Nodules are small, solid and generally well circumscribed formations that can form in numerous locations in the body . Very often they go completely unnoticed as they do not give visible signs or symptoms of particular importance.
However, in certain locations they may be evident as they are palpable and as long as they are visible to the naked eye. And this is the case with the thyroid , neck, breast and armpit.
Thyroid nodules , as mentioned, can be identified by touch as solid and well localized structures, however in the vast majority of cases they are identified randomly during the execution of an ultrasound of the neck.during a preventive visit or in connection with checks for other pathologies.
Although the word nodule can evoke nefarious and malignant meanings, triggering fears and fears that it is a tumor, it is good to clarify, before any further study, that it is mostly benign formations and that the need to carry out investigations, is part of a diagnostic process aimed at ascertaining its nature, and therefore at limiting progressions in a malignant sense. In fact, a tumor ( thyroid carcinoma ) is a rather rare event that is accompanied by notable symptoms.
Having said that, let’s go into the details of the symptoms and signs related to the presence of one or more thyroid nodules, but first it is important to understand what the functions of this organ and its location are, in order to better understand the consequences of any alterations in thyroid function.
What is the thyroid and how it works
The thyroid is an endocrine gland located in the anterior region of the neck, and consists of a central part called the isthmus that connects the two lateral lobes, which together give it the appearance of a butterfly. The thyroid is an organ made up of follicles, i.e. small spherical vesicles that have the function of producing thyroid hormones, namely triiodothyronine (T3) and tetraiodothyronine or thyroxine (T4) .
Thyroid hormones have the task of regulating heart rhythm, basal metabolism, regulating body temperature, increasing the capacity of skeletal muscle contraction, regulating bone metabolism and the ossification of cartilage in the growth phase.
Thyroid nodules can present as single or multiple formations and their formation is influenced by factors such as age (they tend to be more frequent in people over 60), female sex and geographical areas where iodine is present. (essential for the production of thyroid hormones) and poor, a condition typical of Alpine areas up to the last century or of developing countries.
What symptoms are associated with the appearance of the nodules
As mentioned, in most cases the thyroid nodules do not give any symptoms, they are therefore asymptomatic, however, depending on the size, number and location they can manifest neck pain, difficulty in swallowing or breathing, subcutaneous solid mass, swelling of the lymph nodes in the neck, swelling and systemic symptoms such as rapid weight loss.
Hyperthyroidism and hypothyroidism: what they entail
Thyroid nodules can be divided into:
- Hot: they are less subject to a transformation in a neoplastic sense, and involve a greater release of thyroid hormones, a condition that can result in a picture of hyperthyroidism . Numerous symptoms occur in this condition, such as increased skin temperature, sweating, increased blood circulation, retraction of the eyelid, decreased body weight due to increased basal metabolic rate, increased appetite, diarrhea, increased heart rate ( tachycardia ), hyperactivity and insomnia;
- Colds: they are rarer but have a greater tendency to transform into a malignant sense, and cause a lower release of thyroid hormones, resulting in a condition that takes the name of hypothyroidism. Characteristic signs are dry and thickened skin, decreased heart rate (bradycardia), weight gain, fluid retention, difficulty concentrating, sleepiness, tiredness and sensitivity to cold.
Thyroid nodules: in what conditions are formed
Multinodular goiter
Enlargement of the thyroid also called struma, which may have a familiar tendency, be linked to a territory (i.e. endemic, typical of the Alpine areas up to the last century) or derive from a maternal hypothyroidism ( which generates cretinism in the fetus). The endemic goiter is due to a lack of iodine in the diet, a mineral typically drawn from table salt (or sea salt).
Thyroiditis
A group of inflammatory pathologies affecting the thyroid gland that lead to its enlargement and the formation of nodules . One example is Hashimoto’s thyroiditis(or autoimmune thyroiditis), mostly due to iodine deficiency. It mainly affects the female sex, determines a picture of hypothyroidism which is accompanied by the presence of auto-antibodies and the formation of lymphatic follicles, with a nodular and solid appearance, which lead to an enlargement of the thyroid.
Thyroid
adenoma In the case of an adenoma, a single nodule or multiple nodules can be formed which take on considerable size, solid consistency and regular margins, to the point of being easily palpated. Nodules are mostly of the cold type, and must be observed for the risk of malignant neoplastic transformation.
Thyroid cancer
This is a rare event compared to all the causes that lead to the onset of thyroid nodules. At the base there are promoting factors, among which smoking, familiarity with thyroid cancer and male sex stand out. In the case of carcinoma, there is usually only one fast-growing nodule, which is associated with hoarseness and lymphadenopathy, then with swelling of the lymph nodes in the neck. The treatment involves the surgical removal of the thyroid gland (thyroidectomy) which can be partial or total, to which oncological therapies can also be added.
On the next page we will deal with the ways in which thyroid nodules are diagnosed and the most used medical treatments.
Diagnosis and Treatment
As mentioned in most cases the thyroid nodulesthey are identified by chance on the occasion of a diagnostic test carried out for other reasons, and in these cases a precise diagnostic path is taken by the same doctor who identified them.
What to do when you notice a lump on the neck because it is visible or palpable
In this case it is necessary to promptly contact your GP, without making the mistake of waiting to see if it resolves itself, but nevertheless you must not panic, both because it is a rather common event, and because , as seen, in the vast majority of cases that lump does not indicate a tumor, or a risk factor for one’s life. Having said this, it is important to undergo the necessary checks to limit as much as possible the degeneration of the problem and any neoplastic transformations.
What visits are required in case of nodules
The necessary tests must only be indicated by a doctor, and generally include:
- A blood sample through which to check the levels of thyroid hormones (T3 and T4) and TSH (hormone produced by the pituitary gland with the aim of regulating the functioning of the thyroid), useful for identifying thyroid function and hyper or hypothyroidism. Through blood sampling it is also possible to have an idea of ​​probable autoimmune diseases (such as autoimmune thyroiditis), by measuring the values ​​of anti-thyroperoxidase antibodies (TPOAb) and anti-thyroglobulin antibodies (TgAb) ;
- Ultrasound: simpler and more practical examination to see the size of the nodule, the number and the location;
- Eco-doppler: investigation that allows you to view the blood flow to the thyroid and nodules, taking into account that it is a richly vascularized organ and subject to hemorrhages;
- Agoaspirato (FNAB): technique that allows, under ultrasound guidance, to take a sample of the lump content through a needle, in order to understand its nature, therefore whether malignant or benign;
- Scintigraphy : examination more indicated to evaluate if the lump is hot or cold.
The treatments depend on the triggering cause, the characteristics of the nodule and its activity, therefore they should only be indicated by a specialist in endocrinology, after carefully evaluating the diagnostic investigations.
If the nodules do not attract particular attention, the indication is generally that of regularly undergoing control investigations, with the aim of keeping the condition under observation and promptly intervening in case of alterations.
If the conditions include alterations in thyroid function, treatment involves the prescription of drugs: in the case of hypothyroidism, the indication is generally on drugs containing the hormone T4 (or thyroxine), such as typically Eutirox®,allowing to regulate the metabolic functions described above. Sometimes the therapeutic indication involves partial or total surgical removal (thyroidectomy) of the thyroid.
If the cause of the thyroid enlargement is due to iodine deficiency, its integration is trivially indicated.
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