Thyroid Nodular Goiter 101: What to Know if You have one

Thyroid Nodular Goiter 101: What to Know if You have one

Thyroid Nodular Goiter 101: What to Know if You have one

Thyroid Nodular Goiter 101: What to Know if You have one.

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  1. 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.
  2. However, this is becoming a rarer cause because iodine is now present in drinking water and some of the foods we eat, such as table salt.
  3. Hashimotos thyroiditis and Graves’ disease, two autoimmune diseases, are much more common causes of goiter in the western world.
  4. Nodules are lumps in the thyroid gland. Thyroid nodules are common and occur in 50 per cent of adults. Most nodules don’t cause any signs or symptoms.
  5. 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.
  6. In some cases, thyroid nodules produce additional thyroxine — a hormone secreted by the thyroid gland. The extra thyroxine can cause symptoms of hyperthyroidism such as:
  7. Unexplained weight loss;Intolerance to heat,Tremor;Nervousness; and Rapid or irregular heartbeat.
  8. A few thyroid nodules (5%) are cancerous.
  9. Determining which nodules are malignant can’t be done by symptoms alone.
  10. 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.
  11. The imaging modality of choice for the investigation of thyroid nodules is high-resolution ultrasound.
  12. Ultrasound assessment of an enlarged thyroid gland ids needed.
  13. Thyroid nodules which are suspicious in appearance need to undergo a biopsy procedure called Fine Needle Aspiration Cytology (FNAC) to check for cancerous cells.
  14. The ultrasound features suggestive of malignancy are as follows: CALCIFICATIONS, Microcalcifications are one of the most specific features of thyroid malignancy. They appear as tiny white spots without shadowing on ultrasound and are most commonly found in papillary thyroid cancer.
  15. LOCAL INVASION AND LYMPH NODE METASTASIS
  16. Direct tumour invasion of adjacent soft tissue and mets to lymph nodes are very specific signs of thyroid malignancy.
  17. There may be subtle extension of the tumour beyond the contours of the thyroid gland or frank invasion of adjacent structures.
  18. Clinical features include shortness of breath, hoarseness and difficulty swallowing, depending on the neck structure invaded.
  19.  If a diagnosis of indeterminate is made molecular markers for cancer and benign classifier can be done on the slides, thin prep or repeat biopsy needle washout.
  20. If thyroid cancer is made, a detailed lymph node mapping of the neck should be done before the surgery. It is important as finding positive cancer lymph nodes can change the surgery to include the lateral neck dissection in 30%.
  21. Alternative therapy with ethanol PEI or radiofrequency ablation RFA is available for benign large symptomatic nodules instead of surgery.
  22. Call me at 310-393-8860 or email to thyroid.manager@protonmail.com for details of alternative therapy or thyroid cancer consult.
  23. DR.G.
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