A visible swelling at the front of the neck is the most common reason patients are referred for thyroid review. This guide explains what causes a goitre and how it is treated.
What is a goitre?
A goitre is a generalised or localised enlargement of the thyroid gland. It may be smooth (diffuse) or contain multiple nodules (multinodular).
Common causes
Iodine deficiency, autoimmune disease (Hashimoto's, Graves'), multinodular change with age, and rarely thyroid cancer.
Symptoms
Visible neck swelling, difficulty swallowing, voice change, breathing discomfort when lying flat, and tightness in collared shirts.
Investigations
TSH, T3, T4, ultrasound of the neck, FNAC of dominant nodules, and a CT scan if retrosternal extension is suspected.
Treatment
Small, asymptomatic goitres can be monitored. Surgery is indicated for compressive symptoms, cosmetic concern, suspicion of malignancy, or retrosternal extension. Medical therapy is added when thyroid function is abnormal.