Understanding Multinodular Goitre
Goitre means enlargement of the thyroid gland, and when the enlargement is caused by multiple nodular growth it is called multinodular goitre (MNG).
Multinodular goitre refers to a condition where the thyroid gland becomes irregularly enlarged due to the presence of multiple nodules. Unlike a simple goitre, which has a uniformly enlarged gland, a multinodular goitre features distinct lumps within the gland. These nodules can differ in size and may grow slowly over time.
The development of MNG is typically a slow process that may not present symptoms for many years. It generally begins with slight irregularities in the thyroid tissue that gradually grow into nodules. Over time, these nodules can increase in number and size, contributing to the overall enlargement of the gland.
Signs and Symptoms of Multinodular Goitre
Multinodular goitre is often asymptomatic, especially in the early stages. However, as the nodules grow or if the goitre becomes significantly large, it can lead to a range of noticeable signs and symptoms. These symptoms mainly arise from the physical presence and pressure of the enlarged thyroid gland, which can affect nearby structures in the neck. Understanding these signs and symptoms is important for early detection and management of the condition.
- Neck Swelling: The most obvious symptom of multinodular goitre is an enlarged thyroid gland that appears as a swelling at the base of your neck. This swelling might be uneven due to the irregular sizes of the nodules.
- Discomfort in the Neck: Some individuals may feel a tightness or pressure in their neck, which can be uncomfortable.
- Difficulty Breathing: If the nodules are large enough, it can exert pressure on the windpipe (trachea), leading to respiratory difficulties. This might be more apparent during physical activities or when lying down.
- Difficulty Swallowing: The enlarged gland can also press on the oesophagus, which can interfere with the normal swallowing of food. Patients might experience a sensation of food being stuck in the throat, especially with solid foods.
- Hoarseness of Voice: Pressure on the recurrent laryngeal nerve, which serves the vocal cords, can lead to hoarseness or a chronic cough. Changes in voice are a common complaint among those with significant goitre development.
Diagnosing Multinodular Goitre
In order to determine whether the lesions are malignant or benign, Endocrinologists may employ various methods, including:
- Detailed medical history taking: Your Endocrinologist will understand your current health issues and medical history, guiding further assessments and decisions.
- Physical examination: this includes inspecting the neck from the front and side to determine the lump’s location. The neck will also be examined for abnormal enlargement, contour, asymmetry, and masses, especially during repeated swallowing, by physically touching and feeling the lumps.
- Imaging tests: Imaging tools like ultrasound, CT scans, and MRI also provide invaluable diagnostic information about the nature of the neck lumps.
- Biopsy: Fine Needle Aspiration (FNA) involves using a thin needle to take a tiny tissue sample from the lump. The sample will be scrutinised under a microscope.
As multinodular goitres are associated with a higher risk of developing thyroid cancer, your Endocrinologist will most likely screen you for thyroid cancer as well.
Multinodular goitre (MNG) is typically not life-threatening, but it can lead to complications depending on its size and the presence of other symptoms:
- Compression Effects: If the goitre becomes large enough, it can press on the trachea (windpipe) and oesophagus (food pipe), which can cause breathing difficulties, swallowing problems, and even acute respiratory distress in extreme cases.
- Cosmetic and Psychological Impact: While not life-threatening, the appearance of a large goitre can cause significant psychological distress and affect quality of life.
- Thyroid Function: In some cases, a multinodular goitre can lead to hyperthyroidism (overactive thyroid). If left untreated, it can result in serious conditions like thyrotoxicosis or thyroid storm, which are potentially life-threatening.
- Rare Malignant Transformation: There is a small risk that one or more of the nodules within the goitre could be cancerous. Thyroid cancer, depending on the type and stage, can be life-threatening if not treated promptly.
Treatment Options for Multinodular Goitre
The underlying cause of the neck lumps determines the treatment plan. The treatment may include:
- Thyroid Hormone Suppression Therapy: Administering levothyroxine to suppress TSH (thyroid-stimulating hormone) production, which may help to prevent further growth of the nodules, though its effectiveness varies.
- Radioactive Iodine Therapy: Used to reduce the size of the goitre, particularly in cases where the goitre is causing symptomatic hyperthyroidism. This treatment involves taking a radioactive iodine drink or capsule that selectively destroys thyroid tissue.
If you notice any lumps in your neck or discover that you have thyroid nodules (incidentally seen during CT scan or Ultrasound imaging), or multinodular goitre, you can schedule a consultation with Harmony Thyroid, Endocrinology and Diabetes Centre’s experienced Senior Consultant Endocrinologist and Medical Director Dr Vikram Sonawane. Dr Vikram will come up with a personalised treatment plan for your condition.
References:
- Multinodular Goiter: Causes, Treatment, Complications, and More. Healthline. Published August 29, 2017. https://www.healthline.com/health/multinodular-goiter
- Mayo Clinic. Thyroid Cancer – Diagnosis and treatment – Mayo Clinic. Mayoclinic.org. Published2019. https://www.mayoclinic.org/diseases-conditions/thyroid-cancer/diagnosis-treatment/drc-20354167
