Thyroid Nodule Diagnosis and Treatment

What is Thyroid Gland?

The thyroid gland is one of the endocrine gland located It is located in the lower part of front of the neck.

The gland is shaped like a butterfly wrapped around the windpipe just above the color bone. The two wings or lobes on either side of the windpipe are joined together the isthmus over the front of the windpipe

Thyroid gland makes hormones to regulate physiological functions of body like metabolism.

What is a Thyroid Goiter?

A goiter is enlarged Thyroid Gland.

Multiple conditions can cause goiter including iodine deficiency, hyperthyroidism, hypothyroidism, thyroid tumor, Hoshimotos thyroiditis, Graves’s disease.

Treatment of Thyroid Goiter will also depend on condition causing thyroid goiter, which may be simple observation, medicine or surgery.

What is Thyroid Nodule?

“Thyroid nodule” means any abnormal solid or fluid-filled lumps in the thyroid gland.

Most of the thyroid nodules aren’t serious and don’t cause symptoms. Only small percentage of thyroid nodule can be thyroid cancer. Most of the time thyroid nodules are discovered during routine examination or routine ultrasonography. Once discovered evaluation aim to know whether surgery is required for thyroid nodule?

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Types and Causes of Thyroid Nodule:

Cause of most thyroid nodules is unknown. In certain cases, insufficient iodine in the diet can cause the thyroid to develop nodules, but this is no longer common.

  • If the nodule produces excess thyroid hormone causing overactive gland called hyperthyroidism.

  • Nodule produces less thyroid hormone causing underactive gland called Hyroidism

Nodules may be single or multiple. Cancerous or non cancer (90%)

  • A thyroid gland that contains multiple nodules is called multinodular goiter.

  • If the nodule is filled with fluid or blood, it is called a thyroid cyst.

The most common types of single thyroid nodules are noncancerous colloid nodules or follicular adenomas.

Cancerous nodules include papillary, follicular, medullary, or poorly differentiated (anaplastic) cells.

What are the Symptoms of Thyroid Nodule?

  • Most of thyroid nodules do not cause symptoms.

  • Cells of nodule may secrete thyroid hormone causing symptoms of hyperthyroidism such as- Sudden, unexplained weight loss, Nervousness, Rapid or irregular heartbeat

  • A nodule may be seen /felt as lump front of neck

  • A very large nodule may compress food pipe or windpipe and cause difficulty in swallowing or breathing or change of voice

How are Thyroid Nodules Diagnosed?

Thyroid nodules are discovered during routine examinations or occasionally patient may notice a lump in neck. Once discovered proper evaluation to be done to see if surgical excision is required.

History:

Age, any history of radiation, difficulty swallowing, breathing or change in voice.

Although more common in females, male have more chances of having cancerous nodule

Physical Examination:

Feel of thyroid nodule including lymph node. Any signs of Thyroid underproduction (Hypothyroidism) or Overproduction (Hyperthyroidism)

Blood Tests:

Thyroid Function Test –Free T3-T4 and TSH levels: Interpretations

Increased TSH with suppressed T3T4 –Hypothyroidism

Reduced TSH with increased T3T4 -Hyperthyroidism

Thyroid Antibody toitre may be helpful to diagnose autoimmune thyroiditis.

Ultrasonography (USG) :To determine size of thyroid , number of nodules, whether nodule is solid or cystic.USG can not decide whether a nodule is benign or cancerous.

CT scan or MRI may be advised in special situations.

Thyroid Scan (Radionucide scanning): When Radioactive Iodine is administered orally or by IV injection it accumulates in the thyroid gland and light up. Hot nodule is producing too much hormone; cold nodule is non functioning nodule. A cold nodule has more risk of being cancerous.

Fine Needle Aspiration Cytology: FNAC is direct way to determine what types of cells are present. For small nodule FNAC can be done with guidance of sonography. Fine needle is used to take material from thyroid and cells are examined under microscope.

In 3% of cases a benign nodule diagnosed by FNA may still be cancerous. Another biopsy may be necessary if the nodule is growing.

Surgical Excision and Histopathology: After evaluating all thyroid reports surgeon decides whether surgery is required for thyroid nodule. Some time only surgery and biopsy confirms if nodule is cancerous.

How Thyroid Nodules are Treated?

Wait & Watch: Benign nodule

Thyroid Hormone suppressant Therapy:

Surgery : Surgery is the best treatment for thyroid nodules that are:Read More >>

  • Cancerous (malignant)nodule

  • Suspected to be cancerous or indeterminate nodule.

  • Large nodule causing pressure symptoms problems with breathing or swallowing or change in voice

  • Nodule causing Hyperthyroidism

Treating nodule causing Hyperthyroidism:

  • Antithyroid medicines

  • Radioactive Iodine

  • Thyroid Surgery Read More >>


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