These 5 common conditions of thyroid nodules, don't be silly and unclear!

This article is reproduced from: Endocrinology Channel of the Medical Community

The author of this article is Wang Jianhua, director of the Diabetes Diagnosis and Treatment Center of Jinan Hospital in Shandong Province

Nowadays, the detection rate of thyroid nodules is getting higher and higher, and due to the lack of sufficient understanding, it often brings a lot of psychological pressure to patients. Some patients mistakenly equate thyroid nodules with thyroid cancer and are apprehensive.

In fact, thyroid nodules are a general term for masses that are different from normal tissues inside the thyroid gland, and the vast majority of thyroid nodules are benign clinically, and generally do not require special treatment and can coexist peacefully. Only malignant nodules and a few benign nodules need to be treated.

The etiology of thyroid nodules is complex and is currently thought to be related to factors such as radiation exposure, autoimmunity, heredity, inadequate or excessive iodine intake. It can be classified as follows:

In nature, it can be divided into benign and malignant;

Morphologically, it can be divided into solid, cystic or cystic;

Functionally, it can be high-functioning (hot nodules), normal-functioning (warm nodules), or low-functioning (cold nodules);

Quantitatively, it can be single or multiple.

Image credit: 123RF

Below, we introduce several thyroid nodules that are common in the clinic.

1. Simple nodular goiter

Simple nodular goiter is a form of thyroid inhomogeneity enlargement and nodular degeneration.

It is mainly due to insufficient iodine intake and reduced thyroid hormone synthesis, pituitary compensatory secretion of thyroid-stimulating hormone (TSH), thyroid gland under the long-term stimulation of TSH after repeated or sustained hyperplasia of the thyroid gland.

In addition, excessive iodine intake, certain goiter-causing substances, and genetic defects can also lead to goiter.

1. Clinical manifestations

More common in middle-aged women, it presents predominantly as goiter with multiple nodules of varying sizes and, rarely, a single nodule. Patients usually have no obvious discomfort and are mostly detected by physical examination. However, if the nodule is large, it can also produce symptoms of compression such as poor breathing and swallowing, and hoarseness.

2. Auxiliary inspection

Thyroid function tends to be normal; thyroid B ultrasound mostly presents with normal echo or hyperecholicity, clear boundaries, regular morphology, no blood flow signals or less blood flow, and no local lymph node lesions.

3. Treatment

Generally, no special treatment is required, and if it is caused by iodine deficiency, iodine intake can be appropriately increased. Patients can be followed up once every six months to one year for ultrasound and nail work to monitor changes in nodules. Smaller nodules usually do not need to be treated. Surgery may be considered in patients with a significantly enlarged thyroid gland, marked symptoms of compression, or suspected malignant nodules.

Reminder: The use of thyroid hormone (levothyroxine sodium tablets) to treat thyroid nodules requires TSH to be controlled at a low level (less than 0.1 μIU/ml), and the dosage of levothyroxine sodium tablets is larger than the dose of alternative therapy, which may lead to drug-induced hyperthyroidism, cardiovascular problems (atrial fibrillation, heart failure, etc.) and osteoporosis, and is not 100% effective, so it is not routinely recommended.

2. Toxic nodular goiter

Toxic nodular goiters, including toxic adenomas (Plummer disease) and toxic nodular goiter, are less well understood. Thyroid nodules or adenomas persist and autonomic secretory dysfunction occurs.

In addition to nodules, patients are also accompanied by hyperthyroidism -

Clinical manifestations of thyroid nodules and goiter: eg, neck discomfort, dysphagia, dyspnea.

Clinical manifestations of hyperthyroidism: such as polyphagia, weight loss, heat intolerance, hyperhidrosis, palpitations, hand tremors, increased frequency of stool, emotional irritability, anxiety and insomnia. Women may present with oligomenorrhea, while men generally experience decreased libido, erectile dysfunction, and breast development.

Alpha work tests showed a decrease in TSH and an increase in FT3 and FT4. Radionuclide scans show increased nuclide concentrations in the area of nodular thyroid lesions and decreased nuclides in extranodular thyroid tissue.

Radiation iodine or surgery is often used.

3. Inflammatory thyroid nodules

Inflammatory thyroid nodules are divided into infectious and non-infectious, the former is mainly caused by viral infections "subacute thyroiditis", the latter is mainly caused by autoimmune disorders caused by chronic lymphocytic thyroiditis (also known as "Hashimoto's thyroiditis").

Subacute thyroiditis: patients have a more acute onset, and often have prodromal symptoms of upper respiratory tract infection at the beginning of the disease, which are mainly manifested as local swelling and fever of the thyroid gland, mainly single nodules, hard nodules, obvious tenderness, and pain can be released under the jaw and behind the ears.

Patients have a significant increase in erythrocyte sedimentation rate (>50 mm/h), which may present early with mild hyperthyroidism and a significant decrease in thyroid iodine uptake rate.

Hashimoto's thyroiditis: more common in young and middle-aged women, slow onset, thyroid is symmetrically enlarged to varying degrees, may be accompanied by multiple nodules, but no obvious tenderness, and not accompanied by fever.

Thyroid function tests, suggesting that thyroglobulin antibodies and thyroid peroxidase antibodies are often strong positive.

2. Treatment

Subacute thyroiditis is mainly anti-inflammatory and analgesic, symptomatic treatment, and the drug may be selected as a non-tantal anti-inflammatory drug or glucocorticoids. The treatment of Hashimoto's thyroiditis is mainly to correct the abnormal work of the thyroid.

4. Thyroid cysts

The vast majority of thyroid cysts are formed by degenerative changes in the nodules or adenomas of the goiter, which contain blood or micromixes.

1. Clinical features

Cysts are usually benign and occur in women aged 20 to 40 years. Most are single-onset, but may also be multiple, with clear nodule boundaries, smooth surfaces, no tenderness, and movement up and down with swallowing; patients are usually unwell.

Ultrasound examination is a round or rounded, well-defined, no-echo nodule in the thyroid gland; radionuclide imaging is a "cold nodule"; and thyroid function test is normal.

In the past, thyroid cysts were mostly treated surgically, but at present, puncture aspiration and injection of sclerotherapy are mostly advocated. Sclerotherapy can cause aseptic necrosis of the cyst wall, make the cyst wall adhesion, cystic cavity occlusion, and achieve the purpose of treating cysts.

V. Suspected malignant thyroid nodules (cancerous nodules)

Malignant thyroid nodules are closely related to exposure to radiation and genetic factors, and the patient's medical history may include head and neck radiation exposure, systemic radiation exposure, and family history of thyroid cancer.

It is more common in the elderly and children, often as a single isolated nodule, early patients often do not have any clinical symptoms, and late tumor compression or invasion of surrounding tissues can be manifested as dyspnea, dysphagia, hoarseness, etc.

Ultrasonography suggests a hypoechoic nodule, uneven internal echo, unclear boundaries, microcalcification of the nodule, abundant blood supply within the nodule, and disordered blood flow. Lymphadenopathy on one or both sides of the neck. For suspected malignant nodules, a thyroid nodule puncture cytology or biopsy is required to confirm the diagnosis.

Surgical excision.

summary

In short, when ultrasound B finds thyroid nodules, it is also necessary to combine the patient's medical history, symptoms and other related tests, such as thyroid function, thyroid autoantibodies, thyroid nuclide scans, thyroid aspiration cytology, etc., to further clarify the diagnosis, and give scientific and reasonable treatment for thyroid nodules of different etiologies and natures.

Image source: 123RF

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