5-15 percent of them should be examined because they carry a cancer risk. Some of the nodules may cause a clinical condition called “hyperthyroidism” by working excessively, except for cancer, or they may enlarge and press on the trachea. Although nodules are generally harmless, they should be taken seriously and should be examined by patients because of the risks they carry.
Nodules are one of the most common thyroid gland diseases. Iodine deficiency in drinking water and the food we take has an important effect on the formation of the disease. Thyroid gland inflammation and ionizing radiation can be counted among other causes. It is usually difficult to detect unless it is large enough. However, due to the widespread use of thyroid ultrasound today, very small ones can be detected even in the very early period.
Symptoms of thyroid nodules:
Swelling and/or occasional pain in the neck (fast growing, larger than 4 cm, single, painful and hard nodules are more likely to be cancer. Patients who previously received radiotherapy for diseases such as bone marrow transplant, head and neck cancers, who has a family history of thyroid cancer, who are under the age of 20 or over the age of 70 who have a history of neck nodules accompanied by enlargement of lymph nodes larger than 1 cm are in the high-risk group).
- Feeling of lump in throat when swallowing
- Hoarseness or deterioration in sound quality
- Difficulty breathing or swallowing
- Sweating, heart palpitations, tremors, hair loss, restlessness due to excessive hormone production by the nodules
Among the diagnostic methods, the patient's history and a careful neck examination are very important, but with biochemistry (such as free t3-t4 in the blood, tsh, anti-tg or anti-tpo) and radiological diagnostic methods (such as usg, mr, ct, pet, scintigraphy), we can accurately determine the diagnosis and the path to be followed.
Ultrasound (USG) is a very fast and simple diagnostic tool. If the risk of the nodule being cancerous is detected by USG, a sample can be taken from the nodule for examination with “fine needle biopsy/IB” (collecting a cell sample from the swelling in the neck with the help of USG with the help of a special injector). Those with cystic internal structures are less likely to have cancerous tissue. If the nodule is larger than 1 cm or the nodule is larger than 5 mm and has risk factors, IB should be performed.
Thyroid scintigraphy using special radioactive materials shows us whether the nodule is cold, hot or warm according to its hormone production capacity. This is extremely important because cold nodules have a greater risk of becoming cancer (5-10%).
According to the results of fine needle aspiration biopsy, surgery is the gold standard in most of the nodules that cause cancer or cancer suspicion. In the operation, some or all of the thyroid tissue is removed depending on the condition of the case, and sometimes it may be necessary to clean the lymph nodes in the neck due to spread to the lymph nodes.
Fine-needle biopsy is generally not needed because hot nodules have less risk of becoming cancerous. If the hot nodule is single and less than 2 cm, it can be treated only with radioactive iodine without the need for surgery. If the hot nodule is larger than 2 cm and/or more than one, surgery is considered instead of iodine treatment.
Fine needle biopsy may not always give accurate results. For this reason, all nodules with a good IB result are not left alone and USG is performed at regular intervals by being closely followed, and it is necessary to apply IB again to nodules that have grown by 20-25 percent compared to the previous one.