Nodular Goitres

What are nodular goitres?

Nodular goitres, often called thyroid nodules or a "lump in the throat," is a condition that affects the thyroid gland in the neck — a butterfly-shaped organ responsible for producing hormones to regulate your body's metabolism.

In this condition, the thyroid gland develops one or more lumps or nodules. These nodules vary in size and may be solid or filled with fluid. While the majority of thyroid nodules are non-cancerous (benign), some can be cancerous (malignant).

What causes nodular goitres?

Nodules in the thyroid develop due to various factors related to the thyroid gland's function and growth and are mostly non-cancerous, but they can still cause symptoms and require attention.

Causes include:

• Iodine deficiency: in regions with insufficient dietary iodine, the thyroid may develop nodules as it tries to compensate for the deficiency, as iodine is essential for producing thyroid hormones.
• Thyroid inflammation: inflammatory conditions such as thyroiditis can lead to the formation of nodules, and chronic inflammation can disrupt the normal structure of the thyroid gland.
• Benign tumours: in some cases, nodules are benign, growing for reasons not entirely understood.

What are the symptoms of nodular goitres?

Symptoms include:

• Neck swelling
• Difficulty swallowing
• Change in voice
• Difficulty breathing
• Changes in thyroid function
• Pain or discomfort

If you suspect you have symptoms or are concerned about your thyroid health, consult an endocrinologist for a proper evaluation and diagnosis.

Are nodular goitres painful?

Thryoid nodules, in most cases, are not painful. Most people with nodular goitres do not even realise they have them until they are discovered during a routine physical examination or imaging tests for unrelated issues – commonly referred to as thyroid incidentalomas. The lack of pain is often because these nodules are usually small, slow-growing, and benign.

However, there are some exceptions. If a nodule becomes large or starts pressing on nearby structures such as the windpipe or oesophagus, it can lead to symptoms like difficulty swallowing or even voice changes. Additionally, in rare cases, nodules can become inflamed or develop into thyroiditis, which can cause pain in the neck.

Who is at risk of nodular goitres?

Several factors can influence the risk of developing nodular goitres; risk factors include:

• Age: thyroid nodules are more commonly associated with ageing. As individuals grow older, the likelihood of developing thyroid nodules tends to increase. 
• Iodine deficiency: iodine intake plays a significant role in thyroid health. Deficiency in iodine has been linked to an increased risk of nodular goitres.
• Radiation exposure: radiation exposure, particularly in the head and neck area, is a known risk factor for thyroid nodules. Individuals with a history of radiation exposure in these regions should be particularly cautious and undergo regular thyroid assessments.
• Gender: women are more prone to developing thyroid nodules compared to men. Additionally, a family history of thyroid nodules or thyroid cancer can also slightly elevate the risk.
• Obesity: obese individuals are at a higher risk of developing nodular goitres.
• Insulin resistance: individuals with insulin resistance are linked to a higher incidence of developing nodular goitres.
• Metabolic syndrome: studies have shown that metabolic syndrome is associated with nodular goitres.

How are nodular goitres diagnosed?

Diagnosing nodular goitres typically involves a comprehensive approach.

Here's what you can expect during the diagnostic process:

• Clinical evaluation: your endocrinologist will begin with a thorough clinical assessment. They will review your medical history, including any family history of thyroid issues, and discuss your symptoms. During this evaluation, it is important to describe any changes in your neck or any swallowing difficulties.
• Physical examination: a physical exam focusing on your thyroid gland will be conducted. Your endocrinologist will check for any visible or palpable lumps or enlargement in your neck.
• Imaging tests: ultrasounds are commonly used to visualise the thyroid and any nodules. It provides detailed information about the size, location, and characteristics of the nodules.
• Fine needle aspiration (FNA): if suspicious nodules are identified, an FNA biopsy may be recommended. During this procedure, a thin needle extracts a small tissue sample from the nodule for laboratory analysis. FNA helps determine if the nodules are benign or cancerous.
• Blood tests: blood tests, including thyroid function tests, may be performed to assess thyroid hormone levels. These tests can help identify any underlying thyroid conditions.
• Further testing: in some cases, additional tests like thyroid scans or molecular marker analysis may be conducted for a more comprehensive evaluation.

Once the diagnosis is confirmed, your endocrinologist will discuss treatment options or the need for ongoing monitoring based on the nature of the nodules and your overall health. Early detection and diagnosis play a crucial role in managing nodular goitres effectively.

What are the treatment options for nodular goitres?

The treatment options for nodular goitres depend on various factors, including the size of the nodules, symptoms, and whether they are benign or cancerous.

Common approaches in the treatment of nodular goitres include:

• Observation: small, non-cancerous nodules often require no treatment but may be monitored regularly through ultrasound to ensure they do not grow or cause symptoms.
• Medication: thyroid hormone replacement therapy, such as levothyroxine, may be prescribed to shrink nodules, particularly if they are causing hyperthyroidism or discomfort.
• Fine needle aspiration (FNA) or biopsy: if nodules are suspicious, an FNA biopsy can help determine if they are cancerous or benign, guiding further treatment.
• Surgery: surgical removal of nodules or partial thyroidectomy may be necessary for large nodules, suspicious nodules, or cases where compression or swallowing difficulties occur. Examples of thyroid surgery include, transaxillary endoscopic thyroidectomy , minimally invasive video-assisted thyroidectomy (MIVAT) , conventional open hemithyroidectomy , near total thyroidectomy, and total thyroidectomy +/- neck lymph node dissection. Radioactive iodine therapy: radioactive iodine therapy is used for hyperthyroidism or benign nodules, and it may shrink the nodules or decrease hormone production.

Your endocrinologist will recommend the most suitable treatment based on your specific condition; discussing the options, benefits, and potential risks with them is important to make an informed decision about your care.

If you are suffering from a thyroid disorder, have a family history of thyroid disorders, or are concerned about developing thyroid cancer, schedule an appointment with ACE Surgery and Endoscopy for a detailed examination and individualised treatment plan.

Frequently Asked Questions