THYROID NODULES (NODULAR Goiter):
Definition: Lesions originating from the thyroid gland and having a different character from the gland radiologically and pathologically are called thyroid nodules. It is more common in women and increases with aging in both sexes. Ultrasonographically, there is a nodule frequency of up to 60% in the population. So it is a very common health problem.
Symptom: Thyroid nodules usually do not cause symptoms, so they are mostly detected incidentally during head and neck imaging (USG, CT, MRI) performed for another reason or during a doctor’s examination. In addition, especially large-sized nodules may cause compression symptoms such as swelling in the anterior neck region, hoarseness, difficulty in swallowing, and shortness of breath. Again, hormone-producing nodules (warm nodules) may cause hyperthyroidism (thyroid hormone excess), causing symptoms such as palpitation, sweating, tremor, irritability, and weight loss.
Approach to Nodules: The first thing to do in suspected people is to check whether there is a palpable nodule with the thyroid gland examination. TSH level and Thyroid Ultrasonography test should be checked in people with nodules. If TSH is suppressed (low), Thyroid Gland Scintigraphy test must be performed to understand whether the nodule produces hormones (hot/cold nodule). Again, in patients with nodules, Calcitonin level should be checked for once in order to rule out the risk of Familial Thyroid Cancer (Medullary Ca). Thyroid Fine Needle biopsy should be planned in cases deemed necessary after these tests in terms of the risk of other Thyroid cancers.
Treatment: There are two different treatment methods in thyroid nodules, generally Surgical and Radioactive iodine (Atom) treatment. As a result of the tests: .
Malignant (including thyroid cancer) or suspected malignant nodule: Surgical treatment is recommended
Hot nodule (hormone-producing): Surgical or radioactive iodine treatment is recommended considering the other characteristics of the patient.
Nodules that cause compression symptoms such as dysphagia, hoarseness, shortness of breath, although they are cold (does not produce hormones) and benign (benign): Surgical treatment is recommended.
Nodules that do not produce hormones, have Bening character and do not cause symptoms of pressure: Follow-up at appropriate intervals is recommended without any action.
Follow-up: Re-evaluation of the nodule is performed at intervals that your following Endocrinologist deems appropriate, according to the features seen in ultrasonography. In these evaluations, the characteristics of the nodule such as growth, blood supply and function are examined. Thyroid biopsy is performed from the nodules where a suspicious change is noticed.
Thyroid hormone therapy is usually started after the treatment in patients who have undergone surgery or radioactive iodine treatment due to nodule, and hormone levels should be checked at appropriate intervals.
