The causes of goiter are numerous, different depending on whether it is homogeneous or heterogeneous, with or without an abnormal thyroid function. It can be linked:

– nutritional, genetic and hormonal factors (hence the greater frequency in women);

– tobacco which promotes goiter by competing with iodine;

– exposure to radiation, cervical irradiation in childhood or environmental exposure.

Homogeneous goiters

These are goiter in which the thyroid gland is swollen throughout its volume in a homogeneous manner.

A homogeneous goiter with normal thyroid function meets in 80% of cases at women. It is painless, of variable size, and does not require special care.

Goiter with hyperthyroidism or Graves’ disease: more common in women than in men, and often of family origin, it is accompanied by weight loss, irritation, feverishness, excessive sweating, tremors. In some cases there is exophthalmos, ie large eyeballs, giving the appearance of globular eyes, protruding out of the orbit.

Homogeneous goiter with hypothyroidism is also more common in women. It can be caused by drugs like lithium, or an iodine deficiency in certain regions of France like the Alps, the Pyrenees, etc. Goiter was very common before the use of iodine fortified cooking salt. It can also be of family origin or caused by an autoimmune disease (Hashimoto’s thyroiditis) in which the body makes antibodies against its own thyroid.

Goiter due to iodine overload after radiography with contrast agents or treatment with amiodarone (treatment intended to treat cardiac arrhythmias) may cause hypo or hyperthyroidism. They regress spontaneously in the first case or after stopping amiodarone.

Goiters that are painful and associated with fevermay correspond to subacute Quervain’s thyroiditis leading to hypothyroidism and often hyperthyroidism. It usually heals on its own within a few weeks or months. The doctor may prescribe aspirin, corticosteroids, and treatments to slow the heart in tachycardia.

Heterogeneous or nodular goiters.

Palpation or ultrasound shows the presence of one or more nodules, whether or not associated with an abnormal thyroid function. The nodule (s) may be “neutral” with normal hormonal function, “cold” or hypoactive with decreased production of thyroid hormones or “hot” or overactive with increased secretion of thyroid hormones. Hot nodules are unusually cancerous. But solid, liquid or mixed cold nodules can in 10 to 20% of cases correspond to a malignant tumor, therefore cancerous.

Which doctor to consult when you have a goiter?

In front of a goiter, therefore an increase in the volume of the thyroid gland at the base of the neck, one can consult his general practitioner who according to the examination and the first elements of the assessment will refer to an endocrinologist (specialist in hormonal functioning) or a ENT.

Clinical examination.

Examination of the neck by the doctor will observe whether or not the swelling at the base of the neck is related to the thyroid. It also allows to see if it is painful or not, homogeneous or not, if the swelling concerns one lobe or both, its hard, firm or soft consistency. The examination by the doctor can also look for the presence of lymph nodes in the neck.

During the general medical examination, the doctor’s questions combined with a physical examination look for signs of abnormal functioning of the thyroid.

The doctor will also ask what are the treatments usually taken by the person, if there were thyroid problems in the family, irradiation of the neck in childhood, the geographical origin, the contributing factors (tobacco, lack of iodine, pregnancy).

Biological examinations.

They analyze the functioning of the thyroid by assaying thyroid hormones (T3 and T4) and TSH (hormone produced by the pituitary gland which controls the secretion of thyroid hormones). In practice, it is above all TSH which is measured for a first assessment. If it is increased, it means that the thyroid is not functioning enough, if it is low, that the secretion of thyroid hormones is excessive.

The doctor may also order a laboratory examination to check for the presence of anti-thyroid antibodies.

Radiological examinations.

The essential examination is thescan which specifies the size, the heterogeneous character or not of the goiter, the characteristics of the nodule (s) (liquid, solid or mixed), its exact situation and in particular the extension of the goiter towards the thorax (what is called a plunging goiter ). She also looks for lymph nodes in the neck.

La thyroid scan. It consists of giving the person who is going to take the exam radioactive markers containing a substance that will bind to the thyroid gland (iodine or technetium). As these markers are radioactive, it is easy to obtain an image of the areas of binding of the markers. This test specifies the overall functioning of the thyroid gland. It can show nodules not seen on palpation and shows

– if the nodules are “cold”: they bind very little radioactive marker, and this shows a decrease in thyroid hyperfunction,

– if the nodules are “hot”, they fix a lot of radioactive markers, which shows excessive manufacture

– if the nodules are neutral, they fix moderately radioactive markers, which shows normal hormonal functioning.

La puncture of a noduleallows to look for the presence of malignant cells or to evacuate a cyst. It is systematically performed for all cold nodules

La simple radiology could show calcifications of the goiter and its extension to the chest

L’IRM is interesting for specifying the extension of the thyroid to neighboring structures and in particular the existence of a goiter plunging towards the thorax, to search for lymph nodes.