Thyroid Gland Enlargement (Goiter)

Goiter is a treatable condition. It arises from a malfunction of the thyroid gland, and if diagnosed in time, it can be controlled. If neglected, it can lead to cancer.

Goiter, often perceived as a lump in the front of the neck, refers to the enlargement of the thyroid gland, which plays a crucial role in balancing many body functions. This enlargement negatively affects the function of the thyroid gland. The thyroid gland is an endocrine gland normally weighing about 15-25 grams, located on either side of the trachea in the neck. It is a highly vascular organ that secretes thyroid hormones into the bloodstream. A decrease or increase in this secretion can have adverse effects.

If the thyroid gland secretes hormones in normal amounts, it is called “euthyroidism.” If it secretes too much hormone, it is called “hyperthyroidism,” and if it secretes too little, it is referred to as “hypothyroidism.”

Symptoms of Hyperthyroidism:

• Nervousness
• Weight loss despite increased appetite
• Excessive sweating
• Tremors in the hands
• Muscle weakness
• Frequent bowel movements
• Frequent urination
• Menstrual irregularities
• Infertility
• Palpitations
• Prolonged cases may lead to exophthalmos (protruding eyes) and inability to close the eyelids

Symptoms of Hypothyroidism:

• Weakness
• Rapid fatigue
• Slowed movements and heart rate
• Drowsiness
• Cold intolerance
• Hoarseness
• Hair and eyebrow loss on the outer edges
• Constipation
• Cessation of menstruation in women

Types of Goiter: Thyroid gland enlargement should be assessed in two ways: diffuse hyperplasia and nodular goiter.

1. Diffuse Hyperplasia: This condition involves only growth with no other formations or pathologies within the thyroid gland. It is often seen in areas with iodine deficiency.
2. Nodular Goiter: In this condition, there are nodules within the thyroid gland that are the size of lentils or chickpeas, and sometimes even larger.

Symptoms of Goiter: If the enlargement of the thyroid gland does not affect hormone levels, meaning there is no hyperthyroidism or hypothyroidism, it may not present significant symptoms other than cosmetic concerns. Goiter is noticeable as swelling in the front of the neck that moves with swallowing. Large goiters may cause difficulty in breathing and hoarseness due to pressure. Occasionally, excessive growth of thyroid tissue may extend into the chest cavity.

Diagnosis and Treatment: The doctor can often detect enlargement and sometimes nodules through physical examination. Further tests such as thyroid ultrasound, thyroid hormone levels (blood tests), and possibly thyroid scintigraphy are requested. An aspiration biopsy may also be necessary.

Based on these tests, the method of treatment for goiter is determined. In addition to medication, surgery may be necessary depending on the doctor’s evaluation.

In diffuse hyperplasia (simple goiter), surgery is recommended if the thyroid gland is excessively enlarged and causing difficulty in breathing or aesthetic concerns.

For nodular goiter:

1. Suspicion of cancer
2. Symptoms of compression
3. Hyperthyroidism
4. Growth extending into the chest cavity
5. Cosmetic reasons (surgery is performed if there is a deformity in the neck)

Ultrasound and thyroid scintigraphy are crucial in diagnosis. If a single cold nodule is detected during these tests, there is a risk of cancer.

Data shows that single nodules in men are at higher risk of cancer compared to women, and nodules in younger individuals have a higher risk than those in older adults. Thyroid cancer risk is significantly high in individuals who received radiation therapy in childhood.

How is Surgery Performed? Before surgery, thyroid hormone levels must be checked. If hyperthyroidism is present, surgery cannot be performed as the patient may experience a thyroid crisis during the procedure. Therefore, hormone levels must be normalized with medication to avoid complications. This normalization process may take months. Surgery is performed under general anesthesia and takes between 30 minutes to 1.5 hours.

A 4-5 cm incision is made in the front of the neck, just below the goiter, to access the thyroid tissue. Total bilateral thyroidectomy is performed to remove all thyroid tissue. In some cases, removal of a single lobe may be sufficient.

Post-Surgery Situation: If bilateral total thyroidectomy is performed correctly, the risk of recurrence is minimal due to the absence of residual tissue. The most significant risk of surgery is voice hoarseness or complete loss of voice, usually seen in cancer cases. The nerve to the vocal cords is located immediately behind the thyroid tissue. Temporary hoarseness may occur after surgery due to swelling in the tissues, but this generally resolves within a few days to a few months.