Cold knot
| Classification according to ICD-10 | |
|---|---|
| E04.1 | Non-toxic solitary thyroid nodule |
| E04.2 | Non-toxic multi-nodular goiter |
| ICD-10 online (WHO version 2019) | |
A "cold lump " is a scintigraphic finding (hypofunctional area / lump) on the thyroid gland . The term “cold knot” refers to the area's reduced or non-existent ability to absorb radioactive (“hot”) iodine or technetium . Cold nodules produce little or no thyroid hormones triiodothyronine (T3) and thyroxine (T4).
Explanation
Fig. 1
Anatomy of the thyroid gland
Fig. 2
Ultrasound image : right flap (longitudinal section)
Fig. 3
Ultrasound image : Thyroid in cross section
Fig. 4
Cold lump (shown in anatomical reference)
An area of the thyroid gland that does not show up on scintigraphy is ultimately called a “cold lump”.
Figure 1 shows the basic anatomy of the thyroid gland. It can be easily recognized sonographically (see Figs. 2 and 3). The case of cold nodules shown in Figure 4 shows a right-hand representation of the thyroid gland. The examination was performed for a grade 3 goiter . The discrepancy between the sonographically displayed enlargement of the thyroid lobes and the findings in the scintigraphy was noticeable; the lower part of the right lobe and the lateral part of the left lobe are missing in the scintigram, although thyroid tissue has been demonstrated sonographically there. This lack of presentation of existing thyroid tissue is the characteristic of the "cold lump".
Complementary examinations
(→ main article examination of the thyroid gland )
A detailed anamnesis clarifies whether there is a familial predisposition, when the lump first became noticeable and whether it has grown since then. Rapid growth can indicate a malignant tumor. During the palpatory examination, the position, size, consistency and mobility of the node are checked. If the consistency is coarse and the lump cannot be swallowed, this can indicate a malignant tumor. On sonography , a cold lump often appears reduced in echo compared to the surrounding, echonormal thyroid tissue. However, hyperechoic or mixed nodules and anechoic cysts are also found . Poorly demarcated and hypoechoic nodules can indicate a malignant tumor. (With thyroid scintigraphy , which is performed from a sonographic nodule diameter of 1 cm, the findings of a cold nodule can only be made if the nodule absorbs little or no radioactive nuclide . If a cold nodule is detected, a further examination, e.g. . as the fine needle aspiration for the production of material for cytological study, necessary.)
meaning
A cold lump without simultaneous hypothyroidism is often an incidental finding if, for example, goiter is present at the same time , or it is felt by the patient himself. Patients with one or more cold lumps do not necessarily have to have an underactive thyroid ( hypothyroidism ). As a rule, the healthy thyroid tissue compensates for the lack of hormone release from the cold node and ensures the supply of thyroid hormones.
In the case of a cold lump, depending on its size and course, there is a certain probability that thyroid cancer is present (in the case of Fig. 4, around 10%) .
What to do after a cold lump is discovered depends on the cause.
See also
Main Products:
Individual evidence
- ↑ Gerd Herold: Internal Medicine. Cologne 2013, ISBN 978-3-9814660-2-7 . P. 747.
