Goitre: when does a swollen thyroid need surgery (thyroidectomy)?

What a goitre is

A goitre is a swelling of the thyroid gland, at the front of the neck below the Adam's apple. It moves up when you swallow. It can be smooth, or contain one or more lumps (nodules). The thyroid may be working normally, too much (overactive) or too little (underactive). In parts of Nigeria goitre has long been linked to low iodine, which iodised salt has reduced, but there are many other causes.

The tests a goitre needs

• Thyroid blood tests (TSH and often T4) to see how the gland is working
• An ultrasound of the neck to look at the size and any nodules
• A fine needle aspiration (FNA) of any nodule that looks suspicious on ultrasound, to look at cells under the microscope
• Sometimes a CT scan if the goitre goes down behind the breastbone

When surgery is usually advised

• Pressure symptoms: difficulty swallowing, a feeling of choking, noisy breathing or breathlessness when lying flat
• A nodule that is suspicious or confirmed as cancer on FNA
• An overactive thyroid that keeps returning or cannot be treated with tablets or radioactive iodine
• A goitre growing down into the chest
• A large visible swelling that you want removed

When watching is the better choice

If the blood tests are normal, the ultrasound shows no worrying nodules, and you have no pressure symptoms, most doctors advise watching the goitre rather than operating. That usually means a check and sometimes a repeat ultrasound at intervals your doctor sets, and coming back sooner if anything changes.

An overactive thyroid is usually treated first with tablets, and sometimes radioactive iodine, before surgery is considered. An underactive thyroid is treated with thyroxine tablets, not surgery. Do not take iodine tablets, seaweed products or herbal 'goitre' remedies on your own: too much iodine can upset the thyroid in some people.

Half or all of the thyroid

A hemithyroidectomy removes one side and is often used for a single nodule. Many people keep enough thyroid function afterwards not to need tablets, though some do. A total thyroidectomy removes the whole gland and means daily thyroxine tablets for life. Your surgeon will explain which suits you and why.

Get urgent attention if

• The swelling is growing quickly over weeks
• Your voice becomes hoarse and stays that way for more than a few weeks
• You have difficulty breathing or noisy breathing
• You are losing weight without trying, or have hard lumps elsewhere in the neck

Common questions