Thyroid gland; It is an endocrine gland that resembles a butterfly in shape, in the front of the neck, under the protrusion of the larynx called the Adam's apple, in front of the trachea. It regulates the body's metabolism with the thyroid hormone it secretes.
What does goiter mean?
The enlargement of the thyroid gland located in the front of the neck for a reason other than inflammation or cancer and becoming visible from the outside is called "Goiter". When goiter is mentioned in the society, it is generally expressed as goiter in diseases where the thyroid gland does not grow but causes hormonal disorder, as well as the enlargement of the thyroid gland.
What does Internal-External Goiter mean?
Such a classification in medical terms. Although there is no such thing as internal goiter and external goiter, the terms are frequently used in society. Internal goiter is generally used in cases where external growth is not noticeable but the thyroid gland produces too much hormone (hyperthyroidism). However, it is not a very accurate definition. The term external goiter is used when the thyroid gland is enlarged, visible from the outside, which is the real goiter.
What are the main diseases of the thyroid gland?
1. The condition in which the thyroid gland secretes less hormone, that is, hypothyroidism
2. Hyperthyroidism, where the thyroid gland overworks and produces too much hormone.
3. Enlargement of the thyroid gland with nodules (euthyroid nodular goiter) or without nodules (simple goiter) without hormone imbalance
4. A form of goiter in which nodular structures in the thyroid gland secrete excess hormones (toxic multinodular goiter or toxic adenoma)
Nodular goiter
Thyroid nodules can be single or multiple, solid, cystic or mixed in structure, functional or It may be dysfunctional. They vary in size and can be detected in different sizes, from small masses detected incidentally to large masses that cause serious symptoms.
Nodular goiter is a clinical condition that is more common, especially in women. The incidence of nodules increases with age.
While the frequency of nodules that can be detected by manual examination in adults is 3 to 7%, the frequency of nodules that cannot be detected clinically but are detected by ultrasonography is reported to be between 20 and 76%.
In clinical practice, when a nodule is detected in the thyroid, the most feared thing is that it may be cancer. But with this It should be kept in mind that most of the lesions are benign and that the patient can be simply followed up after a good evaluation.
What are the symptoms?
Although most patients do not have any symptoms, patients usually have neck pain caused by a thyroid nodule. They apply with the complaint of painless swelling. In some patients, symptoms such as persistent cough, difficulty in swallowing and breathing may be observed as a result of the nodule putting pressure on neighboring organs. Symptoms such as pain, hoarseness as a result of vocal cord paralysis, and a mass in the neck that appears in a short time are very rare.
What should be done in a patient suspected of having thyroid disease?
In a patient suspected of having thyroid disease, the first priority is hormones. levels should be checked. In addition, a thyroid ultrasound should be performed to see the structure of the thyroid gland and to detect whether there is a nodule. As a result of these two tests, in some cases, the patient may need to undergo other tests such as thyroid scintigraphy and needle biopsy. It is rarely used in computed tomography (CT) and magnetic resonance imaging (MRI).
Thyroid Ultrasonography;
It is an imaging method used especially in the distinction of cystic and solid structures. Examination of cystic lesions, sub-1 cm nodules and lymphadenopathies with fine needle aspiration biopsy becomes much easier under USG.
Thyroid Fine Needle Aspiration Biopsy (TINAB);
In the differential diagnosis of benign and malignant thyroid nodules. One method used to determine the need for surgery is fine needle aspiration biopsy.
Thyroid scintigraphy;
Scintigraphic examinations basically give information about the functional status of the thyroid gland. According to their scintigraphic appearance, nodules are mainly classified as hypoactive (cold nodule), hyperactive (hot nodule) and normoactive nodule. Studies have found that approximately 5-8% of nodules seen as normoactive or hypoactive on thyroid scintigraphy are cancer. Hot nodules have a low risk of cancer, less than 1%.
How common are thyroid cancers?
Thyroid cancers are the most common cancer of the endocrine system and account for all cancers in developed countries. It constitutes approximately 1%. The risk of detecting cancer in thyroid nodules is approximately 5-10% in a single nodule, while it is 1-5% in the presence of multiple nodules.
What are the risk factors for thyroid cancer?
Many factors are blamed for the etiology of thyroid cancer. . The main ones are radiation exposure, genetic causes, insufficient iodine intake in the diet, geographical region, goitrogens, age, gender, race and family history.
Papillary thyroid cancer is the most common cancer of the thyroid gland. Long-term life expectancy is quite good. However, in some patients, local recurrence, metastasis and fatal clinical results may develop even after years.
In what cases is surgery required for thyroid nodules?
1. Presence of findings due to enlarged goiter or nodules causing pressure on neighboring organs,
2. In hyperthyroidism, mainly in the presence of the following conditions:
a. In cases of hyperthyroidism that cannot be controlled despite drug treatment,
b. In case of serious side effects due to drug treatment,
c. In young patients and pregnant women who are not suitable for radioactive treatment,
d. In the presence of large or multiple nodules where the effect of radioactive treatment is thought to be insufficient
3. Detection of cancer or suspicion of cancer in thyroid nodules
4. Image defect (aesthetic defect) caused by goiter on the patient's neck
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