Thyroid Goitres

Thyroid Goitre Sydney Endocrine Surgeon Dr Susannah Graham

What is a multinodular thyroid goitre?

A goitre is a swelling or enlargement of the thyroid gland. “Multinodular goitre” is an enlarged thyroid gland containing thyroid nodules. Thyroid nodules are common and are usually benign (non-cancerous). Occasionally the nodules can cause the thyroid gland to make too much thyroid hormone. If a multinodular goitre has this type of nodule(s), it can cause symptoms of hyperthyroidism (overactive thyroid).

What are the symptoms of multinodular thyroid goitre?

Most people with a multinodular goitre do not have symptoms. The swelling and nodules might be found on an imaging test (often ultrasound or CT) that has been performed for another reason.

Some people with a multinodular goitre are able to see or feel a lump in their neck. If a multinodular goitre presses on the trachea (windpipe) or oesophagus (food pipe) it can cause symptoms such as difficulty breathing, shortness of breath, choking or difficulty swallowing. If the nodules are causing increased production of thyroid hormone, you may have symptoms of hyperthyroidism.

What tests will I need?

There are a number of tests that are used to make sure the nodule is not a threat to your health. These include:

  • Blood tests - used to assess thyroid function and hormone levels

  • Ultrasound – imaging test to look at thyroid gland and any nodules that may be present as well as lymph nodes in the neck

  • Fine needle aspiration biopsy – depending on the size and characteristics of the thyroid nodule, a biopsy may be required to diagnose the cause of the nodule and whether further treatment is required. A small needle is inserted into the thyroid nodule and a sample of cells is taken for a pathologist to look at under the microscope.

  • Thyroid scan – you will need this scan if you have hyperthyroidism (overactive thyroid). A radioactive substance is injected and a special camera takes a picture of the thyroid gland.

  • CT scan – this is sometimes required to assess the size of the gland and its relationship to nearby structures.

How is a multinodular thyroid goitre treated? 

The treatment required will depending on a number of factors and your preference. Many multinodular gotires do not need treatment and careful observation with repeat ultrasound may be all that is required.

Treatment may be required if:

  • You have hyperthyroidism (overactive thyroid)

  • You have symptoms such as breathing or swallowing problems

  • The thyroid gland or nodules are very large

  • There is a suspicion or diagnosis of cancer

Treatments for thyroid goitre include:

  • Surgery – removal of half of the thyroid (hemithyroidectomy) or all of thyroid (total thyroidectomy) may be required. Surgery is usually recommended if the thyroid gland is very large, if there is a very large nodule or if there is a suspicion or diagnosis of cancer.

  • Medication – if you have hyperthyroidism (overactive thyroid), Dr Graham will work in conjunction with an endocrinologist to determine the best treatment plan for you. Medication can be used to lower thyroid hormone levels.

  • Radioactive iodine – radioactive iodine can be used to destroy the thyroid gland so it does not make so much thyroid hormone. It comes in a pill or liquid that you swallow.