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Goitres: a real pain in the neck – thyroid problems in children and adolescents

Written by: Dr Mark Vanderpump
Edited by: Cal Murphy

A swelling in the neck is always a reason to see a doctor. Sometimes, such a swelling may be the result of a thyroid problem, such as a goitre. Goitres occur fairly commonly in children and adolescents. But what is a goitre, and what causes it? Expert endocrinologist Mark Vanderpump explains:

What is a goitre?

When the thyroid gland in the neck becomes swollen and enlarged, we call this a goitre. The thyroid creates hormones responsible for regulating metabolism in the human body. In children each lobe of the thyroid is smaller than the child’s thumb. About 4% of school-aged children will develop a goitre at some stage.

Symptoms of a goitre

In most cases, the swelling is minimal, and may not show any symptoms. While usually painless, more severe goitre symptoms include the child coughing, experiencing a tight feeling in the throat, finding it difficult to breathe or swallow, and hoarseness.

What causes a goitre?

Goitres can occur in children with normal thyroid function (as in most children), and also in those with overactive or underactive thyroids.

Autoimmune diseases such as Graves’ disease and Hashimoto’s disease are frequently connected to goitres. Iodine deficiency, viral thyroiditis, and, in rare cases, thyroid cancer can also cause an enlarged thyroid.

Some children are born with goitres, as there is some evidence that some kinds are hereditary, and research is ingoing.

Girls going through puberty may experience a somewhat swollen thyroid, but this is normal and not necessarily indicative of an underactive (hypothyroidism) or overactive (hyperthyroidism) thyroid, and normally diminishes with age.

Types of goitre

Goitres can be diffuse or nodular:

  • Diffuse goitre – The whole thyroid gland is enlarged. With autoimmune thyroiditis (Hashimoto’s), the goitre is usually this variety.
  • Nodular – Several separate lumps develop on the gland, making it “knobbly”.

Graves’ disease can manifest as a goitre and hyperthyroidism, but this is relatively uncommon. It is more common in adolescent girls and is rare in boys.

The World Health Organisation (WHO) has a grading system for goitres.

Goitre treatment

The type of treatment depends on the specific characteristics of the case, such as how old the child is, and whether the thyroid is functioning properly.

For example, if the serum TSH (thyroid stimulating hormone) level in the patient is high, levothyroxine (L-T4) may be prescribed, and can result in the goitre shrinking. However, this treatment is usually ineffective if the serum TSH level is normal.

It is important to diagnose a goitre in order to manage it correctly. If you think you or your child has a goitre, you should see your doctor or a specialist. Although thyroid cancer is rare, it is important to detect it as early as possible. If the goitre is indeed malignant, a thyroidectomy will be necessary.

By Dr Mark Vanderpump
Endocrinology, diabetes & metabolism

Dr Mark Vanderpump is a highly experienced endocrinologist with a career spanning over 30 years. His main area of expertise is thyroid disease, but his clinic practice includes all aspects of diabetes and endocrinology. He also sees referrals of less frequently occurring conditions such as thyroid cancer; pituitary conditions such as acromegaly; and adrenal disorders including Addison's disease, plus calcium and bone disorders.

He is the former President of the British Thyroid Association, serves on several boards, and lectures on diabetes and thyroid disease. He is widely published in research papers and has published a book on the subject of thyroid disease.

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