Have you noticed a large bump on your neck lately? Is it causing you discomfort and seems to be worsening? You may have a goiter, a type of thyroid disease. Though treatable, not all forms of goiter treatment are suitable during pregnancy.
What is Goiter?
A goiter is an enlargement of the thyroid gland. The thyroid gland is located in your neck and produces hormones that regulate metabolism in the human body. A goiter can cause difficulty in swallowing and breathing. There are two types of goiter: diffuse and nodular. A diffuse goiter refers to consistent enlargement of the thyroid gland while a nodular goiter is enlargement of the thyroid from one or two nodules. Although rare in the U.S., pregnant women living in iodine-deficient areas of the world are more vulnerable to developing goiters during pregnancy. A baby is dependent on the mother for thyroid hormone for the first 10 to 12 weeks of pregnancy.
Signs and Symptoms of Goiter
If you have a goiter, some of the typical goiter symptoms you may notice include:
- tightness in the throat
- thyroid gland enlargement
- trouble swallowing
- trouble breathing
Causes of Goiter
The thyroid gland produces a number of hormones that regulate metabolism, body temperature, heart rate and protein production. A goiter may not necessarily affect the levels of hormones or the production of hormones. But if the hormone production is abnormal it could be due to a number of reasons including:
Your doctor can use physical examination, blood tests, antibody tests, ultrasound and a thyroid scan to determine what is causing the goiter.
During a physical exam, the doctor will feel your thyroid gland and look for the presence of nodules and check what areas are tender.
The doctor can test the levels of hormones in your blood by conducting blood tests. An underactive thyroid will have a low level of thyroid hormone and a high level of thyroid-stimulating hormone (TSH). An overactive thyroid will have a high level of thyroid hormone and a low level of TSH. The blood test can also check for the production of irregular antibodies in your blood that can be caused by a goiter.
An ultrasound uses sound wave to detect the presence of nodules that cannot be felt through physical examination.
Another method for diagnosing a goiter is by a thyroid scan. A thyroid scan involves injecting radioactive isotope into your elbow vein. The isotope will travel to your thyroid and illuminate it for further examination. You will lie down on a table and tilt your head backward for the isotope to reach your thyroid gland. A camera will then take a picture of your thyroid gland.
Treatment During Pregnancy
The treatment for goiter depends on the specific nature of the goiter. If the goiter is small and not causing you much difficulty, your doctor may just wait to see what happens. However, if the goiter is increasing in size and you find it quite painful, your doctor has variety of options to treat you.
Goiter due to Gravesï¿½ Disease
If you are pregnant, your doctor will take this into consideration before beginning on a course of treatment. If the goiter is caused by Gravesï¿½ Disease, you may be considered as a candidate for treatment with anti-thyroid medication, particularly propylthiouracil (PTU). Your doctor will want to keep your T3 and T4 levels in the normal range with a low dose of this medication. This drug is also administered to prevent your baby from developing hypothyroidism or a goiter.
Aspirin or corticosteroid medication may be prescribed to treat goiter inflammation, but these have been noted to impair fetal growth in the long-term. You will not be recommended for surgery, as this is a danger to you and your baby at this time.
Goiter Caused by Hashimotoï¿½s Disease
If you are diagnosed with Hashimotoï¿½s Disease, your doctor may prescribe levothyroxine to you. Levothyroxine is a medication used to treat hypothyroidism and will reduce the size of your goiter. Your dosage of this medication may have to be doubled during pregnancy. Doctors will check your thyroid hormone function every six to eight weeks during pregnancy to ensure that everything is functioning normally.
Other Treatment Options
If you are not pregnant, you may have surgery to remove your goiter. A thyroidectomy is surgery on the thyroid gland. Your doctor may opt for surgery if you have a large, uncomfortable goiter that interferes with your breathing and swallowing or if you have thyroid cancer.
Radioactive Iodine Treatment
If you have an overactive thyroid gland, your doctor may decide to treat your goiter with radioactive iodine. Radioactive iodine, taken orally, will travel through your bloodstream, eliminating thyroid cells. The treatment will reduce the size of the goiter but may result in an underactive thyroid gland and lifelong dependence on hormone replacement therapy. However, this treatment is not recommended during pregnancy.