If you have a goitre, the treatment that you receive will depend on:
- the size of the goitre
- any associated symptoms that the goitre is causing
- whether you have any underlying health conditions, such as an overactive or underactive thyroid gland (a gland in your neck that produces hormones)
If tests reveal that your thyroid gland is working normally, and the goitre is small, no immediate treatment may be recommended. Your condition may just be monitored.
If you have a problem with your thyroid gland, it will be treated. If treating the underlying cause of your goitre does not improve your condition, you may need to have surgery. One study estimated that up to one in seven people with goitres may eventually require surgery.
Underactive thyroid gland
If testing reveals that you have an underactive thyroid gland, one treatment option involves using a synthetic (man-made) hormone to replicate your normal thyroid function. This is called hormone therapy.
The synthetic hormone, which is called levothyroxine, is taken orally (by mouth), usually once a day.
Side effects of levothyroxine include:
- chest pain
- an irregular or rapid heart beat
- muscle cramps (when your muscles suddenly shorten, causing pain)
- muscle weakness
- vomiting
- diarrhoea
- weight loss
- problems sleeping
- headaches
- shaking (tremors)
- sweating
These side effects should pass in a few days as your body starts to get used to the hormone. However, if they continue you should speak to your GP because your dosage may need to be adjusted. In most cases, hormone therapy will need to be maintained for the rest of your life.
See the Health A-Z topic about Hypothyroidism - treatment for more information about treating this condition.
Overactive thyroid gland
If you have an overactive thyroid gland, there are several different treatments that may be recommended. Some are of these are described below.
See the Health A-Z topic about Hyperthyroidism - treatment for more information about treating this condition.
Thionamides
If you have an over-active thyroid gland, you may be given medicines called thionamides. Thionamides help to reduce the amount of thyroid hormones that your thyroid gland is producing.
Thionamides are usually taken orally (by mouth). The medicine works by gradually reducing the levels of thyroid hormones, so it may be several weeks before you notice any effects.
Side effects of thionamides include:
- a mild skin rash
- pain in your joints
- nausea (feeling sick)
- itchy skin
In very rare cases, thionamides can cause a serious condition called agranulocytosis (a sudden drop in the number of white blood cells). If this occurs, it will usually be during the first three months of treatment.
You should seek urgent medical attention if you are taking a thionamide and you develop:
- a high temperature (a fever) of 38C (100.4F) or above
- sore throat
- mouth ulcers
- other signs of infection, such as a rash or swelling
You may need to take thionamides for two to four months before your thyroid gland is under control.
Radioactive iodine
Radioactive iodine is another treatment for an over-active thyroid gland that is taken orally (by mouth). When the iodine reaches your thyroid gland, it destroys the thyroid cells and reduces the size of the goitre. However, the treatment may cause your thyroid gland to become under-active. If this happens, you may need to have hormone therapy (see above).
Iodine supplements
Your GP may recommend iodine supplements if your goitre is caused by an iodine deficiency.
Iodine supplements are also available in many health food shops without prescription. However, you should always consult your GP before taking them. This is because the amount of iodine that is needed by the body varies from person to person. Taking too much iodine may cause other health problems and it could also have toxic (poisonous) effects.
Surgery
If your goitre is interfering with your breathing, or swallowing, and it has not responded to other forms of treatment, surgery may be required to remove part, or all, of your thyroid gland.
You will be given a general anaesthetic, so you will be unconscious and unable to feel anything.
During surgery, the surgeon will make an incision (cut) in the front of your neck so that they can see your thyroid gland. They will usually remove half of your thyroid gland. This should reduce the amount of thyroid hormones being produced, and reduce the size of your goitre.
The surgeon will attempt to remove enough of your thyroid gland to relieve your symptoms, while leaving enough so that normal thyroid hormone production can continue. However, in some cases, this is not always possible and you may require hormone therapy following surgery.
Surgery to remove the thyroid gland is usually safe, but as with all surgical procedures, there is a risk of complications, such as post-operative infection. Some other possible complications are briefly described below.
Nerve damage
The thyroid gland is very close to the two laryngeal nerves (the nerves that control your vocal cords). If these are accidentally damaged during surgery you could:
- have a temporary or permanently hoarse voice
- not be able to speak
- have difficulty breathing
Some studies have found that permanent damage to the laryngeal nerves affects one or two people in every 100 who have this type of surgery. Temporary damage may affect up to five people in every 100.
Parathyroid gland damage
The parathyroid glands are glands that help to regulate the amount of calcium (a mineral that is needed for strong teeth and bones) in your body. If the parathyroid glands are damaged, you will probably need to take calcium supplements for the rest of your life.
The risks of complications occurring after thyroid gland surgery are estimated to be 1-2%.
