Studies conducted in recent years have confirmed the assumption of doctors that the nodules of the thyroid gland remain the most common diseases of this organ. These processes can proceed in the form of nodular and cystic neoplasms of this endocrine gland – in the first case, the parenchymal structure is determined, while in the second, the cavity structure in which fluid is found. It is impossible to say unequivocally what the nature of the node is – before the diagnosis is established and an effective treatment is prescribed, a comprehensive and comprehensive examination of the patient should be carried out, the results of which will not only answer the question of what disease has developed, but also what is its cause.

NODES AND CYSTES LOCATED IN THE TISSUE OF THE THYROID GLAND

Thyroid nodes and cysts are changes in the structure of this organ, capable of passing into each other in the course of their evolution. In endocrinology, a node of the thyroid gland is called the formation of a parenchymal structure, which has its own capsule that delimits it from the healthy tissue of the organ. The cyst of the thyroid gland is a neoplasm that has not only a capsule, but also a cavity filled with a colloid (a special fluid containing a large amount of hormones produced by organ cells).

In either case, pathological changes in the gland can exist asymptomatically for a fairly long time – in this case, they are detected only during a routine examination, which includes an ultrasound examination of organs located on the front of the neck.

If the nodes of the thyroid gland reach significant sizes, they affect organs and tissues located in the immediate vicinity – that is why patients may complain of choking, changes in the timbre of the voice, various disorders of swallowing, there is a feeling of a foreign body in the throat, and pain occurs. Cysts, unlike nodes, can suppurate – an infection provokes an acute inflammatory process in the organ, which is accompanied by the development of severe intoxication, an increase in temperature, sharp soreness directly in the projection zone of the altered node, as well as in the surrounding structures. In addition, both nodes and cysts can become malignant – the causes of malignant cell degeneration are not always possible to identify, therefore endocrinologists insist that patients with nodular or cystic formations of the thyroid tissue should be under constant dynamic observation.

Studies have shown that such changes in industrialized countries are found in 10% -15% of the adult population. Of course, in the overwhelming majority of patients, these neoplasms remain benign, but the threat of a malignant tumor makes the patient undergo regular examinations with a doctor and take the recommended tests.

Nodal changes in the thyroid gland can manifest the following diseases:

• nodular colloid goiter;
• cystic fibrous adenoma;
• simple cyst of the thyroid gland;
• carcinoma.

These diseases are much more likely to occur and are diagnosed in women, and with age, the likelihood of a node increases significantly.

The reasons, the effects of which provoke pathological changes in the tissue of the organ, can be:

• genetic predisposition;
• insufficient intake of iodine with water and food;
• toxic effects of substances used in industry and agriculture;
• the need to use radiation therapy and X-rays for the diagnosis and treatment of human diseases.

In the case when the above studies find a single node in the thyroid tissue, a conclusion is made about solitary changes, while when several nodes are found, multiple adenoma is diagnosed. Depending on whether thyroid hormones are produced in the tissue of the node or not, a conclusion is made about a toxic or quiet node. 

If we consider the structure of the thyroid gland, we can see that this organ of the endocrine system consists of many small lobules formed by follicles. They actively synthesize thyroid hormones, which affect almost all types of metabolism in the body, as well as their accumulation. Outside, such an acinus is surrounded by a network of capillaries, through the wall of which hormones enter the systemic circulation. A protein substance of a special structure, called a colloid, fills the cavities inside the acinus – it is this substance that is the depot of prohormones in the body. If some part of the thyroid tissue begins to produce more colloid, then a cyst is formed, which will tend to increase its volume. Depending on whether growth occurs quickly or slowly, the doctor can indirectly judge the benign quality of the volumetric process in the organ. 

Malignant cysts of the thyroid gland (cyst-cancer) are much less common than adenocarcinomas – without a thorough examination, the doctor cannot make an accurate diagnosis and determine the nature of the new formation. Both nodes and cysts of the thyroid gland in the vast majority of cases are characterized by slow growth. Detection of a tendency to accelerate and increase the volume of the neoplasm forces the doctor to prescribe the patient an extraordinary examination. To say that the nodes and cysts of the thyroid gland disappear on their own, it is possible to speak only, unfortunately, in a small number of cases – only small-sized cysts that arise in response to minor inflammation in the organ can resolve. 

STAGES OF THYROID NODES DEVELOPMENT

An ultrasound examination of the neck is used to determine the stages, size and possible nature of the thyroid nodule.

Depending on the stage, ultrasound can reveal:

• a homogeneous isoechoic node – its density is almost the same as the surrounding tissue of the organ, but along the edges there is a significant increase in blood circulation and an expansion of the network of blood vessels, this is the structure of the surrounding.
• heterogeneous isoechoic node – in this case, various changes in the tissue inside the capsule of the node can be detected. These changes can range from isolated and minor to the detection of areas of cystic degeneration (a small cyst with a fluid level in it is found inside the node). 
• non-echogenic ( hypoechoic ) node – is found if the normal tissue of the thyroid gland in this part of the organs is completely destroyed, and inside the formed dense cyst there is a large number of dead cells and fluid. It is in this case that a typical thyroid cyst is diagnosed.   

The stage of cyst resorption usually stretches for a considerable time, at which time the dead cells of the organ are replaced by loose connective tissue. The scarring stage is characterized by the formation of a dense scar at the site of a node or cyst. If the inflammatory process in the organ goes beyond the node stage (resorption and scarring of the focus begins), then restoration of the organ structure is impossible.

HOW THE THYROID NODES ARE MANIFESTED

At an early stage of the development of the pathological process , it is almost impossible to detect any specific symptoms inherent only to the nodes of the thyroid gland. As long as these neoplasms remain small, they do not manifest themselves clinically, therefore it is impossible to get any complaints from the patient. In this case, the nodes of the thyroid gland become an accidental finding, found during a routine examination or examination prescribed for the diagnosis of other diseases.

At the stage when the node reaches a size of 5 mm or more, it can also be detected by palpation – it is possible to palpate the neoplasm only when it is located in the immediate vicinity of the edge of the organ or close to the surface. The pathological focus is felt as an area of ​​dense elastic tissue located under the skin – it does not mix when trying to press and it differs to the touch from the normal tissue of the thyroid gland.

For qualified medical care, the patient most often turns to only at the moment when the node becomes clearly visible – the neoplasm changes the visible contours of the neck and is visualized (often by outsiders). In the overwhelming majority of cases, these changes are detected only when the size of the node (nodes) exceeds 3 cm, which significantly reduces the possibility of prescribing conservative therapy. 

At this stage in the development of the pathological process, the patient may complain about:

• pain in the neck, and the patient cannot always indicate the age of these unpleasant sensations;
• the appearance of perspiration and a feeling of a lump in the throat – difficulty swallowing progresses as the disease progresses;
• respiratory failure – an enlarged thyroid gland or part of this organ squeezes the larynx and trachea, passing behind the thyroid gland ;
• voice changes – the tissue of the gland squeezes the laryngeal nerve, which is responsible for the innervation of the vocal cords;
• thickening of the lymph nodes located on the neck should alert the doctor – metastasis is characteristic only of malignant neoplasms in this endocrine gland.

In the case when an autonomous (“hot”) node is formed in the structure of the thyroid gland, the symptoms characteristic of hyperthyroidism come to the fore – the patient complains of attacks of unreasonable heartbeat, heart rhythm disturbances, hot flashes, unexplained excitement, emotional instability, protrusion eye (exophthalmos).

If during the examination of the patient it is found that only a single ( solitary ) node is present in the thyroid tissue , then a comprehensive examination is mandatory, the results of which will allow to exclude or confirm the presence of a malignant neoplasm in the organ. In such patients, the progression of the disease is often noted (thyroid cancer is currently one of the most invasive tumors of the human body) – a rapid growth of the primary tumor focus is found, as well as damage to regional lymph nodes. If the results of the study confirm the presence of several nodes (multiple adenoma), then the prognosis of the disease is certainly more favorable, although examination is also necessary. Even the use of modern diagnostic methods does not always allow an accurate diagnosis to be made on time – that is why patients with identified volumetric processes in the thyroid gland should remain under the dispensary supervision of a qualified endocrinologist.

Complications accompanying fibrocystic changes in the thyroid gland

It is not necessary to say that nodular and cystic changes are completely safe for the patient (if the examination made it possible to exclude malignant neoplasms) is completely safe for the patient. Even with a favorable development of the disease, inflammation and suppuration may occur – these conditions will manifest themselves with severe pain, symptoms of systemic intoxication, high fever, swollen lymph nodes, which requires active treatment. 

In the event that the festering cyst reaches a large size, it will also squeeze the surrounding organs and tissues – active and timely treatment allows you to quickly eliminate the symptoms of the disease and its complications.

In 8% of patients, initially benign thyroid nodules become malignant – to prevent this complication, dynamic dispensary observation by an endocrinologist is necessary.

MODERN OPPORTUNITIES IN THE DIAGNOSIS OF NODULAR DISEASES OF THE THYROID

The first and most important method for diagnosing nodular and cystic neoplasms of the thyroid gland is sonographic examination – ultrasound of the thyroid gland can be performed on patients of any age. During the examination, it is necessary to determine the size and structure of the neoplasm, its type (if possible).

If a single node is found in the thyroid gland, then the next stage of diagnosis is a puncture fine-needle biopsy. To conduct this study, a thin needle is inserted into the cavity formation under the control of an ultrasound sensor, through which the contents of the node are aspirated. The resulting fluid is sent for cytological and histological examination. Already on the basis of a visual assessment of the fluid received, the doctor performing the puncture can make a preliminary conclusion regarding the nature of the node. If a yellowish fluid is visible during examination, then it is likely that this formation is a congenital cyst of the gland. If pus is visible in the syringe and test tube, then it is likely that the patient has a thyroid abscess. A typical cyst of the gland contains a hemorrhagic fluid, in which, during laboratory research, individual cellular elements and the stroma of the organ are found.

If the doctor is sure of the good quality of the punctured formation, then after removing the contents of the cyst, its cavity can be filled with a special sclerosing solution – in about 50% of cases, such treatment will help completely get rid of the disease.

To assess the functional capabilities of the thyroid gland and the endocrine system of the body, the patient is prescribed laboratory tests – the level of hormones produced by the cells of the organ’s epithelium (thyroxine, tyrosine a and TSH) is determined.

Performing scintigraphy – scanning of the thyroid tissue after the introduction of radioactive isotopes of iodine or technetium into the patient’s body, helps to determine the nature of the node, its hormonal activity and the state of the unaffected organ tissue. Depending on how the used isotope is accumulated, all detected nodes are divided into:

• warm nodes – the same amount of iodine or technetium is absorbed in them, as in the unaffected parts of the organ;
• hot nodes – they absorb more of the isotope than in the unchanged thyroid tissue;
• cold nodes – they do not accumulate used material, therefore, it is possible to visualize only the unaffected part of the patient’s thyroid gland. such patients require an in-depth examination, because in 10-15% of cases, such a picture indicates cancer (adenocarcinoma) of the thyroid gland.

In such a situation, computed or magnetic resonance imaging is required to clarify the diagnosis. When signs of compression of the neck organs are detected , laryngoscopy and bronchoscopy are shown, which make it possible to exclude pathological neoplasms in the organs of the respiratory system, which are much more common.

If there is a reasonable suspicion of the presence of a malignant neoplasm in the tissue of the thyroid gland, X-ray studies of this organ of the endocrine system are performed – pneumography, demonstrating the spread of the tumor to the surrounding tissues, angiography, showing the features of blood supply, as well as fluoroscopy of the esophagus with barium sulfate contrast. If there is a suspicion of tracheal invasion, X-rays are taken of this organ as well.

MODERN OPPORTUNITIES FOR TREATMENT OF THYROID NODES

The tactics of treating a patient with identified nodular and cystic changes in the organ directly depends on the number of pathological foci in the organ tissue, their size, the patient’s age, and the general condition of his body.

In the case when several nodes are found, the size of which does not exceed 1 cm, then the patient is dynamically monitored – medical manipulations and medication are not indicated in this case. If a single small node is found, then it can also be left under the supervision of a doctor, but every 3 months a second consultation with an endocrinologist and laboratory tests are shown.

The tactics of treating a cyst depends on its size and the dynamics of the process – cysts of a large volume, as well as formations, which quickly after puncture are again filled with collodion, are also an indication for surgical treatment. Small cysts, after filling them with solutions of sclerosants, can be further treated conservatively – the endocrinologist in this situation is limited to the appointment of iodine and thyroid hormone preparations . In this case, monitoring of the condition of patients should be repeated monthly (a doctor’s examination and laboratory tests are carried out), and an ultrasound examination of the neck organs will be repeated once every 3 months. In this case, a sharp increase in the level of hormones or antibodies in the blood requires an immediate rejection of further therapy and examination of the patient, aimed at excluding the existence of autoimmune thyroiditis.

If the puncture results reveal a purulent fusion of the thyroid gland or part of it, then antibiotics and detoxification therapy become an obligatory component of treatment . Selection of drugs based on the results of microbiological and bacteriological examination of the obtained biopsy is desirable.

In all other situations, surgical treatment remains an option to relieve the patient of numerous symptoms of the disease and avoid possible complications. In a benign process, partial resection of the thyroid gland tissue is performed (most often limited to resection of its lobe), which does not violate the hormonal status of the patient’s body.

In the case when the doctor determines that the node in the thyroid gland is malignant, a total strumectomy is performed, followed by the appointment of hormone replacement therapy. In addition, the prescription of calcium preparations is mandatory, because with total resection the parathyroid glands are inevitably removed. 

The prognosis for nodes and cysts of the thyroid gland directly depends on the histological structure of the neoplasm. With benign nodes, a complete recovery of the patient is possible, while with cystic changes, relapses of the pathological process often occur. In the case of detection of malignant neoplasms of an organ, the prognosis directly depends on the tumor and its spread throughout the body – early detection and timely removal of the tumor promise recovery, while cases of advanced adenocarcinoma are often fatal. That is why doctors of all specialties insist that any nodular changes in the thyroid gland are easier to prevent than to cure later. 

HOW TO FORGET ABOUT THYROID DISEASES?

Lumps on the neck, shortness of breath, sore throat, dry skin, dullness, hair loss, brittle nails, puffiness, puffiness of the face, dull eyes, fatigue, drowsiness, tearfulness, etc. – it’s all a lack of iodine in the body. If the symptoms are “on the face” – it is possible that your thyroid gland is no longer able to work normally …