The thyroid gland is an important organ in the endocrine system. It produces hormones triiodothyronine, thyroxine and calcitocin, which are involved in metabolic processes. The thyroid gland is located in front of the trachea on the front of the neck. 

Diagnosis of nodes on the thyroid gland

Poor ecology, hereditary diseases, lack of iodine in the body, treatment with radiation therapy, contact with toxic substances and many other factors cause damage to the thyroid gland. One of the symptoms of thyroid disease are nodes of various sizes.

Nodules are called neoplasms rounded in shape in the tissues of the thyroid gland. The nodes have their own capsules that separate it from healthy tissue. Knots with a diameter of more than 3 cm are usually easy to detect when probing, nodes of a smaller diameter can be detected only with the help of special equipment. The most informative and convenient way to detect nodes in the thyroid gland is an ultrasound examination: it will not only help determine the size of the nodes and their exact number, but also their density.

If you suspect the presence of nodes on the thyroid gland, in addition to ultrasound, the following examinations are performed:

• blood test for thyroid hormones;
• general blood and urine tests;
• chest x-ray;
• gynecological examination;
• electrocardiogram;
• scintigraphy.

Scintigraphy is a scan of thyroid tissue after radioactive iodine has been injected into the body. This procedure helps to determine the hormonal activity of the neoplasm and the condition of the tissues surrounding the node.

In most cases, the detected nodes are not malignant neoplasms, but since such nodes have the ability to degenerate into a malignant form, at the slightest suspicion of the presence of a node on the thyroid gland, an examination and treatment should be carried out.

Nodular neoplasms manifest such serious diseases:

• carcinoma;
• simple cyst;
• cystic fibrous adenoma;
• nodular colloid goiter.

Symptoms and signs of thyroid nodules

Often the formation of nodes on the thyroid gland is asymptomatic, and they are detected only when they reach large sizes, such that they begin to compress the organs of the neck or even become visible to the naked eye as a bulge on the neck. Sometimes the symptoms manifest in full force, but the patient attributes everything to stress or fatigue.

Symptoms of a thyroid nodule include:

• excessive drowsiness;
• increased fatigue;
• imbalance;
• a change in body weight that occurs abruptly and does not have a rational explanation;
• severe dry skin;
• frequent constipation;
• feeling cold or hot in the limbs.

As the node grows, the following signs are observed:

• dyspnea;
• difficulty breathing
• hoarseness of voice;
• difficulty swallowing.

Types of nodes on the thyroid gland

The nodes detected as a result of ultrasound scanning are divided into hypoechoic, isoechoic and hyperechoic (echogenicity is the intensity with which a sound signal is reflected from tissues during an ultrasound examination). Such a division is not a diagnosis, but only helps to correctly draw up a plan for a subsequent examination. A healthy thyroid gland on ultrasound should be isoechoic and homogeneous.

A thyroid nodule is found in every 15th young woman and every 40th young man. With age, the probability of detecting a thyroid nodule increases: at the age of 50, half of people have at least one thyroid nodule, after 60 years, nodules can be found in 60% of people, and after 70 years – in 70%.
If one node is found on the thyroid gland, they speak of solitary changes. If a single node on the thyroid gland is detected, a biopsy should be urgently performed, since thyroid cancer most often develops as a single node that grows rapidly. If several nodes are found, they speak of multiple adenoma – while the prognosis of the disease is more favorable.

If hormones are produced in a node, then such a node is called toxic, otherwise the node is called calm.

Hypoechoic node

Hypoechoic is a nodule on the thyroid gland in which normal tissue has completely collapsed. The hypoechoic node of the thyroid gland is a sign of a malignant process in the thyroid gland: in 70-90% of cases, the hypoechoic node in a subsequent examination turns out to be a cancerous tumor. If the hypoechoic node during ultrasound examination does not have clear boundaries, then this also indicates malignancy of the neoplasm.

Often, after detection of a hypoechoic node in the thyroid gland, the patient is referred to a fine needle biopsy in order to determine the type of malignant neoplasm (papillary, medullary or follicular cancer) with the help of a cytological examination. More than 80% of hypoechoic malignant nodes are papillary carcinomas.

The hypoechoic node of the thyroid gland may not manifest itself with any symptoms for a long time (this depends on the disease that triggered the occurrence of the node). When the knot becomes large enough, it begins to squeeze the organs of the neck.

Isoechoic node

If the node on the thyroid gland is isoechoic, then this indicates that there are no obvious changes in the structure of the thyroid gland. The density of a homogeneous isoechoic node coincides with the tissue surrounding it, only at the edges there is an increase in blood circulation. With a heterogeneous isoechoic node, a tissue change occurs inside the capsule of the node.

In the case of isoechogenicity of the formed node, in 27% of cases it is malignant. Moreover, in 95% of cases, the malignant neoplasm is papillary cancer, in 3% follicular and 2% medullary.

Hyperechoic node

A hyperechoic node of the thyroid gland is diagnosed in the case of a higher level of echogenicity of the tissue of the node compared to the surrounding tissue of the thyroid gland. This echogenicity is often found in papillary carcinoma.

Treatment of thyroid nodules

If one or more nodes with a diameter of up to 1 cm are detected, the patient is monitored dynamically with an ultrasound every 3 months.

The treatment of the hypoechoic node of the thyroid gland (hyperechoic or isoechoic) depends on the final diagnosis. The choice of a method for treating a malignant node depends on the degree of malignancy of the process, the presence of metastases, complications, and the general condition of the patient. If the biopsy confirms the malignancy of the process, then most often the node is removed surgically. If surgery is contraindicated, then chemotherapy and radiation are prescribed.

If, during a biopsy, the node turns out to be benign, the contents of the node are removed, and its cavity is filled with sclerosing solution. This procedure helps to get rid of the disease in 50% of cases. Also, with a benign node, a partial resection of the thyroid gland can be performed. With purulent inflammation of the thyroid gland, antibiotics are prescribed and detoxification therapy is performed.

Thyroid Complications

If during a biopsy it turned out that a hypoechoic thyroid nodule is not malignant, this does not mean that it is safe for humans. In such nodes, suppuration and inflammation may develop, which will be manifested by an increase in body temperature, intoxication, severe pain, swollen lymph nodes and may require serious treatment. In addition, in 8% of patients, nodes are magnetized – degenerate into a malignant form, which entails a danger to life.

After a total stumectomy (complete removal of the thyroid gland) as a result of an advanced malignant process, the patient is forced to undergo life-long hormone replacement therapy, as well as to constantly take calcium preparations, since the parathyroid glands are also removed with the thyroid gland.

To prevent the development of nodes on the thyroid gland is much easier than to cure.