This week Dr Ciarán Roarty of Scally McDaid Roarty looks at a common problem seen in the community – Goitre.

A goitre is a swelling of tissue called the thyroid which is located at the front of the lower part of the neck. It can be caused by an underactive or overactive thyroid gland and treatment will depend on the underlying cause. It may be that the entire gland is swollen or sometimes there may be one or more swellings in part of the thyroid gland.

The thyroid gland lies just in front of the windpipe and is butterfly-shaped. Usually, we cannot feel or notice our thyroid gland – unless it is swollen. The thyroid gland makes thyroid hormones which help keep our metabolism functioning at the correct pace. Lots of tissues in the body need thyroid hormones which are produced by the thyroid gland in order to function properly.

Are there different types of goitre?

There are different types of goitre and they usually have different causes.

A smooth enlarged thyroid gland may be caused by autoimmune conditions ( where the body’s immune system attacks the body’s own cells) as well as inflammation (thyroiditis), infection, radiotherapy treatment and iodine deficiency (which is not too common in this part of the world). Certain drugs which are used to treat other conditions may actually cause goitre while some people seem to have a genetic predisposition for the thyroid gland to enlarge.

A nodular goitre occurs when a small lump or a number of lumps develop in the thyroid gland and is called a multinodular goitre. Causes of a single nodule include a cyst, benign growth, cancer (which is rare) and other rare causes.

Goitres can be associated with the thyroid gland producing too much thyroid hormone, too little or indeed the correct amount. Your doctor will usually do blood tests to determine which category you fall in to. It is important also to remember that your thyroid may produce too much or too little hormone without you developing a goitre at all.

Does a goitre cause any symptoms?

Often there are no symptoms apart from a swelling. They are usually painless unless inflamed.

If the thyroid produces too much thyroid hormone ie is overactive, symptoms may include:
Feeling restless or agitated, hand tremor, weight loss, palpitations, diarrhoea, shortness of breath, thinning of the skin and itch, tiredness, and eye problems if the cause is a condition callled Grave’s disease.

If the thyroid is underactive i.e produces insufficient thyroid hormones, symptoms may include:

Tiredness, constipation, weight gain, feeling cold and achy, dry skin, fluid retention, depression. Sometimes it may lead to hoarseness, loss of libido and infertility .
A very large goitre may actually press on the windpipe or oesophagus (gullet) causing difficulty breathing or swallowing.
As well as blood tests, other diagnostic tests your doctor may order include an ultrasound (scan) of your neck as well as a biopsy – where a tiny segment of your thyroid gland is sent off for analysis. In some cases more specialised blood tests and scans such as MRI or CT may be required.

How is Goitre treated?

Well, this really depends on the cause and the size of the goitre and how many symptoms it is causing.

If the goitre is small and is not caused by cancer, and the thyroid gland is producing just the right amount of hormones, then you may not require any treatment at all. If the thyroid is making too much or too little thyroid hormones, then you may need medicines to replace or reduce the amount of these hormones. In certain cases, surgery may be required.

In certain cases of over-active thyroid gland, radioactive iodine is used to destroy some of the thyroid tissue. In rare cases attributed to cancer, surgery will almost certainly be required.

The above information is intended as advice only and should you have any concerns please contact your own Doctor.

Dr Ciarán Roarty MB, BCh BAO MICGP DRCOG Grad. Cert. Obst. Ultrasound, is a full-time GP at Scally McDaid Roarty Medical Practice, Scally Place, Letterkenny, Tel 0749164111 http://scallys.ie

Dr Ciaran Roarty at the Scally McDaid Roarty surgery in Letterkenny.


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