The diagnosis of goiter frequently happens during a regular physical examination or during an imaging test for a different condition. The doctor usually notices a thyroid enlargement, a single nodule, or multiple nodules by feeling the neck. The diagnosis of a goiter signals a problem with the thyroid gland.
To evaluate a goiter, the doctor may require several tests to determine the size of the thyroid, look for any nodules, determine if the thyroid is hyperactive or underactive, and identify the underlying cause of the goiter. The series of tests typically involve:
- Thyroid function tests: These tests aim to examine the thyroid hormone values, which indicate whether the thyroid is functioning normally. Specifically, the blood sample will determine how much TSH the pituitary gland produces, as well as how much T-4 and T-3 the thyroid produces. These tests will confirm if the goiter is caused by fluctuations in thyroid hormone levels.
- Antibody test: This blood test checks for specific antibodies produced by particular types of goiters. It detects an antibody associated to an autoimmune ailment, such as Hashimoto’s disease or Graves’ disease. The need for an antibody test depends on the findings of the thyroid function test.
- Ultrasonography: A wand-like instrument, known as transducer, is used during ultrasound. The echoes from high-frequency sound waves are captured and converted into film or photographs to see the tissues in the neck, determine the size of the thyroid and whether it contains nodules.
- Radioactive iodine uptake: This test measures how much radioactive iodine is absorbs by the thyroid gland in a specific time. During this test, the patient will be given a little dose of radioactive iodine and will be monitored using a scanning instrument. This can be performed in conjunction with a radioactive iodine scan to produce a visual representation of the uptake pattern. The findings may aid in determining the cause and function of the goiter.
- Biopsy: A biopsy may be performed to rule out cancer by extracting a sample of tissue or cells from the thyroid nodules during a fine-needle aspiration biopsy and sent to the laboratory testing.
Treatment may not be necessary for people with small goiters, who do not have any symptoms and have a normal thyroid function. Instead, they may be advised to carefully monitor it for any changes. Generally, treatment for goiters vary according to the underlying cause, the signs and symptoms, and the size of the goiter. Common treatments include surgery, medications, and radioactive iodine treatment.
- Medications: Healthcare provider may prescribe drugs to treat a goiter:
- Increasing hormone production. A thyroid hormone replacement therapy will be used to reduce the size of the goiter and cure hypothyroidism. As a T-3 replacement, the medication liothyronine may be administered. Levothyroxine drug substitutes T-4, causing the pituitary gland to produce less TSH.
- Reducing hormone production. The doctor will prescribe an anti-thyroid drug such as methimazole if the cause of the goiter is hyperthyroidism. This drug can decrease the size of the goiter and inhibit hormone production.
- Blocking hormone activities. The most common beta blockers drugs are atenolol and metoprolol. Beta blockers can disrupt the action of thyroid hormones in the body and controls symptoms caused by hyperthyroidism.
- Managing pain. A steroid may be used to relieve extreme pain caused by goiter. Aspirin, naproxen sodium, ibuprofen and other pain medicines are often prescribed to manage discomfort caused by thyroid inflammation.
Another treatment option is surgical removal of the whole or a portion of the thyroid gland (total or partial thyroidectomy). This is often recommended if the goiter is large enough to cause breathing and swallowing problems.
If a cancer or a hyperthyroidism-causing nodules is found in the thyroid, surgery is also necessary. The patient may be required to undergo thyroid hormone replacement treatment following surgery. The treatment can potentially last a lifetime.
Radioactive iodine treatment
This therapy requires consuming radioactive iodine orally. The radioactive iodine enters the thyroid gland and destroys thyroid cells which reduces or stops hormone production, causing the goiter to shrink. Radioactive iodine is commonly administered for an overactive thyroid gland. Following this treatment, patients may require lifelong thyroid hormone replacement therapy.