Goitre

Also called Thyroid swelling, Thyroid nodule

A swollen thyroid. Usually benign, and thyroid function tests may be entirely normal, which does not make the lump nothing.

What it is

Enlargement of the thyroid gland in the neck, either generally or as one or more nodules.

Thyroid nodules are extremely common, particularly in women and with age, and the great majority are benign. Around 5 per cent turn out to be cancer, and thyroid cancer generally has an excellent outlook.

Two things are worth understanding.

First, **a goitre can occur with an overactive, underactive or completely normal thyroid**. Being told the thyroid blood tests are normal does not mean the lump does not need assessing; the tests and the lump are separate questions.

Second, the assessment pathway is standard: examination, thyroid function tests, ultrasound, and a needle biopsy where the ultrasound appearance warrants it. A neck lump should not simply be watched without imaging.

Causes include hypothyroidism from autoimmune thyroiditis, hyperthyroidism from Graves' disease, multinodular goitre, iodine deficiency, and cysts.

A large goitre can press on the windpipe or gullet, causing breathing or swallowing difficulty, particularly when lying flat or reaching up, and that needs surgical assessment.

Features raising more concern are a hard fixed lump, rapid growth, a hoarse voice, swallowing difficulty, or a lump in a child, a man, or after neck radiation.

Signs you might notice

A visible or palpable swelling at the front of the lower neck, moving up when swallowing.

A feeling of tightness, or of something in the throat.

Difficulty swallowing, or a sensation of food sticking.

Breathlessness, particularly lying flat or when raising the arms.

Hoarseness or a change in the voice.

Symptoms of an over- or underactive thyroid: weight change, palpitations, heat or cold intolerance, tiredness, hair and skin changes.

Urgent: a rapidly enlarging lump; a hoarse voice lasting more than three weeks; difficulty swallowing or breathing; a hard, fixed or irregular lump; or enlarged lymph nodes in the neck. See head and neck cancer.

Emergency: sudden difficulty breathing.

How it can affect day-to-day life

Waiting for biopsy results is a hard few weeks and the reassurance that most nodules are benign is worth stating explicitly at the start.

Fine needle aspiration is uncomfortable rather than painful and does not require anaesthetic; knowing that in advance helps.

Some results come back indeterminate, meaning surgery is needed to find out, which is frustrating and is not a hidden diagnosis.

For large goitres, symptoms are often positional, and people adapt without realising: sleeping propped up, avoiding high shelves. Asking about those specifically uncovers more than asking whether it causes problems.

After thyroid surgery, the two things to watch are voice change from nerve injury and low calcium from parathyroid damage. See hypoparathyroidism.

Where the thyroid is removed, lifelong levothyroxine is needed and must not be missed.

Supporting someone well

Get any neck lump assessed, including an ultrasound. Do not accept normal blood tests as the end of it.

Ask about the ultrasound grading and whether a needle biopsy is indicated.

Report positional breathlessness or swallowing difficulty; ask about them specifically.

Get a hoarse voice lasting three weeks assessed urgently.

After surgery, report tingling around the mouth or in the fingers immediately, and any voice change.

Take levothyroxine consistently, on an empty stomach and away from calcium and iron.

Ask for the actual thyroid function numbers rather than being told they are normal.

For a lump in a child, or after previous neck radiotherapy, ask for a lower threshold for referral.

Where to get help

A GP practice for examination, blood tests and ultrasound referral.

Endocrinology or ENT for nodules needing biopsy or surgery.

999 for sudden difficulty breathing.

Thyroid UK run an information service and support network.