Thyroid nodules are round or oval masses of different sizes that form in the thyroid gland and do not resemble the normal tissue of the gland. It is known that thyroid nodules are more common in areas with iodine deficiency, in women, in the elderly, and in those exposed to radiation.
Nodules may be one or multiple. Their sizes are also different. Thyroid nodules are a significant health problem, but fortunately most are benign. Almost more than 90 percent of them do not contain cancer cells. The decision on how to treat the thyroid nodule should be left to the doctor monitoring the patient. Thyroid specialists consider many things simultaneously when planning the treatment approach to nodules. How and when the treatment will be given varies depending on the patient. While immediate surgical intervention is recommended for some thyroid nodules, for others it may be sufficient to simply monitor it.
Whether you notice it, your friends warn you by seeing the swelling in your neck, or you do not undergo any examination. Once your doctor detects the nodule, the first thing to do is to make sure whether it is cancer or not. It is unknown why nodules form, especially benign nodules. Iodine deficiency is thought to drive nodule development. Nodules, whether they contain cancer cells or not, have many workers, few workers, and normal workers. While your doctor is investigating your nodule, he will also investigate the status of its hormone production.
Some of the thyroid nodules have declared their independence and produce hormones without taking into account the thyroid hormone needs of the thyroid gland and the body. In this case, toxic goiter may occur. Nodules that actively produce hormones in this way are called hot nodules. It is unclear what independent (autonomous) nodules will do and what kind of change they will follow.
Some nodules do not produce hormones. These are defined as cold nodules. These nodules are more likely to contain cancer cells. This possibility increases especially if there is a single, cold nodule. Some nodules are filled with fluid or blood. These are called cystic nodules. These nodules, which are less likely to be malignant than other nodules, can cause severe pain if bleeding occurs within the nodule.
Thyroid nodules do not have any serious symptoms. Although some nodules may cause itching in the throat, difficulty in swallowing, shortness of breath, hoarseness or pain, in general nodules are often overlooked.
Very large, very hard, painful and rapidly developing nodules. You should take it seriously. Having thyroid cancer in a first-degree relative and receiving radiotherapy (beam therapy) for the head and neck during childhood or adolescence increases the likelihood of cancer in thyroid nodules. In men, thyroid nodules that develop under the age of 20 or after the age of 60 are likely to be malignant. Rapid growth of a known nodule, especially while under thyroid hormone drug treatment, increases suspicion of cancer.
Thyroid Ultrasonography (USG): The thyroid nodule contains a hard and liquid component and is hypoechoic. Edge irregularity, thick irregular border findings, thin point and millimetric size calcifications (calcifications) and increased blood flow within the nodule in color Doppler examination are ultrasonographic findings supporting cancer.
Thyroid Fine Needle Aspiration Biopsy (FNAB): FNAB is a very valuable method used first in the evaluation of thyroid nodules that appear suspicious on ultrasonography, in distinguishing whether they are benign or malignant, and in the selection of patients requiring surgical treatment. The diagnostic accuracy rate in detecting thyroid cancers was found to be 95%. With the widespread use of FNAB in the evaluation of thyroid nodules, the number of patients treated with surgery has decreased by 35-75%. FNAB is a diagnostic method that can be applied in outpatient clinics, is simple, inexpensive, can be repeated when necessary, and has very few side effects. Biopsy should be performed by experienced physicians trained in this field. In case of insufficient material, FNAB should be repeated. It has been shown that if the biopsy is repeated with ultrasonography, the rate of non-diagnostic results decreases from 15% to 3%. Therefore, FNAB should be performed under ultrasonography, especially in nodules smaller than 1-1.5 cm. It was determined that 50% of the nodules whose biopsy results were persistently nondiagnostic were malignant. Therefore this patient These should be treated with surgery.
Treatment of Thyroid Nodules Surgical Treatment: Conditions requiring surgical treatment are listed below; As a result of FNAB, there are cancer or nodules that are suspicious for cancer, the presence of pressure symptoms such as difficulty in swallowing, shortness of breath, voice disorders, hyperthyroidism (excess thyroid hormone) due to a large hormone-producing nodule, or if multiple nodules are accompanied by hyperthyroidism, the size of the nodule is 3 cm or more. , inadequate/nondiagnostic FNAB results at least three times, growing nodules during follow-up, continued clinical suspicion of cancer even if the FNAB result is benign... Thyroid surgery should be performed by surgeons experienced in this field.
Medical Treatment of Thyroid Nodules: TSH suppression therapy with “Levothyroxine Sodium – LT4” has been used for years for the drug treatment of thyroid nodules that have been shown to be benign. Whether L-T4 treatment is given or not, patients with benign thyroid nodules are followed up with regular physical examination, TSH level and USG. If the nodules grow, repeat FNAB and surgical treatment may be considered.
Read: 0
