowing, or a choking feeling (compressive symptoms). Others may have changes related to thyroid dysfunction, like mood swings, weight changes, or fatigue.
Causes Medical Teams Look For
Doctors look for causes such as iodine deficiency, autoimmune diseases (like Hashimoto’s thyroiditis or Graves disease), infections (postpartum thyroiditis, subacute thyroiditis, silent thyroiditis), and growths like benign nodules or multinodular goiter.
Treatment
Medicine Options
Doctors use several medicines to treat goiter. For underactive thyroid (hypothyroidism), thyroid hormone replacement helps make up for low hormone levels.
| Type | Purpose |
|---|---|
| Thyroid hormone replacement | Increases hormone, shrinks goiter |
| Antithyroid drugs | Reduces hormone, shrinks goiter |
| Beta blockers | Controls symptoms of hyperthyroidism |
| Pain relievers | Reduces inflammation/pain |
Sometimes, a synthetic triiodothyronine (T3) hormone supplement is used. These hormone therapies can help reduce the size of the goiter over time.
If the thyroid produces too much hormone (hyperthyroidism), doctors may prescribe an antithyroid medication to reduce hormone production. For symptoms such as rapid heartbeat and tremors caused by excess thyroid hormone (thyrotoxicosis), a beta blocker can help manage these effects.
Doctors treat pain from thyroid inflammation with pain relievers like ibuprofen or naproxen. For serious pain, they may use corticosteroids.
Removal Procedures
Doctors may recommend surgery if the goiter is very large, causes trouble with breathing or swallowing, or if thyroid nodules cause hyperthyroidism. If they find thyroid cancer, they may perform a thyroidectomy (removal of the thyroid).
Total or partial thyroid removal means the patient may need to take thyroid hormone pills for life to keep hormone levels normal.
Use of Radioactive Iodine
Radioactive iodine therapy treats overactive thyroid glands and toxic multinodular goiter. The patient swallows a dose of radioactive iodine, and the thyroid absorbs it.
This destroys thyroid cells, lowers hormone production, and can shrink the goiter. Some people may still need pills to replace thyroid hormones after this treatment.
Self-Care
Eating foods with enough iodine, such as saltwater fish, shellfish, seaweed, dairy, and soy, supports thyroid health. Using iodized salt is another way to meet daily needs.
Limiting both low and high iodine intake helps prevent thyroid problems. People with goiter should watch for hoarseness, difficulty swallowing (dysphagia), breathing trouble, or fast heartbeat (atrial fibrillation) and seek care if any occur.
Getting Ready for Your Healthcare Visit
Before you see a healthcare provider about a goiter, prepare ahead of time.
- Bring a list of all your symptoms and any recent changes you have noticed.
- Write down your main questions and concerns to talk about during the appointment. These questions can include the cause of the goiter, how serious it is, and possible treatment options.
- Ask how the goiter could affect other health conditions you have.
- Find out if there are different ways to treat it.
- Ask what might happen if you do not start treatment right away.
- You may also want to know how likely the goiter is to get bigger and if the treatment will change how it looks.
- You can use a simple list like the one below to organize your thoughts:
| Question to Ask | Purpose |
|---|---|
| What caused the goiter? | Understand the root problem. |
| Is it serious? | Know possible risks. |
| Treatment options? | Explore all available choices. |
| What happens if I wait? | Learn about possible outcomes. |
| Medication details? | Plan for future care. |
