Goiter

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
  • hoarseness

 

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:

 

  • A lack of iodine causing the thyroid to enlarge because it cannot produce enough of the hormones thyroxine and T-3 which contain iodine.
  • Graves� Disease causes the uniform enlargement of the thyroid gland due to over-stimulation.
  • Hashimoto�s Disease causes the pituitary gland to over-stimulate and enlarge the thyroid.
  • A multinodular goiter is when nodules grow on both sides of the thyroid gland making the thyroid gland bigger.
  • Solitary thyroid nodules are single nodules grown anywhere on the thyroid gland.
  • Thyroid cancer causes an abnormal growth on one side of the thyroid gland.
  • Pregnancy can cause the thyroid gland to enlarge slightly due to the hormone human chorionic gonadotropin (hCG).
  • Inflammation causes the enlargement of the thyroid gland and painful swallowing.
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    Diagnosing Goiter

    Your doctor can use physical examination, blood tests, antibody tests, ultrasound and a thyroid scan to determine what is causing the goiter.

    Physical Exam
    During a physical exam, the doctor will feel your thyroid gland and look for the presence of nodules and check what areas are tender.

     

    Blood Test
    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.

    Ultrasound
    An ultrasound uses sound wave to detect the presence of nodules that cannot be felt through physical examination.

    Thyroid Scan
    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 Graves� 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 Graves� 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 Hashimoto�s Disease
    If you are diagnosed with Hashimoto�s 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

    Surgery
    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.

     

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