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 a goiter may also involve:

  • hormone test. Blood tests can determine the amount of hormones produced by your thyroid and pituitary glands. If your thyroid is underactive, the level of thyroid hormone will be low. At the same time, the level of thyroid-stimulating hormone (TSH) will be elevated because your pituitary gland tries to stimulate your thyroid gland to produce more thyroid hormone.

    A goiter associated with an overactive thyroid usually involves a high level of thyroid hormone in the blood and a lower than normal TSH level.

  • An antibody test. Some causes of a goiter involve production of abnormal antibodies. A blood test may confirm the presence of these antibodies.
  • Ultrasonography. A wand-like device (transducer) is held over your neck. Sound waves bounce through your neck and back, forming images on a computer screen. 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. During a thyroid scan, you'll have a radioactive isotope injected into the vein on the inside of your elbow. You then lie on a table with your head stretched backward while a special camera produces an image of your thyroid on a computer screen.

    The time needed for the procedure may vary, depending on how long it takes the isotope to reach your thyroid gland. 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.

Treatment

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 (Levoxyl, Synthroid, Tirosint) 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 a 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.

Lifestyle and home remedies

If your goiter is caused by your diet, these suggestions can help:

  • Get enough iodine. To ensure that you get enough iodine, use iodized salt or eat seafood or seaweed — sushi is a good seaweed source — about twice a week. Shrimp and other shellfish are particularly high in iodine. If you live near the coast, locally grown fruits and vegetables are likely to contain some iodine, too, as are cow's milk and yogurt.

    Everyone needs about 150 micrograms of iodine a day (the amount in slightly less than half a teaspoon of iodized salt). But adequate amounts are especially important for pregnant and lactating women and for infants and children.

  • Avoid excess iodine consumption. Although it's uncommon, getting too much iodine sometimes leads to a goiter. If excess iodine is a problem, avoid iodine-fortified salt, shellfish, seaweed and iodine supplements.

Preparing for your appointment

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 doctor, such as:

  • What caused this goiter to develop?
  • Is it serious?
  • What can be done to treat the underlying cause?
  • I have these 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?
  • Will the treatment you're suggesting improve the appearance of the goiter?
  • Will I have to take medication? For how long?
Nov. 09, 2016
References
  1. Goldman L, et al., eds. Thyroid. In: Goldman-Cecil Medicine. 25th ed. Philadelphia, Pa.: Saunders Elsevier; 2016. http://www.clinicalkey.com. Accessed Oct. 4, 2016.
  2. Flint PW, et al. Disorders of the thyroid gland. In: Cummings Otolaryngology: Head & Neck Surgery. 6th ed. Philadelphia, Pa.: Saunders Elsevier; 2015. http://www.clinicalkey.com. Accessed Oct. 4, 2016.
  3. Medeiros-Neto G, et al. Iodine-deficiency disorders. In: Endocrinology: Adult and Pediatric. 7th ed. Philadelphia, Pa.: Saunders Elsevier; 2016. http://www.clinicalkey.com. Accessed Oct. 4, 2016.
  4. Goiter. American Thyroid Association. http://www.thyroid.org/what-is-a-goiter/. Accessed Oct. 4, 2016.
  5. Goiter. Hormone Health Network. http://www.hormone.org/questions-and-answers/2013/goiter. Accessed Oct. 4, 2016.
  6. Iodine deficiency. American Thyroid Association. http://www.thyroid.org/iodine-deficiency/. Accessed Oct. 4, 2016.
  7. Simple nontoxic goiter (euthyroid goiter). Merck Manual Professional Version. http://www.merckmanuals.com/professional/endocrine-and-metabolic-disorders/thyroid-disorders/simple-nontoxic-goiter. Accessed Oct. 4, 2016.
  8. Walsh JP. Managing thyroid disease in general practice. Medical Journal of Australia. 2016;205:179.
  9. Townsend CM Jr, et al. Endocrine. In: Sabiston Textbook of Surgery: The Biological Basis of Modern Surgical Practice. 19th ed. Philadelphia, Pa.: Saunders Elsevier; 2012. https://www.clinicalkey.com. Accessed Oct. 6, 2016.
  10. Nippoldt TB (expert opinion). Mayo Clinic, Rochester, Minn. Oct. 26, 2016.