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Thyroid Complications in Women: Thyroiditis, Goiter, Nodules & Cancer

woman holding her thyroid

What is thyroiditis?

Thyroiditis is when the body’s immune system makes antibodies that attack the thyroid and cause inflammation.

Thyroiditis can be caused by:

● Genetics

● Autoimmune diseases

● Viral or bacterial infection

● Certain types of medicines

Two common types of thyroiditis are postpartum thyroiditis and Hashimoto’s disease.

What is a goiter?

A goiter is an abnormally enlarged thyroid gland. A goiter may only be temporary and can go away on its own without treatment. However, it could also be a symptom of another thyroid disease that requires treatment. According to the twenty‐year follow‐up of the Whickham Survey, goiter is more common in women than in men and this is especially true in pre-menopausal women.

Common causes of goiter include:

● Thyroiditis

● Thyroid cancer

● Graves’ disease

● Thyroid nodules

● Hashimoto’s disease

The only symptom patients typically experience is neck swelling. However, the swelling can be large enough that the patient can visibly see or physically feel the lump. A very large goiter can also cause tension in the patient’s throat, coughing, problems swallowing or breathing. Tests must be performed by a health care provider to ensure that the goiter isn’t caused by another thyroid disease. 

How is goiter treated?

Patients with goiter may not need treatment if their thyroid functions normally and the symptoms do not disturb them.

If a patient needs treatment, medications should be able to shrink the thyroid back to near normal size. Otherwise, the patient may need surgery in order to take out a part, or the majority of the thyroid.

What are thyroid nodules?

Thyroid nodules are swelling in a section of the thyroid gland. The nodule may be solid or filled with fluid or blood. A patient could have just one thyroid nodule or multiple nodules.

According to the British Medical Bulletin, thyroid nodules are common and affect four times as many women as men. However, researchers do not yet know why nodules form in otherwise healthy and normal thyroids.

What are the symptoms and signs of thyroid nodules?

According to the British Medical Bulletin, most thyroid nodules are asymptomatic and are benign (noncancerous). Some thyroid nodules make excessive thyroid hormones, which causes hyperthyroidism. Nodules can even enlarge to the point that they cause issues with swallowing or breathing. About one-third of nodules are detected by the patient, another third by the doctor, and the other third through an imaging test of the neck.

A patient can sometimes see or feel a thyroid nodule themselves. They do this by standing in front of a mirror, raising their chin slightly, and looking for a bump on either side of their windpipe. If the bump moves up and down when they swallow, it may be a thyroid nodule and they should have their doctor take a look at it.

How are thyroid nodules treated?

Treatment depends on the type of nodule or nodules that the patient has. Treatments include:

● Monitor. If the nodule is benign, the doctor may decide to just monitor the patient’s condition with regular physical exams, blood tests, and possibly thyroid ultrasound tests. If the nodule doesn’t change, they may not need further treatment.

● Surgery. Surgery may be necessary to remove nodules that could be cancerous or large nodules that cause difficulty breathing or swallowing.

● Radioiodine. This type of treatment is helpful if the patient has nodules that make too many thyroid hormones. Radioiodine is a type of chemical that decreases the size of the nodules and reduces the number of thyroid hormones in the body.

What is thyroid cancer?

Thyroid cancer is when cancer cells form in the tissues of the thyroid gland.

Most patients with thyroid cancer have an asymptomatic thyroid nodule. If a patient does have symptoms, they may have swelling or a lump in their neck. The lump may cause problems swallowing and some people get a hoarse voice.

In order to ensure that the lump or nodule is benign, the doctor will order certain tests. Thankfully, most thyroid nodules are noncancerous. For more information and resources on thyroid cancer, please visit the National Cancer Institute’s thyroid cancer page.

Who is at an increased risk for thyroid cancer?

According to the American Thyroid Association, women (compared to men) are three times more likely to get thyroid cancer. Additionally, the number of women with thyroid cancer is also going up and is expected to double, from 34,000 to 70,000 women, this year.

According to the American Association for Cancer Research, thyroid cancer is more common in women who:

● Are between the ages of 25-65

● Have a personal history of goiter

● Have a family history of thyroid cancer

● Have had cancer radiation therapy to the head or neck, particularly in childhood

How is thyroid cancer treated?

The main treatment for thyroid cancer is surgery to remove as much of the thyroid gland as can be safely removed. Surgery alone has the potential to eradicate thyroid cancer if the cancer is small and hasn’t spread to the lymph nodes.

The doctor may also use radioiodine therapy after surgery to destroy any thyroid cancer cells that were not removed during surgery or any cancer cells that have spread to other parts of the body.

Additional treatment options are available, we encourage patients to talk to their doctor to learn about all the options available. Learn more about thyroid cancer treatments from the National Cancer Institute.

Come back next week for the third and final part of this series where we will discuss thyroid complications, their impact on pregnancy, and external resources for patients. 

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