Thyromegaly – More Than Just a Swelling in the Neck

Thyromegaly is also known as goiter. The condition results from an enlarged thyroid gland (1). The thyroid gland is located the lower part of the neck, below Adam’s apple. It is a shaped like a butterfly with two lobes that lie on either side of the windpipe and is joined in the center by the isthmus. 

The thyroid gland is an essential part of the endocrine system, which regulates bodily functions through the release of hormones. The hormones produced by the thyroid control the way your body metabolizes carbohydrates and fat. They regulate the production of protein, control body temperature and ensure that the heart beats at a regular pace, so any interference in the production of these hormones can have some nasty side effects.

The thyroid gland works together with the pituitary gland that is located in the base of the brain and sends signals in the form of Stimulating Thyroid Hormone STH to the thyroid when it is producing too few hormones (2).

Your chances of getting a thyromegaly increase with age and the condition is much more likely over the age of forty. More women than men suffer from the disorder (3).

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Types of Thyromegaly

  • Euthyroid – a non-cancerous mass that does not affect the function of the thyroid
  • Hyperthyroidism - overactive thyroid
  • Hypothyroidism - underactive thyroid
  • Diffuse goiter – the thyroid is completely covered in masses
  • Nodular Goiter – where one or more nodules are present on the thyroid. These can be either: Non-toxic goiter or toxic goiter and Unimodular or multinodular goiter.
  • Cystic Goiter – Contains fluid

The Size of the Goiter

There are three classes of goiter. They are classified according to their size and visibility

  • Class 1 goiter – a palpation goiter is not visible but it is palpable
  • Class 2 goiter – can usually be seen
  • And, class 3 goiter – are quite large and visible

Causes

Many triggers cause the enlargement of the thyroid gland, as discussed below

1. Endemic Goiter

  • Iodine deficiency – iodine is an essential element for the proper functioning of the thyroid gland. If you lack iodine the thyroid will swell up as it attempts to produce T3 and T4. The body does not produce iodine so it must form part of your diet. Iodine-deficiency usually only occurs in parts of the world where using iodized salt is rare. Yet this is one of the most common causes of thyromegaly (2).

2. Sporadic Goiter

  • Genes – this is often an inherited disorder, and if you have a family member who has had thyromegaly, you have a much greater chance of getting the condition (4).
  • Medications that contain cobalt or lithium
  • Autoimmune diseases
  • Grave’s Disease – the body causes the thyroid to produce excess hormones, and the result is hyperthyroidism (2). 
  • Hashimoto’s Disease or Hashimoto’s thyroiditis causes serious damage to the thyroid gland and results in severe hypothyroidism (2).
  • Thyroiditis – inflammation caused by bacterial or viral infectionoThyroid cancer – in rare cases
  • Exposure to radiation
  • Pregnancy – hormonal changes can result in confused signals which cause over or underproduction of T3 and T4.

Symptoms

The extent of the symptoms will depend on the size of the enlarged thyroid gland (5).

  • Swelling in the lower neck – can range from a small swelling to a large mass
  • Tightness in the throat
  • Hoarseness
  • More frequent coughing
  • Difficulty swallowing
  • In severe cases, there may be difficulty breathing, dizziness, vomiting and high temperature
  • Additional symptoms
  • Too many thyroid hormones could result in heat intolerance, chest pain, insomnia and high blood pressure
  • Too few and you could suffer from lethargy, cold, constipation, depression and weight gain.

Diagnosis

thyromegaly diagnosis

You should consult a doctor as soon as you suspect that you may have thyromegaly. The swelling may not be evident in the early stages of the condition, but early diagnosis is crucial as treatment can prevent the goiter from growing to a size that might later cause damage to the surrounding tissues.

The doctor will check the lower neck for any signs of swelling or tenderness. If the swelling is relatively small, he may suggest that you wait it out to see whether the problem clears itself. He will draw blood and send it to the laboratory to test TSH, T3 and T4 levels.

T3 and T4 are the hormones that your thyroid secretes. T3 is an active hormone, and T4 is not. If the blood tests indicate that there may be a problem an ultrasound or thyroid scan will be ordered. The ultrasound helps to determine the size and shape of the swelling and any effects that it may have had on the surrounding tissues (5). To do the thyroid scan, the doctor will inject you with radioactive iodine. Imaging is then used to determine whether you have a hot or cold nodule. Hot nodules are hyperactive and cold nodules hypoactive. A cold nodule may be malignant or benign.

If the gland appears swollen but the hormone levels are normal the doctor will do a Fine Needle Aspiration Cytology FNAC. This procedure is a biopsy which will help to ascertain the type of tumor or nodule present.

Treatment

Treatment often depends on diagnosing the source of the problem. It will also depend on the size of the goiter and on whether it is cancerous or not (6)

treatment for thyromegaly
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    Radioactive iodine therapy is used to treat hyperthyroidism. The iodine kills off part of the gland reducing its size and the amount of hormone that it produces
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    Where the thyroid gland is moderately enlarged the doctor may prescribe medication to prevent further enlargement.
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    An iodine deficiency can be treated by diet or iodine supplements
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    If medications are the cause of the goiter the dosage size may be reduced
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    Hormone replacement medication can help to bolster an underperforming thyroid
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    Ethanol infusion is known to work, but in some cases, the goiter grows rather than shrinks.
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    Surgery is the last resort and will happen in severe cases or where cancer is present. In these cases, a total or partial thyroidectomy may be necessary. One lobe removal is called a hemithyroidectomy. If the muscle between the two lobes is removed the surgery is called an isthmusectomy.

Thyromegaly and Cancer

Sometimes tumors growing around the thyroid may be the cause of the thyromegaly. If these tumors are found to contain malignant cells, they must be removed. Early detection is important because in the early stages the tumors can be removed without removing the thyroid gland completely (7). 

Diet

thyromegaly diet

Thyromegaly is not preventable, but some dietary changes can help to reduce the symptoms (8)

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    Limit your intake of goitrogenic foods which include vegetables from the cabbage and cauliflower species, strawberries, soy products, peaches, spinach, sweet potatoes, and peanuts. If you have to eat these vegetables ensure that they are thoroughly cooked as cooking removes the goitrogenic contents
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    Include foods rich in selenium such as dairy, meat, seafood, eggs, poultry, barley, onions and sunflower seed.

Early Detection is Key

Enlarged thyroid glands and nodules on the thyroid are not uncommon. Remember that early detection is key to avoiding complications later on so if you suspect that you may have thyromegaly seek help. A swollen thyroid gland is an outward display of an internal dysfunction.

Treatment can only commence once the doctor has diagnosed the underlying cause. Disruptions to the endocrine system can cause unexpected symptoms that can have a negative impact on your life and can even affect you emotionally. It is therefore in your own best interest to take the problem to the doctor.

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