A swelling in the neck due to an enlarged thyroid gland is called a goitre. Nodules are lumps in the thyroid gland. Most are harmless but you should arrange an appointment with your doctor as soon as you find a lump or swelling.

Main causes of enlargement of the thyroid

• Hashimoto’s thyroiditis and Graves’ disease
• Dietary Iodine deficiency - this is rare in the UK
• Excessive consumption of kelp - a seaweed rich in iodine
• Certain drugs such as amiodarone and lithium
• Radiotherapy to the head or neck
• Large amounts of radioactivity such as seen in Hiroshima and Chernobyl

Investigations

• Fine needle aspiration - removes cells from the swelling for investigation
• Ultrasound scan - checks size and shape of thyroid
• Blood tests - check hormone levels
• X-rays - to check position of thyroid
• Radioactive iodine scan - checks size, shape and whethe overactive (“hot”) or underactive (“cold”)

Main types of thyroid nodules and swellings

• Single thyroid nodule (solitary nodule)
• Multiple thyroid nodules (multinodular goitre) - sometimes caused by an overactive thyroid
• Retro - or sub-sternal goitre - thyroid develops lower down behind the breastbone (often a multi-nodular goitre)
• Diffuse enlargement - found in Hashimoto’s thyroiditis and Graves’ disease (autoimmune thyroid disorders)

More about single nodules

• Colloid nodule - thyroid tissue is enlarged
• Hyperplastic nodule - either solitary or part of a multi-nodular goitre
• Thyroid adenoma - a solid lump
• Thyroid cyst - swelling that contains fluid
• Thyroid cancer - rare and has a high cure rate

Treatment

This may involve one or several of the following:

• surgery
• radioactive iodine
• antithyroid medication
• levothyroxine tablets

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