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Thyroid nodules – causes, symptoms, treatment

Thyroid nodules appear as small formations in the thyroid (located in the front of the neck below the Adam’s apple) which usually grow slowly and remain unnoticed for a long time.

To locate better thyroid nodules, thyroid is situated on the front of the trachea, in the lower side, butterfly-shaped and moves during swallowing

Causes of thyroid nodules: appearance of nodules on the thyroid is usually due to iodine deficiency, but smoking is also a risk factor. Iodine is needed to produce thyroid hormones. Thyroid hormones are of two types T3 and T4. Their secretion is controlled by TSH produced in pituitary gland. If the level of thyroid hormones is low then appear symptoms of hypothyroidism, and if increased above the normal there appear specific symptoms of hyperthyroidism.

Due to iodine deficiency, and thus a decrease in thyroid hormones, thyroid cells grow, multiply in compensation and thus appear thyroid nodules. Often it is possible that thyroid nodules accompany a clinically visible goiter, the causes and symptoms find overlap.

Symptoms of thyroid nodules: Thyroid nodules usually do not have subjective complaints. The onset: the patient has no symptoms. In evolution can occur: at the palpation of thyroid appear nodular formations, pain, hoarseness, trouble breathing, symptoms of overactive thyroid (hyperthyroidism).

Difficulty breathing, fever, joint pain, rapid growth of volume of existing nodes, swollen thyroid, are all signs which require immediate medical attention.

Complications of thyroid nodules: thyroid nodules are classified as warm or cold from investigations (thyroid scintigraphy). 85% of cold thyroid nodules and 95% of those warm are not cancerous. The rest have real potential for malignancy (thyroid cancer). Cold nodules have an uncontrolled development potential, hot nodules have the ability to produce thyroid hormones and cause hyperthyroidism.

Diagnosis of thyroid nodules:

To diagnose thyroid nodules is necessary to present to the doctor. The endocrinologist will complete the investigations:

  • Blood tests: for dosing of hormones and pituitary TSH;
  • Eco thyroid – reveals changes in the thyroid, sets the actual size of nodules, and relationship with surrounding organs;
  • Thyroid scintigraphy is performed in thyroid nodules greater than 1 cm. A capsule or liquid radioactive iodine will be swallowed by the patient that accumulates iodine in the thyroid. Depending on the amount of iodine in the nodes they are classified in warm (‘hot’) and  ‘cold’ nodules. The difference between the two types of nodes consists in their evolution and is explained above;
  • Fine needle biopsy determines the degree of benign / malignancy of nodules.

Treatment of thyroid nodules:

There are 3 methods of treatment, depending on the particular individual patient and specific of nodes. The goal of therapy is to reduce the volume of thyroid nodules, and to balance the production of thyroid hormones.
Drug therapy: For benign nodules due to iodine deficiency is recommended the drug therapy with iodine and possibly with levothyroxine.

Radioiodine therapy for nodules detected as ‘hot’ during scintigraphy. Radioactive iodine is administered in liquid or capsule form, stored in the thyroid where with short radiation restricts thyroid tissue expansion.

If there are potentially malignant nodules, malignancy detected or nodules are too large and do compression on surrounding organs, it is recommended partial or complete excision of the thyroid. After a radical surgery of a pathological thyroid with nodules there is required a hormone replacement therapy with thyroid hormones.

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