Thyroid nodules
In addition to the enlargement of the thyroid gland ( goiter ), thyroid nodules are among the most common morphological changes in the thyroid gland .
Symptoms
A small thyroid nodule or a slight enlargement of the thyroid usually do not cause any local symptoms. With the increasing size of the node and total thyroid gland, however, more and more patients complain of a feeling of pressure, tightness or lumpiness, abnormal sensations when wearing a tight collar, difficulty swallowing, shortness of breath when exercising, depending on the position of the head, and a tendency to bronchitis . A third-degree goiter can mechanically displace neighboring structures ( trachea , neck vessels, esophagus ) and lead to corresponding symptoms , such as pronounced swallowing difficulties or shortness of breath even at rest, as well as stridor .
Dignity
In iodine deficient areas , the vast majority of nodules are benign. In countries with an adequate iodine supply, thyroid nodules are significantly rarer overall, so the relative proportion of malignant nodules is higher. The malignant nodules are predominantly thyroid carcinomas , rarely metastases .
Diagnosis
History and clinical findings
Clinical criteria for malignancy are:
- Family history of thyroid cancer
- female gender
- Age under 30 or over 60 years
- local irradiation in the past
- palpable single knot
- Laboratory results (increased calcitonin , CEA , thyroglobulin )
Ultrasonic
As part of routine (preventive) diagnostics, the ultrasound examination comes first. It is also suitable for displaying small, asymptomatic changes very precisely. Concerning. Nodes are distinguished between criteria of goodness and badness.
| malignancy | Benignity |
|---|---|
| solitary (single) | multiple, more oval |
| hypoechoic, inhomogeneous | homogeneous and echo-rich, echo-like or echo-free |
| fuzzy border | sharp boundary |
| incomplete or missing border | complete hypoechoic or -free edge |
| incomplete or missing marginal vessel | complete marginal vessel |
| central blood flow with scintigraphically cold nodules (see below) | central blood flow in the case of a non-cold nodule by scintigraphy |
| not very compressible | compressible / change in echo texture under pressure; see also elastography |
| Microcalcifications | coarse calcifications |
| Sound attenuation | no sound attenuation |
| suspicious regional lymph nodes | inconspicuous regional lymph nodes |
Scintigraphy
A distinction is made between nodes that work harder than the rest of the (healthy) thyroid tissue, nodes that show comparable activity, and nodes that work less hard on the extent to which the tracer is absorbed in the thyroid scintigraphy .
Hot nodules
A so-called hot nodule ( autonomous adenoma , often also called warm nodule ) has decoupled its function from the thyroid control circuit between the hypothalamus , pituitary gland and thyroid gland ( thyroid autonomy ). Hot nodules are practically never malignant , but if the production of thyroid hormones in the autonomic parts of the thyroid gland exceeds the needs of the organism, hyperthyroidism (overactive thyroid gland) occurs, which can be a threat to the patient's life.
Normofunctional Nodules
The majority of the nodules found in Germany in the course of thyroid examinations are neither hyperfunctional (“hot” or “warm”) nor hypofunctional (“cold”).
Cold
Lumps Lumps that pick up little or no tracer on the thyroid scintigram are called cold lumps . In iodine-deficient areas, the majority of cold nodules are still benign. Nevertheless, clarification of the dignity by means of a fine needle biopsy or , if in doubt, also by means of a goiter resection is recommended. In countries with an adequate iodine supply, a single (solitary) cold lump is to be regarded as a thyroid carcinoma until proven otherwise.
Sources and References
literature
- Lothar-Andreas Hotze, Petra-Maria Schumm-Draeger. Thyroid diseases. Diagnosis and therapy. Berlin 2003 ISBN 3-88040-002-4
- Torsten Kuwert. Thyroid. In: Torsten Kuwert, Frank Grünwald , Uwe Haberkorn , Thomas Krause : Nuclear Medicine . 4th, newly created and expanded edition. Thieme, Stuttgart et al. 2008, ISBN 978-3-13-118504-4 .
Individual evidence
- ↑ a b Seitz, Schüler, Rettemenmaier (Ed.): Clinical sonography and sonographic differential diagnosis . 2nd Edition. Thieme, Stuttgart 2008, ISBN 978-3-13-126452-7 , pp. 940 .
