Nodular goiter ( thyroid nodules ) - Causes, Symptoms and Treatment .MF .
nodules may accompany almost all diseases of the thyroid gland, so the term "nodular goiter" includes different structure and origin of the formation of thyroid zhelezy.Tak as at present, doctors often prescribe ultrasound of the thyroid gland, most nodes detected by chance inpatients without any complaints.
reasons nodular goiter
Most often, the development of thyroid nodules is nodular colloid proliferative goiter - 90%.Less commonly, it is possible for tumors of the thyroid gland: benign - 5-8%, 1-2%, malignant;and very rarely in patients with autoimmune Hashimoto's thyroiditis ( "pseudoknots"), true cysts and inflammatory diseases of the thyroid gland.Typically, thyroid nodules are benign.Since there is a likelihood of malignancy, thyroid nodules should not be left unattended.
Causes of benign and malignant thyroid tumors are unknown.There is evidence of the role of heredity and irradiation of head and neck tumor development.There is no consensus on the causes and development of nodular colloida
symptoms of nodular goiter
Most often, the vast majority of patients thyroid nodules clinically manifest;rarely seen such a complaint as a violation of swallowing, hoarseness, feeling of pressure in the neck, choking, pain, symptoms increase or decrease thyroid function.When large nodules likely cosmetic defect on the neck.
cosmetic defects of the neck when a large nodular goiter
survey in nodular goiter
To assess thyroid status the method of palpation (probing).If the patient does not complain and had no change in thyroid palpation, the ultrasound is not necessary.
Ultrasound examination of the thyroid gland and lymph nodes of the neck necessary for all patients with palpable nodules.At the same time it is imperative that the physician have the size, shape, site, structure, the clarity of its contours, the presence of inclusions, the state of blood flow to the site.
When a palpable nodule and greater than 1 cm in diameter by ultrasound shows fine needle aspiration needle biopsy under ultrasound guidance.Carrying out this type of biopsy in nodules smaller than 1 cm is necessary only in the presence of "suspicious" of clinical, ultrasonic or signs in patients at risk of developing thyroid cancer.
Symptoms that increase the likelihood of malignancy of thyroid nodule:
- dense consistency node;
- a rapid increase in the size of the node;
- thyroid node welded to adjacent tissues;
- swollen lymph nodes in the neck;
- thyroid node and voice disorders and swallowing disorders;
- previously conducted by irradiation of the head and neck;
- the presence of close relatives with thyroid cancer;
- the presence of diseases such as neurofibromatosis, hyperparathyroidism, adrenal medulla tumors, familial adenomatous polyposis of the gastrointestinal tract;
- ultrasound signs: blurring, incorrect assembly form, chaotic blood flow in the site, the presence of calcifications.
In identifying thyroid nodule and the presence of at least one of the above symptoms as soon as possible address to the doctor-oncologist!
Many patients are afraid of needle biopsy, however, it should be remembered that this diagnostic method is well established and secure.Fine-needle biopsy is performed on an outpatient basis, there is no need in special preparation of the patient.
patient is in the supine position with a roll under the shoulders.To puncture using 5.10 mL syringes.Under ultrasound guidance needle is inserted into the unit and perform aspiration of contents.The resulting material is sent for cytology.
Fine-needle puncture biopsy of thyroid
also to determine the cause of nodal education need laboratory diagnostics: determine the level of thyroid-stimulating hormone.In identifying the reduced level of this hormone is necessary to determine the free fraction of thyroxine level, and at an elevated level - and even the definition of the level anitel thyroid peroxidase.Sometimes prescribed definition calcitonin level.
Treatment of nodes in the thyroid gland
As a result of the biopsy to draw final conclusions.There are several options for a definitive diagnosis:
- nodular colloid goiter;
- thyroid cancer or metastases of tumors of other organs;
- follicular neoplasia (tumor, tumor);
- thyroiditis: a chronic autoimmune;acute purulent;subacute;
- lymphoma of the thyroid.
If detecting nodal colloid goiter treatment is not required (except in rare cases, compression of the surrounding tissues or expressed cosmetic defect).It is proved that intake of iodine drugs or hormones do not reduce the size of the unit, so the majority of endocrinologists refuse the appointment of any drugs in this diagnosis.In these cases an ultrasound thyroid 1 every 6 - 18 months to control the size and structure of the node.The study is preferably carried out in the same professional and be in possession of the results of previous scans.
If found follicular adenoma, thyroid cancer , you must immediately surgery.
forecast in most cases favorable with timely treatment for thyroid cancer.After removal of the thyroid patient is prescribed a substitution therapy with L-thyroxine under the control of thyroid-stimulating hormone 1 every 6-8 weeks.Dose is chosen in such a way as to maintain the level of thyroid stimulating hormone is less than 0.1 mIU / L.Self cancellation of hormonal therapy or changing doses of highly undesirable.
Prevention nodular goiter
Self in nodular goiter is not allowed, especially without establishing a definitive diagnosis using cytology.Supplementation of iodine or thyroxine on the background of certain thyroid diseases associated with the formation of nodules, can lead to the progression of the disease, the appearance of serious side effects.Independent appointment of iodine preparations for the prevention of thyroid diseases are also not allowed.To provide the body the required amount of iodine is much more useful and not harmful to comply with the following rules:
- use iodised salt in an amount of 5-6 grams daily (with hypertension 3 grams);
- store salt in airtight containers, avoiding exposure to sunlight;
- salt food until the end of heat treatment.
- regularly eat fish and other seafood.
endocrinologist Faizulin NM