Goitre / Enlarged Thyroid

Overview

A goitre is an enlargement of the thyroid gland, sometimes visible as a swelling at the front of the neck and sometimes felt only on examination. It can occur with an underactive, overactive or perfectly normal thyroid, and it has many causes — iodine deficiency, autoimmune disease, nodular change or simply a gland working harder. Most goitres are benign, but all need assessment to confirm the function and rule out nodules or anything concerning.

This page is about the structural enlargement. For nodules within the gland, see Thyroid Nodules; for the functional conditions that can accompany a goitre, see Hypothyroidism and Hyperthyroidism.

Symptoms and signs

• A visible or palpable swelling at the front of the neck.
• A sensation of tightness or pressure.
• Difficulty swallowing or breathing if the gland is very large (uncommon).
• Often no symptoms — found incidentally on examination or ultrasound.

Causes

• Iodine deficiency — historically the most common cause worldwide.
• Hashimoto’s thyroiditis — often a firm, painless enlargement.
• Graves’ disease — a smooth, diffusely enlarged gland.
• Multinodular goitre — a gland with many nodules.
• Solitary nodule or, rarely, thyroid cancer.
• Some medicines and pregnancy-related changes.

Evaluation

• TSH and free T4 to assess function.
• Thyroid antibodies where autoimmune disease is suspected.
• Thyroid ultrasound to characterise the enlargement and look for nodules.
• Further tests (such as biopsy) only if a nodule has suspicious features.

Management

A benign, small goitre with normal thyroid function often needs no treatment — just periodic monitoring. A goitre with abnormal function is treated for the underlying condition. Surgery is reserved for very large goitres causing pressure symptoms or for nodules with suspicious features.

How we help

Dr. Nayak assesses the size, function and structure of the gland, identifies the cause, and advises whether monitoring, medical treatment or referral for surgery is appropriate. Consultations are available in-clinic in Bhubaneswar and over teleconsultation.

Related conditions and patient concerns

• Thyroid Nodules
• Hashimoto’s Thyroiditis
• Graves’ Disease
• Hypothyroidism
• Hyperthyroidism
• Abnormal Thyroid Function Tests