Thyroid nodules

Thyroid nodules are oval or round areas inside the thyroid gland that can arise from various diseases. Most knots are harmless.

The thyroid gland is located at the front of the neck, below the Adam’s apple.
The gland:

  • has a butterfly shape,
  • nestles against the trachea.

The two wings or lobes (right and left lobes) lie on the two lateral surfaces of the trachea and are connected by a tissue bridge, the so-called isthmus, which runs over the front of the trachea.

A thyroid nodule can occur in any part of the gland.
Most thyroid nodules are not malignant (malignant) and do not cause problems. Often no therapy is required and the test results are good (that is, the values are normal).
Sometimes such a node can produce too many thyroid hormones.
If one node produces too many hormones, the remaining part of the thyroid gland is suppressed and does not function as usual.


Causes of thyroid nodules

Various diseases can cause the development of one or more nodules in the thyroid gland, including an iodine deficiency.
Iodine deficiency in the diet can lead to thyroid nodules, but these disorders occur only in some poor third world countries.

Classification of thyroid nodules

Excessive growth of normal thyroid tissue. The reason for this growth is not known, sometimes it is a non-tumorous (benign) adenoma of the thyroid gland and is not considered serious if it does not cause discomfort or leads to complications.
Some thyroid adenomas produce thyroid hormones outside the normal influence of the pituitary gland. This leads to the overproduction of thyroid hormones (hyperthyroidism).

Thyroid cysts are fluid-filled cavities and most often the result of the degeneration of thyroid adenomas. Often, solid and liquid components in the thyroid cysts are mixed together.

Cysts are usually benign, but sometimes they contain malignant solid components.

Inflammatory nodules are formed in Hashimoto’s thyroiditis, a disease of the thyroid gland that can lead to enlargement and inflammation of the thyroid gland and reduce the activity of the gland (hypothyroidism).

multinodular goiter or adenomatosis refers to the enlargement of the thyroid gland, which may be caused by:

  • Iodine deficiency
  • a thyroid disease.

A multinodular goiter contains many separate nodules inside, but the cause is not clear.
These nodules produce thyroid hormones that can lead to the development of hyperthyroidism.

Thyroid cancer, when to worry? Even if the possibility of a node being malignant is low, the risk increases in the following cases:

  • Familial accumulation of thyroid cancer or other endocrine tumors
  • Age under 30 or over 60 years
  • Masculine
  • Previous exposure, mainly to the head and neck
  • A large and hard lump, or one that hurts or causes discomfort, is more likely to be malignant
  • Vascularization, if a nodule is not vascularized, it is usually benign

Hot nodules or active nodules are cell masses that produce thyroid hormones.
A hot lump is usually benign, but can provoke hyperthyroidism.
Cold nodules are the inactive ones that do not contain iodine and do not absorb iodine-containing contrast agent.
Cold nodules can turn into malignant neoplasms.

Risk factors for the development of thyroid nodules

  • Those who had an X-ray of the thyroid gland taken in childhood are more likely to develop thyroid nodules.
  • With a pre-existing thyroid condition or a family history, the likelihood of thyroid nodules can increase.
  • Thyroid nodules are more common in women, but men and children are more likely to be malignant.
  • The likelihood of developing a thyroid nodule increases with age. According to the American Thyroid Association, about half of people develop nodules at age 60 and older.

Symptoms of thyroid nodules

Most thyroid nodules cause no symptoms. However, large and multiple nodes may be visible.
Even though this is rarely the case, the nodules can press against other structures of the neck and cause various symptoms, including:

  • Swallowing
  • difficulty breathing or shortness of breath
  • Feeling suffocated and coughing
  • Hoarseness or altered voice
  • Sore throat
  • Goiter (enlargement of the thyroid gland)

An enlargement of the thyroid gland caused by nodules can cause the symptoms of hyperthyroidism.
The result of hyperthyroidism is an overproduction of thyroid hormones.
This causes an increase in thyroid hormone levels in the blood.

Symptoms of hyperthyroidism include:

  • Nervousness/irritability
  • Muscle weakness/tremor
  • Absence of menstrual cycle or weak period
  • Weight loss (emaciation)
  • Insomnia
  • Enlargement of the thyroid gland
  • Visual disturbances or eye irritation
  • Heat sensitivity
  • Tachycardia (accelerated heartbeat)
  • Increase or decrease in appetite
  • Shortness of breath
  • Skin itching/sweating
  • Hair loss
  • Hot flashes (sudden redness of the face, neck and upper chest)
  • Strong palpitations

The thyroid nodules sometimes stem from Hashimoto’s thyroiditis and may be associated with symptoms of hypothyroidism. Hypothyroidism is a condition caused by an underactive thyroid gland.
This causes thyroid hormone levels in the blood to be too low. Symptoms of hypothyroidism include:

  • Fatigue
  • Heavy and frequent or absent menstrual cycles
  • Amnesia
  • Weight gain
  • Dry and rough skin
  • Hair loss
  • Hoarseness
  • Cold intolerance
  • Weakness/irritability

Diagnosis of thyroid nodules

Examinations and tests

Very often the nodes do not cause symptoms. Doctors then find them during a clinical examination or through apparatus examinations carried out for other reasons.
However, in some people, the thyroid nodules are large enough to be detected on a physical exam.
If a knot is larger than one centimeter, then it is palpable, while smaller knots are only noticed when they occur on the surface.
If the doctor finds a lump or if there are symptoms through a lump, the following examinations can be made:

1. Blood test to check the level of TSH (thyroid stimulating hormone) and other thyroid hormones

2. Thyroid scintigraphy

3. Ultrasound: A doctor may order echography of the thyroid gland for the following reasons:

  • To detect nodes that are not easy to feel
  • To determine the number and size of nodes
  • To determine whether a lump appears solid, fluid-filled, or mixed. As a rule, the malignant nodules are solid and have calcifications (low echo)
  • To check if reactive lymph nodes (enlarged or inflamed) are present
  • To support tissue biopsy by fine needle aspiration to diagnose thyroid nodules

Despite its importance, ultrasound cannot determine whether a lump is benign or cancerous.

4. Fine needle puncture of the thyroid gland — In most cases, TSH levels are normal, so the next step is a fine needle puncture.
Fine needle puncture is performed using a fine cannula to remove some cells from the thyroid nodule.
The material is examined under the microscope.
Fine needle puncture can be performed on an outpatient basis under local anesthesia.
In order to find the right place, the examination is carried out:

  • ultrasonically controlled,
  • by buttons.

You may feel a slight discomfort when the local anesthetic is injected, and you may feel a feeling of pressure during the biopsy, but the discomfort is ultimately similar to the dentist.
This examination is precise for identifying cancer changes in a suspicious thyroid nodule.

  • In some cases, the fine needle puncture does not contain enough tissue to make a diagnosis, and the procedure must be repeated.
  • In other cases (10 percent), the outcome of the biopsy is undetermined. The operation is often recommended for indeterminable nodules in order to obtain a reliable diagnosis.

Molekulare Marker sind Substanzen, die in den Körper eingeführt werden, um einige Informationen zu erhalten.
In manchen Fällen dient die Bewertung der molekularen Marker der Auswahl unbestimmter Knoten mit geringem Risiko zur Beobachtung, um einen chirurgischen Eingriff zu vermeiden.

Folgende Ergebnisse der Feinnadelpunktion können sich ergeben:

  1. Benign (non-tumorous)
  2. Malignant (cancer)
  3. Suspected malignancy
  4. Follicular neoplasia (microfollicular thyroid nodules, including nodules with Hürthle cells)
  5. Follicular or atypical lesion of unclear meaning (nodules with atypical cells)
  6. Undiagnosable or inadequate

What should you do? Treatment of thyroid nodules

Therapy depends on the type of thyroid nodule.
Treatment options include:

  1. No treatment/”attentive supervision”. If the nodes are not cancerous, you can decide not to intervene for the time being. The nodes are checked for all possible changes by frequent check-ups.
  2. Thyroid hormone suppression therapy. Some doctors treat non-carcinogenic thyroid nodules with levothyroxine (Euthyrox or Thevier), a synthetic form of the thyroid hormone thyroxine.
    The medical theory is that this drug signals the pituitary gland to produce a smaller amount of the thyroid hormone responsible for the growth of thyroid tissue (the pituitary gland is a small gland in the brain that controls the thyroid gland). The aim of treatment with levothyroxine is to compact or reduce the thyroid nodules.
    Doctors and scientists are still studying the effect of this therapy.
    This medication can also be taken during pregnancy and breastfeeding, because it is not toxic to the fetus, but you should first talk to the doctor.
  3. Radioactive iodine. The doctor may use radioactive iodine to treat the enlargement of the thyroid nodules and against multinodular goiter. The radioactive iodine is absorbed by the thyroid gland and leads to the reduction of nodules. Pregnant women and women who want to become pregnant are not allowed to receive this treatment.
  4. Alcohol injection. The injection of ethanol (alcohol) is an injection into the thyroid nodules to reduce them in size.
    The doctor uses an ultrasound control while injecting ethanol into the thyroid gland.
  5. Laser ablation. The laser is a precise instrument that only treats the knot. The procedure is:
    – minimally invasive, – simple,

    – painless.
    The operation is performed under local anesthesia and is performed by inserting a cannula with an optical fiber to the center of the node.
    The procedure takes about half an hour.

  6. Surgical removal of thyroid nodules
    When is surgery necessary?
    Surgical intervention to remove the nodules is the best treatment for:
    – carcinogenic nodules that cause symptoms (for example, if they are so large that they impede breathing or swallowing);
    – nodules that appear “suspicious” (that is, when they cannot be diagnosed as benign or malignant without being surgically removed for examination). If the patient is a pregnant woman, surgery is usually performed after delivery, but the doctor must decide whether urgent surgery is necessary.

There are no natural remedies that make thyroid nodules disappear or shrink, but useful natural treatments include a healthy diet and physical exercise.

Prevention and long-term outlook for thyroid nodules

There is no way to prevent the development of a thyroid nodule. Once the diagnosis is made, the endocrinologist checks the condition through annual ultrasound and regular blood tests.
Most nodules that are not tumorous are not damaging and many do not require any therapy at all.

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