Nodules & Swellings

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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

  • The main cause is unknown but thyroid nodules and enlargement are more common in women than men
  • Women often develop thyroid enlargement during pregnancy and the menopause
  • Diffuse enlargement is often caused by autoimmune thyroid conditions such as Hashimoto's thyroiditis and Graves' disease and can be associated with a change in thyroid function
  • Certain drugs such as amiodarone (because of its iodine content) and lithium
  • Previous x-ray treatment (radiotherapy) to the head or neck increases the risk of thyroid nodules
  • Large amounts of radioactivity such as seen in Hiroshima and Chernobyl
  • Iodine deficiency, although this is rare in the UK
  • Unusual dietry habits (such as consuming large quantities of kelp which is a seaweed rich in iodine)

Investigations

  • Fine needle aspiration cytology (FNAC) - 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 windpipe (trachea)
  • Radioactive iodine scan - checks size, shape and whether over-active (“hot”) or under-active (“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 substernal 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 multinodular goitre
  • Thyroid adenoma - a solid benign 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

It is well recognised that thyroid problems often run in families and if family members are unwell they should be encouraged to discuss with their own GP whether thyroid testing is warranted.

 

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