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The Enlarged Thyroid
A goitre merely refers to an enlarged thyroid gland. It should be noted that goitres may produce normal levels of thyroid hormones (in which they are referred to as being 'euthyroid'), or abnormal levels of thyroid hormones (in which they may be either 'hyperthyroid' or 'hypothyroid').
1. Simple Diffuse Goitre
A simple diffiuse goitre is seen as a symmetrical, painless, smooth swelling in the front of the neck, which moves up and down on swallowing. Most who develop these simple goitres are young women between the ages of 15 to 25 years of age. During pregnancy, these goitres may fluctuate in size.
2. Multinodular Goitre
Middle aged individuals usually present with multinodular goitres. In these goitres there are multiple small lumps within the thyroid gland, which may have arisen from a cyst, benign tumour (an adenoma), or rarely a malignant tumour. Multinodular goitres potentially become very large and may cause compression of the underlying structures, resulting in difficulty swallowing or even breathing.
3. Thyroid Nodules
Single nodules or lumps in the thyroid are also fairly common, and can occur at any age. These nodule may vary size, being as small as a pea, to as large as a gof ball. Sometimes, if bleeding occurs within the nodule, there may be sudden onset of pain. Asymptomatic nodules are also sometimes found on routine medical examination.
Investigating Enlarged Thyroid Glands
Blood Tests: to check if it is a euthyroid, hyperthyroid or hypothyroid gland.
Fine Needle Aspiration: a needle is inserted into a prominent thyroid nodule or cyst under local anaesthetic, to obtain thyroid cells for histological analysis. The appearance of the cells will help determine if the thyroid enlargement is a result of a benign growth or malignant tumour.
X-rays: X-rays are sometimes ordered to assess if there is compression of the trachea.
Ultrasound Scans: ultrasound scans are used to help assess the nature of the thyroid enlargement.
Isotope Scans: this is a radioisotope scan which helps determine if there are regions in the enlarged gland which are hyperactive.
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