Goiter: Thyroid enlargement can be prevented

Article contents at a glance:

Hypothyroidism: The most common symptoms

What is a goiter?

The term goiter refers to the symptom of an enlarged thyroid gland, also colloquially known as goiter. With a goiter, the volume of the thyroid gland is significantly larger than is usual for the age and gender: in adult women over 18 milliliters and in men over 25 milliliters.

Women are affected four to five times more often than men. As you get older, the risk of thyroid enlargement increases.

The thyroid is an important organ for the human body. Among other things, it produces the hormones T3 and T4, the release of which is regulated by the thyroid hormone TSH. To produce these hormones, the thyroid gland requires sufficient amounts of the trace element iodine.

Struma nodosa and multinodosa: Different forms of thyroid enlargement

There are different forms of goiter. They are differentiated as follows:

• Diffuse struma: the entire thyroid is enlarged, there are no nodular changes

• Struma nodosa: refers to a nodule formation in the thyroid and is therefore also called nodular goiter or nodular goiter

• Struma uninodosa: the thyroid has formed a lump

• Struma multinodosa: the thyroid has formed several nodules

An enlarged thyroid can be associated with impaired hormone production. In most cases, however, this is normal.

In around 90 percent of cases, goiter is a so-called euthyroid goiter, which is caused by a nutritional iodine deficiency. It is defined as an enlargement of the thyroid gland that occurs with or without nodules, is non-inflammatory, non-malignant and does not involve hormonal dysfunction.

Cold and hot thyroid nodules – that’s what they say

Experts speak of hot and cold nodes when it comes to goiter with nodule formation. This means the following:

• hot nodes: Such nodules produce hormones independently – independent of regulation by the pituitary gland. Hot nodules are benign, but increased hormone production can cause hyperthyroidism.

• cold knots: These nodules produce little or no hormones and therefore do not affect the functioning of the thyroid gland. Cold nodules can be cysts or inflammation; only in rare cases do they indicate a tumor.

Hyperthyroidism: You should know these symptoms

Causes of a goiter

Euthyroid goiter is a secondary disease of a chronic iodine deficiency. In Germany, iodine intake through diet is good today, but many people still consume too little iodine. If there is an iodine deficiency, the thyroid tries to compensate for the missing trace element by increasing the size of the thyroid cells – triggered by the hormone TSH. New connective tissue and new blood vessels are created with the aim of using the existing iodine as effectively as possible.

In addition to iodine deficiency, an enlarged thyroid can indicate other causes, such as:

• Taking medication with the active ingredients lithium or antithyroid drugs in too high a dosage
• Graves’ disease (immune-related hyperthyroidism)
• Inflammation of the thyroid gland (thyroiditis), for example Hashimoto’s thyroiditis
• Formation of cysts
• Excess growth hormones (acromegaly)
• Enzyme defects
• Thyroid cancer

Nicotine consumption, selenium and zinc deficiency are considered risk factors for the development of goiter.

Signs of goiter: What symptoms occur?

A goiter usually has no symptoms at first. They only appear when the thyroid gets bigger. It can then put pressure on the esophagus, trachea or vocal cord nerves.

• Globus feeling (“frog in the throat” or “lump in the throat”)
• difficulties swallowing
• Pressure and tightness in the throat (for example, when wearing necklaces or tight clothing such as turtlenecks)
• hoarseness
• Difficulty breathing
• Breathing noises when inhaling (inspiratory stridor)
• Shortness of breath with certain head movements

Diagnosis if thyroid enlargement is suspected

Since a goiter can be a sign of various diseases, an accurate diagnosis of an enlarged thyroid is particularly important. When you first have symptoms, your family doctor or an endocrinology practice is the right place to go.

To make the diagnosis, the doctor uses a conversation (anamnesis) about the history of the disease, family predisposition and nutritional status. The organ is then examined by palpation.

An ultrasound examination (sonography of the thyroid) provides a precise picture of the size and location of the thyroid and any lumps that may have arisen. These can also be examined with a nuclear medicine examination (scintigraphy). The amount of thyroid hormones in the blood can also be determined.

If malignant tumors are suspected, a tissue sample is taken from the patient for further clarification.

Therapy for goiter: How does the treatment work?

There are various treatment approaches to shrink the enlarged thyroid gland. They depend on the cause at hand.

• Iodine supplementation: If you have an iodine deficiency, taking iodine can help shrink the thyroid gland.

• medical therapy: Thyroid hormones (levothyroxine) may be prescribed to treat hypothyroidism or to normalize thyroid activity. If there is hyperactivity, medications such as thiamazole can be used to reduce hormone production. To treat goitre nodosa, iodide and the thyroid hormone levothyroxine (L-thyroxine) are usually combined.

• Radioiodine therapy: It is a treatment with radioactive iodine that is particularly used for hyperthyroidism or certain types of thyroid nodules. It aims to destroy overactive thyroid tissue.

• Surgery (thyroidectomy): A surgical procedure in which part or all of the thyroid is removed. This is often done for large goiters that are causing discomfort or if thyroid cancer is suspected.

• Observation: In cases where the goiter is small and does not cause any symptoms, a wait-and-see approach with regular check-ups may be sufficient.

Minimally invasive, non-surgical procedures are also possible to treat thyroid enlargement. These methods can usually be performed on an outpatient basis under local anesthesia:

• Radiofrequency ablation (RFA): Procedure in which heat generated by radio waves is used specifically to shrink thyroid nodules. A thin, needle-shaped RFA applicator is inserted directly into the nodule under ultrasound guidance.

• Ethanol ablation (PEI): In this procedure, ethanol (alcohol) is injected directly into the thyroid nodules to shrink them. It is often used for cystic nodules that are predominantly fluid.

• Laser ablation: Similar to radiofrequency ablation, laser energy is used to specifically heat and destroy thyroid tissue. The procedure is carried out under local anesthesia with ultrasound control.

Can goiter be prevented?

Enlargement of the thyroid gland can be prevented by consuming sufficient iodine with food. To meet your needs, sea fish should be consumed once or twice a week and dishes should be prepared with iodized salt.

When purchasing bread, baked goods, cheese or meat products, you should also choose products made with iodized salt. Since iodized mineral mixtures have been used in animal feed for several years, milk also contributes to the iodine supply.

Taking iodine tablets should always be discussed by a doctor, as they may be unsuitable if you have an overactive thyroid, for example.