Goitre | tenga

Sounds like 'GOI-tur'

A goitre (tenga) is a swelling or enlargement of your thyroid gland.

Key points about goitre

  1. Having a goitre does not necessarily mean you have a tumour or cancer.
  2. Goitre tends to be more common in women and in people over 40 years of age or those with a family history of goitre.
  3. In many cases, the only symptom of goitre is swelling in your neck.
  4. If the goitre grows large enough, it can press on your swallowing tube (oesophagus) or windpipe (trachea).
  5. Treatment of goitre depends on the cause, size and symptoms.
  6. A lack of iodine in your diet may cause your thyroid gland to enlarge, although this is uncommon in Aotearoa New Zealand.

What is the thyroid gland?

The thyroid gland is found in the lower front of your neck. It produces thyroid hormones, which are secreted into your blood and then carried throughout your body. Thyroid hormone is important because it helps your body use energy, stay warm and keep your brain, heart, muscles and other organs working as they should.

What causes goitre?

There are a number of factors that may cause a thyroid gland to enlarge, including iodine deficiency (not getting enough iodine in the food you eat), Graves' disease, Hashimoto's disease, multinodular goitre and thyroid cancer. 

Cause Description
Iodine deficiency Iodine is needed for your body to produce thyroid hormone. A lack of iodine in your diet can sometimes cause your thyroid gland to enlarge Iodine deficiency is uncommon in Aotearoa New Zealand, where iodine is routinely added to table salt and other foods such as bread.
Graves' disease Graves' disease is an autoimmune disease. Your immune system attacks your thyroid gland, causing it to produce too much thyroid hormone. This may result in an enlarged thyroid gland.  
Hashimoto's disease Hashimoto's disease is an autoimmune disease. Your immune system attacks your thyroid gland, causing it to make less thyroid hormone. 
Multinodular goitre With Multinodular goitre, a few solid or fluid-filled lumps called nodules develop in both sides of your thyroid gland. This results in enlargement of the gland. Read more about thyroid nodules.
Thyroid cancer Cancer of the thyroid can cause enlargement in your thyroid gland.

What are the symptoms of goitre?

In most cases, the only symptom of goitre is the appearance of a swelling in your neck. The size of the swelling may vary from a single small lump to a large swelling (mass) at the front of your neck. Sometimes an enlarged thyroid can place pressure on your swallowing tube (oesophagus) and windpipe (trachea).

This can lead to symptoms such as:

  • a tight feeling in your throat or neck
  • difficulty swallowing food, especially solid food
  • cough
  • change of voice or hoarseness
  • difficulty breathing especially when lying flat on your back
  • pain in the area of your thyroid.    

If you are unsure how long the goitre or neck lump has been present, looking back at old photos might help.

Depending on the cause of the goitre, you may make the correct amount of hormones (euthyroid), or have an overactive thyroid (hyperthyroidism) or an underactive thyroid (hypothyroidism).

How is goitre diagnosed?

In most cases, a goitre is discovered during a routine examination, when your doctor might notice the swelling in your neck area. Your doctor may also carry out some other tests to confirm the diagnosis.

Blood tests

To assess the functioning of your thyroid gland, your doctor will request a blood test called a thyroid function test. This test measures the levels of various thyroid hormones.

Your doctor may also request an antibody test that looks for certain antibodies produced in some forms of goitre. An antibody is a protein made by white blood cells. Antibodies help defend against invaders (eg, viruses) that cause disease or infection in your body.

Ultrasound of your thyroid

This test can help your doctor decide whether the thyroid nodule is filled with fluid or thyroid tissue. It can also measure the size of the nodule. The ultrasound is a painless test.

A thyroid scan

During this test, an isotope of radioactive iodine is injected into a vein in your arm. You then lie on a table while a special camera produces an image of your thyroid on a computer screen.

Biopsy

A biopsy is the removal of a sample of tissue or cells to be studied in a laboratory. A biopsy may be needed if there are large nodules in your thyroid gland. A biopsy is taken to rule out cancer.

How is goitre treated?

Treatment for goitre depends on the cause of the goitre, how large the thyroid has grown and your symptoms.

Treatment option Description
No treatment (also called watchful waiting)
  • If the goitre is small and is not bothering you, you and your doctor may decide that it doesn’t need to be treated.
  • However, the goitre will be closely watched for any changes.
Medicine
  • If the goitre is due to a lack of iodine, you may be prescribed small doses of iodine supplements.
  • If the cause of the goitre is an underactive thyroid (hypothyroidism), your doctor may prescribe levothyroxine. This medicine is identical to (the same as) the thyroid hormone produced naturally by your body. This treatment is called thyroid replacement therapy.
  • If the cause of the goitre is an overactive thyroid (hyperthyroidism), your doctor may prescribe medicines such as carbimazole and propylthiouracil. These medicines stop your thyroid from making too much thyroid hormone.
Radioactive iodine treatment
  • In some cases, if the goitre is caused by an overactive thyroid gland, your doctor may prescribe radioactive iodine. This is taken orally as a liquid or capsule.
  • The aim is to shrink your thyroid gland. The iodine goes to your thyroid gland and kills thyroid cells, which shrinks the gland.
  • After radioactive iodine treatment, you will also be prescribed thyroid hormone replacement therapy as ongoing treatment.
Surgery
  • An operation (surgery) may be performed to remove only part or all of your thyroid. 
  • This is an option if:
    • the goitre is large and causes problems with breathing and swallowing
    • the goitre has nodules
    • cancer is present.
  • Depending on the amount of thyroid gland removed, your doctor may prescribe thyroid hormone replacement therapy as ongoing treatment.

What if I have too much iodine?

Iodine is needed for your body to produce thyroid hormone. Although uncommon in Aotearoa New Zealand, too much iodine can cause your thyroid gland to enlarge. If too much iodine is a problem for you, avoid iodised salt, seaweed, shellfish and iodine supplements. If you have questions about the right iodine intake for you, talk to your healthcare professional. 

Questions you might like to ask your healthcare professional

  1. What caused my goitre to develop?
  2. What can be done to manage or treat my goitre?
  3. I have other health conditions. How can I best manage these together?
  4. Will I need to have medicine? How long will I need to take it?
  5. Is there anything else I need to know about my goitre?

Learn more

The following links provide further information on goitre. Be aware that websites from other countries may contain information that differs from New Zealand recommendations.

Goitre (thyroid swelling) PatientInfo, UK
Goitre American Thyroid Association, US
Goitre Better Health Channel, Australia

References

  1. Management of thyroid dysfunction in adults BPAC, NZ, 2010
  2. Goitre in adults Auckland Regional HealthPathways, NZ, 2021
Credits: Health Navigator Editorial Team. Reviewed By: Dr Mark Bolland, Endocrinologist and Associate Professor – Medical, The University of Auckland Last reviewed: 08 Oct 2021