Patient education: Nodular goiter (The Basics)

What is a nodular goiter? — A "goiter" is when the thyroid gland grows bigger than normal. The thyroid gland is in the middle of the neck. People with a nodular goiter also have 1 or more "thyroid nodules." These are round or oval-shaped growths in the thyroid (figure 1).

Thyroid nodules are common and not usually harmful to a person's health. But sometimes, thyroid nodules are caused by a serious condition, such as cancer.

The thyroid gland makes a hormone called "thyroid hormone." Most thyroid nodules do not change the amount of thyroid hormone in the body. But some thyroid nodules cause the thyroid gland to make too much thyroid hormone. If a nodular goiter has this type of thyroid nodule, it can cause symptoms.

What are the symptoms of a nodular goiter? — Most people with a nodular goiter do not have symptoms. The swelling might be found during an imaging test, such as an ultrasound, that is done for another reason. Or a blood test to check thyroid hormone levels might show that a person has too much thyroid hormone. Having too much thyroid hormone can be a sign of a nodular goiter.

Some people with a nodular goiter feel or see a lump in their neck. Or they have symptoms from having too much thyroid hormone, such as:

●Feeling worried or upset, or having trouble sleeping

●Feeling weak or tired

●Losing weight without trying

●Having a fast heartbeat

●Having frequent bowel movements

If a nodular goiter presses on the throat or airway, it can cause:

●Trouble breathing, especially during physical activity, at night, or when reaching or bending

●Wheezing

●Coughing

●A choking feeling

●Trouble swallowing

Will I need tests? — Yes. Your doctor will want to make sure that the nodular goiter is not going to harm your body. You need tests to find out if nodules in the goiter are causing your thyroid gland to make too much hormone. Your doctor will also check the nodules to see how big they are and if they need to be taken out.

Tests usually include blood tests and an imaging test of the thyroid called an ultrasound. This test uses sound waves to create a picture of the inside of your body.

Sometimes, people need more tests. These include:

●Fine-needle aspiration – For this test, a doctor uses a thin needle to remove a small sample of tissue from 1 nodule in the goiter, usually the largest. They might take tissue from more than 1 nodule. Then, another doctor looks at the tissue under a microscope.

●Thyroid scan – People get this test only if they have too much thyroid hormone in the body. For this test, a person gets a pill or a shot with a small amount of a radioactive substance. Then, a special camera takes a picture of the thyroid gland. This test is not safe if you are pregnant or breastfeeding.

How is a nodular goiter treated? — Many nodular goiters do not need treatment. If the nodules are small and do not look harmful, your doctor might watch and wait to see if the swelling gets bigger or needs to be treated.

A nodular goiter needs treatment if it:

●Causes the thyroid gland to make too much hormone

●Causes problems with breathing, swallowing, or other body functions

●Is very large

●Contains cancer

Treatments for nodular goiter include:

●Antithyroid medicines – If your thyroid blood tests show that the thyroid gland is making too much thyroid hormone, doctors can use medicines such as methimazole (brand name: Tapazole) to lower the amount of thyroid hormone it makes. These medicines control thyroid hormone levels until doctors can do other treatments.

●Medicines to help with symptoms caused by too much thyroid hormone, such as atenolol (brand name: Tenormin)

●Surgery to remove the nodular goiter

●Radioiodine – Radioiodine comes in a pill or liquid that you swallow. It has a small amount of radiation in it. The radiation destroys a lot of the thyroid gland, so it does not make so much hormone. Radioiodine is used only to treat nodules that make too much thyroid hormone. It is not safe for if you are pregnant or breastfeeding.

●Injections of alcohol to shrink nodules, or laser treatment to destroy them. The alcohol used in this treatment is not the kind people drink.

What if I want to get pregnant? — If you want to get pregnant, talk with your doctor or nurse. They can make sure your nodular goiter is not making too much thyroid hormone before you get pregnant.

People who are pregnant should not be treated with radioiodine. This is because radioiodine can cause serious harm to a baby.

More on this topic

Patient education: Thyroid nodules (The Basics)
Patient education: Hyperthyroidism (overactive thyroid) (The Basics)
Patient education: Thyroidectomy (The Basics)

Patient education: Thyroid nodules (Beyond the Basics)
Patient education: Hyperthyroidism (overactive thyroid) (Beyond the Basics)
Patient education: Antithyroid drugs (Beyond the Basics)