Thyroid Goiter and Nodules 101: What you need to Know.
- A swelling in the neck due to an enlarged thyroid gland is called a goiter.
- Worldwide, the most common cause of thyroid goiter is iodine deficiency.
- However, this is becoming a rarer cause because iodine is now present in drinking water and some of the foods we eat, such as iodized table salt.
- Hashimotos thyroiditis and Graves’ disease, two autoimmune diseases, are much more common causes of goiter in the western world.
- Nodules are lumps in the thyroid gland. Thyroid nodular goiter is common and occur in 50 per cent of adults.
- Most nodules don’t cause any signs or symptoms.
- Some nodules can become so large that they can be felt or seen, or can press on the windpipe or esophagus, causing shortness of breath or difficulty swallowing.
- In some cases, thyroid nodules produce additional thyroxine — a hormone secreted by the thyroid gland.
- The extra thyroxine can cause symptoms of hyperthyroidism called toxic nodular goiter.
- Graves’s disease causes a goiter and hyperthyroidism.
- Symptoms are unexplained weight loss; Intolerance to heat, Tremor,Nervousness; and Rapid or irregular heartbeat.
- A few thyroid nodules (5 per cent) are cancerous, but determining which nodules are malignant can’t be done by symptoms alone.
- Risk factors for thyroid carcinoma include age of less than 20 years or more than 60 years, a history of neck irradiation and a family history of thyroid cancer.
- The imaging modality of choice for the investigation of thyroid nodules is high-resolution ultrasound.
- The patient’s family physician will therefore refer patients to an endocrinologist for evaluation and ultrasound assessment of an enlarged thyroid gland.
- The is to determine which thyroid nodules are suspicious in appearance and need to undergo a biopsy procedure called Fine Needle Aspiration Cytology (FNAC) to check for cancerous cells.
- The ultrasound features suggestive of malignancy are as follows: CALCIFICATIONS, Microcalcifications,LOCAL INVASION AND LYMPH NODE METASTASIS, Direct tumour invasion of adjacent soft tissue and mets to lymph nodes are very specific signs of thyroid malignancy.
- Abnormal appearing lymph nodes on the same side as the thyroid tumor should arouse suspicions of metastasis.
- After identifying a suspicious nodule, the endocrinologist will then perform an ultrasound-guided fine needle aspiration to retrieve cells, which are then examined by a cytologist.
- Collection of DNA/RNA markers during the biopsy can help decide if surgery is needed.
- If a diagnosis of thyroid cancer is made, the endocrine neck certified endocrinologists will do a complete VII level neck lymph node evaluation looking for suspicious cancer lymph nodes to biopsy before the surgery. This last test can change the original surgery to include a modified neck dissection and total thyroidectomy.
If you have a goiter you need to have an evaluation.
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