Deciding how to treat a goiter involves first figuring out what caused the enlargement. Your doctor will want to know the symptoms you've been experiencing and your family history for thyroid and autoimmune diseases and also whether you have a personal or family history of thyroid cancer. Your doctor may also ask if you've ever been exposed to external radiation.
People who have had previous thyroid problems such as nodular goiters, Hashimoto's or Graves' disease should be careful about ingesting too much iodine. Excess iodine in the diet can raise your risk for hypothyroidism and hyperthyroidism.
In addition, your doctor will do a physical exam of your thyroid area. One test he might perform is a Pemberton's maneuver. During this exam, you will be asked to stand and face him. While looking ahead, you will be asked to raise both arms straight into the air, with both arms near the ears. If your neck turns red, the veins in your neck bulge, and you start to have difficulty breathing, the test will suggest an obstructive goiter, one that is big enough to block the area between the neck and chest and interfere with breathing, swallowing, and blood flow.
A blood test to measure your TSH level will help your doctor determine whether you have hyperthyroidism or hypothyroidism. Elevated levels of TSH suggest that you are hypothyroid, meaning the pituitary gland is producing more TSH in an effort to get the thyroid to make more thyroid hormone. Low levels indicate you have hyperthyroidism and excessive amounts of thyroid hormone. TSH tests can be followed up with autoantibody tests to determine whether you have Hashimoto's or Graves' disease.
An ultrasound of the goiter can reveal its size, whether it contains nodules, and whether those nodules are solid or cysts. Over time, ultrasound can reveal whether the nodules are getting bigger and whether a goiter has formed.
RAIU and Scan
When a goiter is associated with symptoms of hyperthyroidism, an RAIU and scan may be done to see where iodine is being taken up. This test is often done in patients with toxic multinodular goiters. Places where the scan is brighter reveal the presence of hot nodules, which absorb more iodine. These hot nodules are never cancerous. Nodules that are dark are considered cold but may sometimes harbor cancerous cells.