Nodular goiter( nodes of the thyroid gland) - Causes, symptoms and treatment. MF.

Nodal formations may accompany almost all diseases of the thyroid gland, therefore the term "nodular goiter" includes different in structure and origin of the formation of the thyroid gland. Since at the present time doctors often prescribe ultrasound examination of the thyroid, most nodes are detected accidentally in patients withoutany complaints.

Causes of nodular goiter

The nodular colloid proliferating goiter leads most often to the development of thyroid nodules - 90%.More rarely it is possible with tumors of the thyroid gland: benign - 5-8%, malignant-1-2%;and very rarely with autoimmune thyroiditis Hashimoto( "pseudo nodes"), true cysts and inflammatory diseases of the thyroid gland. As a rule, thyroid nodules are benign. Since there is a possibility of malignant formation, the thyroid gland nodes should not be left without attention.

The causes of benign and malignant tumors of the thyroid are unknown. There are data on the role of heredity and head and neck irradiation in the development of tumors. There is no consensus on the causes of nodal colloid goiter. It is known that its prevalence increases with age, therefore nodal colloid goiter is considered as an age-related change in the thyroid gland. Some scientists suggest that iodine deficiency leads to the development of colloid goiter.

Symptoms of nodular goiter

Most often in the vast majority of patients, thyroid nodules are clinically not manifested;rarely such complaints as swallowing disorders, hoarseness of the voice, a feeling of pressure in the neck, choking, pain, symptoms of an increase or decrease in the function of the thyroid gland. At large nodal formations a cosmetic defect on the neck is likely.

Cosmetic neck defect in large nodular goiter

Nodular goiter examination

palpation method ( palpation) is used to assess thyroid status. If the patient does not complain and has no changes in the thyroid gland during palpation, then there is no need for an ultrasound examination.

Ultrasound examination of the thyroid and lymph nodes of the neck is necessary for all patients with palpable nodules. In this case, it is necessary that the doctor indicates the size, shape, structure of the node, the clarity of its contours, the presence of inclusions, the state of blood flow in the node.

When a palpable nodular formation is detected and more than 1 cm in diameter, according to ultrasound data, is shown as a fine needle aspiration needle biopsy under ultrasound guidance. Conducting this type of biopsy with nodal lesions less than 1 cm is necessary only in the presence of "suspicious" clinical, ultrasound signs or in patients at risk for developing thyroid cancer.

Symptoms that increase the likelihood of malignancy of the thyroid nodule:

- a dense consistency of the node;
- rapid increase in the size of the node;
- thyroid gland knot welded to adjacent tissues;
- enlarged lymph nodes of the neck;
- thyroid nodule and voice disorders or swallowing disorders;
- previously conducted irradiation of the head and neck;
- the presence of close relatives with thyroid cancer;
- the presence of such diseases as neurofibromatosis, hyperparathyroidism, adrenal medulla tumors, familial adenomatous polyposis of the gastrointestinal tract;
- ultrasound signs: blurred contours, irregular knot shape, chaotic blood flow in the node, the presence of calcifications.

If you identify a thyroid nodule and have at least one of the above signs, you should contact your oncologist as soon as possible!

Many patients are afraid of a fine needle biopsy, however, it should be remembered that this diagnostic method is well established and safe. A fine needle puncture biopsy is performed on an outpatient basis, and there is no need for special preparation of the patient.
The patient is lying on his back with a roller under his shoulders. For a puncture use syringes for 5-10 ml. Under ultrasound guidance, the needle is inserted into the assembly and aspiration of the contents is performed. The resulting material is sent for cytology.

Thin needle needle biopsy of thyroid

Also, to determine the cause of nodal education, laboratory diagnostics will be required: to determine the level of thyroid-stimulating hormone. When a lower level of this hormone is detected, it is necessary to determine the level of the free fraction of thyroxin, and at an elevated level it is also necessary to determine the level of anitel for thyroid peroxidase. Sometimes a determination of the level of calcitonin is prescribed.

Treatment for nodes in the thyroid

Based on the results of the biopsy , final conclusions are reached. Several variants of the final diagnosis are possible:

- nodal colloid goiter;
- thyroid cancer or metastasis of tumors of other organs;
- follicular neoplasia( tumor, neoplasm);
- thyroiditis: chronic autoimmune;acute purulent;subacute;
- thyroid lymphoma.

In case of detection of nodal colloid goiter treatment is not required( with the exception of rare cases of compression of surrounding tissues or a pronounced cosmetic defect).It has been proven that taking iodine or hormonal preparations does not reduce the size of the site, so most endocrinologists refuse to prescribe any medications for this diagnosis. In these cases, an ultrasound examination of the thyroid gland is recommended once every 6 to 18 months to control the size and structure of the node. It is desirable to conduct the study with the same specialist and carry the results of past scans.

If follicular adenoma is detected, thyroid cancer , then immediate surgical treatment is necessary.

The prognosis for timely treatment of thyroid cancer is favorable in most cases. After removal of the thyroid gland, the patient is prescribed replacement therapy with L-thyroxine drugs under the control of a thyroid-stimulating hormone once every 6-8 weeks. The dose of the drug is selected in such a way as to maintain a thyroid-stimulating hormone level of less than 0.1 mIU / L.Self-abolition of hormone therapy or dose changes are highly undesirable.

Prevention of nodular goiter

Self-treatment for nodular goiter is not allowed, especially without the establishment of a definitive diagnosis with the help of cytological research. Taking medications of iodine or thyroxine against a background of certain thyroid diseases, accompanied by nodal formation, can lead to the progression of the disease, the occurrence of serious side effects. Self-administration of iodine preparations for the prevention of thyroid disease is also not permissible. To provide the body with the necessary amount of iodine it is much more useful and not dangerous to observe the following rules:

- to use iodized salt in the amount of 5-6 grams daily( with arterial hypertension 3 grams);
- store salt in a tightly closed container, avoiding sunlight;
- salt food only at the end of heat treatment.
- regularly eat fish and other seafood.

Doctor endocrinologist Fayzulina N.M.