Goitre - Treating goitre

Treatment for goitre can include medication, hormone therapy and surgery.

The treatment you receive will depend on:

the size of the goitre
the symptoms the goitre is causing
whether you have any underlying conditions, such as an overactive thyroid gland (hyperthyroidism) or an underactive thyroid gland (hypothyroidism)

If tests reveal your thyroid gland is working normally, and the goitre is small, no immediate treatment may be necessary and your condition may just be monitored.

If you have a problem with your thyroid gland, however, it will be treated. Surgery may be needed if your condition doesn't improve with treatment. A study has estimated that up to one in seven people with goitres may eventually require surgery.

Underactive thyroid gland

If tests reveal that you have an underactive thyroid gland, treatment could include using a synthetic hormone to replicate your normal thyroid function (hormone therapy).

The synthetic hormone is levothyroxine and is taken orally, usually once a day.

Side effects of levothyroxine, which usually occur when too much has been taken, can include:

an irregular or rapid heartbeat (palpitations)
muscle cramps (when your muscles suddenly shorten, causing pain)
vomiting
diarrhoea
weight loss
problems sleeping
headaches
sweating

These side effects should pass in a few days as your body gets used to the hormone. However, if they continue, speak to your GP as your dosage may need to be adjusted. In most cases, hormone therapy will need to be carried out for the rest of your life.

Read more about treating hypothyroidism.

Overactive thyroid gland

If you have an overactive thyroid gland, there are several recommended treatments. Some are described below.

Thionamides

Thionamides are a type of medication that help reduce the amount of hormones your thyroid gland is producing.

Thionamides are usually taken orally. They work by gradually reducing levels of thyroid hormones, so it may be several weeks before you notice any effects.

Side effects of thionamides include:

a mild skin rash
joint pain
nausea (feeling sick)
itchy skin

In very rare cases, thionamides can cause a serious condition called a sudden drop in the number of white blood cells (agranulocytosis). This usually occurs within the first three months of treatment.

Signs to look out for include:

a high temperature (fever) of 38°C (100.4°F) or above
sore throat
mouth ulcers

If you notice any of the above, see your GP.

You may need to take thionamides for two to four months before the overactive thyroid gland is controlled.

Radioactive iodine

Radioactive iodine is another treatment for an overactive thyroid gland that's taken orally. When the iodine reaches your thyroid gland, it destroys the thyroid cells and reduces the goitre's size.

However, the treatment may cause your thyroid gland to become underactive. If this happens, you may need hormone therapy (see above).

Read more about treating hyperthyroidism.

Iodine supplements

A well-balanced diet usually provides all the iodine your body needs, and iodine supplements aren't usually required in developed countries like the UK. Your GP can give more advice about extra supplements, if needed.

Iodine supplements are available in many health food shops without a prescription. However, always consult your GP before taking them, because the amount of iodine needed varies from person to person. Taking too much iodine may cause other health problems, and it could also have toxic (poisonous) effects.

Surgery

If your goitre is interfering with your breathing or swallowing, and it hasn't responded to other forms of treatment, you may need surgery to remove part or all of your thyroid gland. This procedure is known as a thyroidectomy.

You will be given a general anaesthetic, meaning you will be unconscious and unable to feel anything.

During surgery, the surgeon will make an incision in the front of your neck so they can see your thyroid gland.

How much of the thyroid gland is removed will depend on the underlying condition causing the goitre. The procedure will reduce the size of your goitre and the amount of thyroid hormones being produced.

The surgeon will attempt to remove enough of your thyroid gland to relieve your symptoms, while leaving enough so that normal thyroid hormone production can continue. However, if this isn't possible, you may require hormone therapy after surgery.

Surgery to remove the thyroid gland is usually safe, but as with all surgical procedures there's a risk of complications, such as post-operative infection.

The risks of complications occurring after thyroid gland surgery are estimated to be 1-2%. Before having the procedure, you should discuss the risks with your surgeon.

Nerve damage and parathyroid gland damage are two other possible complications of thyroid gland surgery. These are briefly described below.

Nerve damage

The thyroid gland is very close to the two laryngeal nerves, which control your vocal cords. If these are accidentally damaged during surgery, your voice and breathing could be affected.

Permanent damage to the laryngeal nerves affects one to two people in every 100 who have this type of surgery. Temporary damage may affect up to five people in every 100.

Parathyroid gland damage

The parathyroid glands help regulate the amount of calcium in your body. If the parathyroid glands are damaged, you will probably need to take calcium supplements for the rest of your life.

Hormones: Hormones are groups of powerful chemicals that are produced by the body and have a wide range of effects.
Incision: An incision is a cut made in the body with a surgical instrument during an operation.
Thyroid gland: The thyroid gland is found in the neck. It produces hormones that are released into the bloodstream to control the body's growth and metabolism (the process that turns food into energy).
White blood cells: White blood cells are the part of blood that fight infection and disease.