Thyroid enlargement

Back to a normal hormone balance

In Germany, which is one of the countries with a low iodine content, thyroid gland enlargement (also known as struma or goitre) is quite common. Women are affected about four times more often than men. A struma usually develops between the 20th and the 40th year of life.

At Schoen Clinic, we specialise in thyroid diseases. We offer you various therapeutic methods to cure your disease.

Causes & symptoms

What is thyroid enlargement?

The thyroid gland is located on the front of the neck under the larynx and next to the trachea and oesophagus. A normal-sized thyroid gland is butterfly-shaped and consists of two lobes joined together. The parathyroid glands are located at the back.

The thyroid gland produces certain hormones, the main component of which is iodine. They are responsible for a normal metabolism. If the thyroid does not get enough iodine, it cannot produce enough hormones. To compensate for the hormone deficiency, the thyroid gland is stimulated in its growth, forms new gland cells and enlarges.

On average, the thyroid gland has a normal volume of up to 18 ml. We speak of an enlarged thyroid gland when its total volume exceeds 25 ml in men and 18 ml in women. Enlargement may affect the whole tissue or may originate from single or multiple nodes in the thyroid gland. In addition to the sheer increase in size or nodular change, there are also often accompanying dysfunctions.

“Warm” or “cold” nodes
The absorbed iodine is processed into hormones to varying degrees in the individual nodes of the thyroid gland. Scintigraphy – an examination in which weakly radioactive iodine is administered into the veins – reveals the ability to form hormones.

Metabolically active areas in which too much iodine is processed and too many hormones are produced are called “hot nodes”. As a rule, these are benign changes. However, if they produce too much thyroid hormone, they must be removed to prevent overactive thyroid.

“Warm nodes" produce about the same amount of hormones as the rest of the thyroid tissue. Warm nodes are always benign.

However, areas in the thyroid where no iodine is absorbed and almost no thyroid hormone is produced are known as “cold nodes”. It is suspected that these are malignant cells.

Thyroid enlargement: Causes

The most common cause of thyroid enlargement is the nutritional deficiency of iodine required to produce thyroid hormones. If there is not enough iodine available, the thyroid gland reacts by becoming enlarged.

But another thyroid disease, such as thyroiditis, thyroid nodules or even cancer, can also lead to an enlarged thyroid.

Other causes of thyroid enlargement:
  • Graves’ disease
  • Certain medications, such as thyrostatic drugs (for hyperthyroidism) or lithium (for manic depression)
  • Cysts in the thyroid gland

Symptoms: Indications of thyroid gland enlargement

Slight to moderate thyroid enlargement does not cause any symptoms at first. However, it usually becomes visible with increasing size. Symptoms of hyperthyroidism or hypothyroidism are not usually present. Warning signs include a foreign body feeling in the throat, swallowing disorders and newly occurring, permanent hoarseness. In these cases, you should consult a doctor immediately.


Diagnosis: How we diagnose thyroid enlargement

First, we determine the volume of your thyroid gland by means of an ultrasound examination. Nodes, enlargements, cancer-suspicious structures, calcifications and cysts can also be easily recognised. With the help of scintigraphy mentioned above, we can then further differentiate between existing nodes.

Cold nodes may be suspected of cancer. For a precise overall assessment, laboratory tests are performed to determine thyroid hormone levels in the blood.