What you need to know about common thyroid problems

Your thyroid gland is a butterfly-shaped gland that sits in front of your windpipe in your neck and produces hormones that control your metabolism ie chemical reactions in your body’s cells. Problems with your thyroid gland can cause localised symptoms in your neck or affect your whole body, if the function of your thyroid gland changes. 

Here we’ll explore the most common types of thyroid problems, their symptoms and treatment. 

The three most common thyroid problems

The most common thyroid problem is the presence of a nodule (a solid lump) or cyst (a fluid-filled lump) in your thyroid gland. You may notice a lump yourself or have it picked up incidentally while having a scan to investigate something else. Nodules can be cancerous or non-cancerous (benign). 

The second most common cause of thyroid problems is goitre. This is when your thyroid gland becomes enlarged, causing a protrusion on the front of your neck, which pushes against nearby structures. 

A less common thyroid problem, affecting around 25 adults in every 100,000 in the UK, is Graves’ disease. This is an autoimmune condition, which means your body’s immune system mistakenly attacks its own cells, in this case, your thyroid gland. This attack causes the thyroid gland to become overactive (hyperthyroidism). 

Goitre: symptoms and treatments

If you have goitre you may notice that your neck has changed shape or appears larger. You may, for example, find that your shirts don’t fit properly anymore. 

Depending on how enlarged your thyroid gland becomes, you may experience pressure or discomfort in your neck area. In severe cases, your thyroid gland may press against your windpipe, causing breathing problems or breathlessness, or against your gullet, causing difficulty with swallowing (dysphagia). 

If your goitre isn’t causing you any problems or a reduction in your quality of life, treatment isn’t needed. If your goitre is causing problems, you can have surgery to remove part or all of your thyroid gland. 

Thyroid nodules and cysts: symptoms and treatments

You may notice a nodule or cyst on your neck as a painless lump, or it may be picked up incidentally during a scan for something else. 

Most lumps need to be investigated with an ultrasound scan. You may also need a needle biopsy to collect a tissue sample for investigation in a lab. 

If your lump is not cancerous and it isn’t causing you any problems, no treatment may be needed. If there is uncertainty about the nature of your lump or if it is causing problems, it can be surgically removed. 

Thyroid cancer: symptoms and treatments

Thyroid cancer usually presents as a painless nodule of your thyroid gland. In some cases the cancer may spread to the lymph glands in your neck or affect nerves which supply your voice box.

Most cases of thyroid cancer are low risk and can be effectively treated with surgery and in some cases, radioiodine after surgery.

Graves’ disease: symptoms and treatments

Graves’ disease causes your thyroid gland to become enlarged as well as overactive. It is diagnosed through a thyroid blood test, which detects raised levels of hormones produced by your thyroid gland. 

Symptoms include weight loss, anxiety, irritability, frequent bowel movements, heat sensitivity, physical tremors, irregular heartbeat, and in women, changes to your menstrual cycle. 

Treatment involves taking medication or radioiodine. In some cases, surgery is also used to treat Graves’ disease by removing the thyroid gland. 

Thyroid gland surgery

Thyroid surgery falls into two main categories: a total thyroidectomy where all of the thyroid gland is removed or hemithyroidectomy where half of the thyroid gland is removed (eg the half that contains a nodule). Less commonly, isthmusectomy is performed to remove the central part of the thyroid gland.

You may need thyroid gland surgery if you have thyroid cancer, a nodule or goitre that is causing symptoms, or in some cases of Graves’ disease. 

Risks of thyroid surgery

These include bleeding, infection and risks relating to general anaesthesia. Risks specific to thyroid surgery include bruising or injury to the nerves that supply your voice box (larynx), resulting in a weak or breathy voice. This complication can recover over time but occasionally it can be permanent and further treatment may be needed to address this.

If you have a thyroidectomy, levels of hormones produced by the glands that sit behind your thyroid gland (parathyroid glands) may drop, which causes a temporary drop in your calcium levels — this is treated by taking calcium supplements.

After a total thyroidectomy, you will need lifelong thyroid hormone replacement, in the form of a daily tablet. If you are older and have a hemithyroidectomy, you may also need thyroid hormone replacement.