What is called a cold nodule in the thyroid gland. Hot thyroid nodule. Decreased hormone levels

One of the areas of work of visceral surgeon Dr. med. Christian Huschke is surgery of cold and hot thyroid nodules. Today we are publishing answers to many questions about the symptoms and methods of treating thyroid diseases in Germany.

Many people know about the so-called goiter as a result of iodine deficiency. What other thyroid diseases exist?

Dr. Huschke: Enlargement of the thyroid gland (goiter), one of the most common diseases of the thyroid gland, usually goes unnoticed for a long time. Very often, goiter is accompanied by hot or cold nodules. They can form without a goiter. In some cases, cold nodules can be cancerous.

In addition, there are dysfunctions of the thyroid gland: increased function (hyperthyroidism) or decreased function (hypothyroidism). In this case, the thyroid gland produces either too much or too little hormones. The result is serious concomitant diseases.

How can a doctor diagnose thyroid disease?

Dr. Huschke: A blood test for thyroid hormones (T3 - triiodothyronine, T4-thyroxine and TSH-Thyroid-stimulating hormone) can provide information on whether thyroid function is impaired. An ultrasound examination can detect enlargement of the thyroid gland and possible nodes. In order to determine the nature of the nodes, an additional examination is necessary - a scintigram.

What are the dangers of cold and hot thyroid nodules?

Dr. Huschke:“Hot” nodes (autonomous adenomas) are particularly active areas of the thyroid gland. They accumulate iodine uncontrollably and this leads to increased production of hormones from this gland. By their nature, these nodes are benign, but can lead to harmless concomitant diseases, so they must be treated. “Cold nodes” are inactive, but are prone to malignant changes. When cold nodes are found in young people, even if it is just one node, I recommend removing it without observing it for a long time, since the number of malignant nodes has increased very noticeably in recent years.

It is possible to distinguish a cold node from a hot one only with the help of a scintigram. There are times when during surgery it is difficult to unambiguously determine the nature of a cold node. In such cases, a rapid tissue test is performed directly in the operating room to determine the nature of the node and a decision is made on how much gland tissue or even lymph nodes need to be removed.

Is it necessary to remove cold and hot nodes?

Dr. Huschke: in case of malignant samples of gland tissue and even if malignancy is suspected, surgery is mandatory.

Even if side effects such as shortness of breath, problems swallowing or hoarseness occur due to mechanical complications, then surgery is inevitable in this case as well. In addition, nodes must be removed if drug treatment for increased thyroid function is ineffective.

What symptoms are signs of an overactive or underactive thyroid?

Dr. Huschke: With increased function, the thyroid gland produces more hormones than the body needs. This leads to increased metabolism. The cause may be antibodies to the thyroid gland's own tissues. Symptoms include nervousness, excessive sweating, hair loss, irregular heart rhythm, weight loss, and Graves' disease.

With reduced function, patients complain of drowsiness and lethargy, as the body produces too few hormones. The cause is very often chronic inflammation of the thyroid gland.

Dr. Huschke: With increased thyroid function, the fight against the production of large amounts of hormones begins with drug therapy, which necessarily includes one cardiac drug. Naturally, all medications have side effects. In such situations, I recommend surgery to eliminate the cause, namely a malfunctioning gland. After the operation, the patient is prescribed the missing hormones in the form of tablets.

In the presence of Basedow's disease, surgery on the thyroid gland stops the process of eye changes, but cannot return the eyes to their previous state.

With reduced function, the situation is controlled by taking the required amount of hormones. Only in rare cases of pronounced nodular goiter is surgery performed.

What surgical techniques do you use?

Dr. Huschke: We work according to the “standard method with neuromonitoring.” The incision is only 4-5 cm long, regardless of whether the operation is performed on one or both sides.

Is it possible to prevent thyroid diseases?

Dr. Huschke: Definitely yes, even if there are additional hereditary risk factors. Since thyroid diseases are associated with iodine deficiency, it is necessary to follow an appropriate diet from childhood. Be sure to include fish dishes in your diet as often as possible, and do not forget about vegetables, salads and salt containing iodine.

If you are interested in thyroid treatment in Germany, feel free to contact EUROMEDICAL and everything will be GOOD!

Whatever a doctor discovers in his patient, it always causes concern in the latter. Especially if such a name has never been encountered in your life’s journey before. A nodule in the thyroid gland is one of those diseases that frightens with its mystery, especially when the doctor calls it hot or cold.

It must be said that a nodule in the thyroid gland does not mean anything sinister. It’s just that a clot of the same cells that make up the thyroid gland itself is found in the gland. Only this clot is located in the shell, and everything that is contained inside it, all these cells, are more closely pressed to each other. The doctors were not original and called this shell a capsule.

There is currently no reliable information about where this node actually comes from. Scientists have only been able to put forward a few theories:

The root cause is a lack of iodine molecules in the human body.
The body, or more precisely, the thyroid gland, was exposed to certain toxins.
Nodules arise due to genetic predispositions. That is, after making such a diagnosis, ask your parents and grandparents if this has happened to them.

But doctors rarely wonder where this formation came from in the patient. They are much more concerned about how they can help him. You need to decide on the quality of the nodule, what size it is and how hormonally active it is. After this, the results are summed up and a decision on treatment is made. Ultimately, the goal is to minimize the impact on human life.

It must be said that this benign node does not imply any particular inconvenience for humans. Contrary to popular belief, you can even safely go on vacation to hot countries. The only warning from the attending physician will be a request not to be under the active sun during dangerous hours and not to overuse tanning. Excessive amounts of ultraviolet rays cause the node to grow. It can also become overactive in cases where you use iodized salt instead of regular salt, and also try to compensate for a non-existent iodine deficiency with special preparations.

Your life, in principle, will not change, but try not to do anything significant without first consulting an endocrinologist. He should become your guiding star, because he will have to correct the situation in case of your mistakes.

Node classification

Doctors classify all thyroid nodules into three subtypes:

"Calm." These nodes in their hormonal activity are absolutely no different from all other cells of the organ.
A cold thyroid nodule is made up of cells that produce less hormones than those contained outside the capsule.
A hot thyroid nodule is always overactive. It produces much more hormonal products than is normally required.

It must be said that the first two types do not allow themselves to be detected, and you will only find out about their presence if you are concerned about your health and always undergo a routine medical examination. But the “hot” variety indicates its presence with various symptoms. Indeed, in this situation, there is too much thyroid hormone in the blood, and in scientific terms - hyperthyroidism. First of all, patients begin to complain of an accelerated and erratic heart rhythm. If you keep silent about such manifestations for a long time, you can lead your body to a heart attack, stroke, or, for example, kidney failure. Therefore, do not delay going to the clinic.

If a person is diagnosed with a hot thyroid nodule, whether surgery is necessary is the first question that arises in his mind. The answer to this question is somewhat disappointing. The fact is that in cases where the entire gland exhibits excessive activity, it is restrained with specialized drugs. They are called thyreostatics. In most cases, they help, and only otherwise is the issue of the deletion operation resolved.

However, when excess hormones in the blood are provided by hot nodes, medications are ineffective. They have a depressing effect on the hormonal activity of the thyroid gland itself, and the formation inside it turns out to be insensitive to such treatment. Therefore, only surgery can help. But don't be alarmed ahead of time. The doctor will thoroughly examine all the characteristics of your node and may only need to remove it. If the thyroid gland remains with you, you will not need any therapy at all later.

Node development

The main concern of a patient who has a nodule in the thyroid gland is that over time it will degenerate into a cancerous tumor. It must be said that such fears are not groundless. But most often, cold nodules of the thyroid gland undergo such a transformation. However, calm and hot formations are also susceptible to this, only much less frequently. But this does not mean at all that all the seals in the thyroid gland need to be cut out immediately.

If the formation that you have discovered does not exceed 1 cm in size, then you just need to observe it. In six months, the endocrinologist will schedule a follow-up appointment for you. You will have a repeat ultrasound to see if the size of the node has increased. If this does not happen, then your next appointment will be only in a year.

If at the very beginning the node was more than 1 cm or its size increased over the diagnostic six months, then the patient undergoes a puncture. During this procedure, a tissue sample is taken directly from the seal itself using a thin needle. The laboratory gives a conclusion about the likelihood of degeneration and the endocrinologist decides on the advisability of the operation. If the risk of degeneration into an oncological tumor is low, then the patient continues to be monitored.

It happens that the size of the node is more than one centimeter, and there is not the slightest hint of cancer in it. But in any case, if the size exceeds 4 cm, it will be removed in any case. And the point here is not at all about oncology, it’s just that at such a size it begins to simply interfere with the organs surrounding it. For example, it becomes difficult for a person to breathe, swallow and even speak.

The thyroid gland is a small unpaired organ located in the neck. The thyroid gland controls the functioning of the entire body thanks to the hormones it produces. The thyroid gland can be susceptible to various pathologies that require timely treatment. The most common pathology to which the gland is exposed are nodes. Nodules are formations in the thyroid gland that can be benign or malignant. They come in several types. A hot thyroid nodule is the rarest type of nodule, which in 95% of cases is benign.

Characteristics of the pathology

Nodules are structural changes in the thyroid gland that have an encapsulated structure that separates them from the surrounding tissues. If a node in the thyroid gland is formed in the singular, then solitary changes in the organ have occurred. If there are numerous nodes, the patient is diagnosed with multiple adenoma. The node may or may not be accompanied by the production of hormones in its tissues.

Radioisotope research is used to identify nodules in the thyroid gland, as well as to determine their type. They can be:

cold – such nodes occur in 85% of cases; they do not absorb the iodine that is administered to the patient during the examination, i.e. formations are hormonally inactive;
warm - such nodes are found in 10% of cases, 90% of which are benign;
hot - these nodes are hormonally active, they absorb large amounts of iodine.

Causes

Nodules in the thyroid gland occur more often in women, especially with age. Hormonal imbalance in the body, which develops in a woman’s body due to age-related changes, may be a prerequisite for the formation of thyroid pathologies.

There are also other reasons that provoke the development of changes in the tissues of the gland. These include:

hereditary predisposition;
the influence of harmful toxic substances on the body;
human exposure to x-rays.

Also, unfavorable environmental conditions and living in areas with iodine deficiency predispose to the development of thyroid pathologies.

Symptoms of the node

A hot thyroid nodule can develop in the body for a long time without symptoms. But when it is significant in size, compression of nearby tissues and organs occurs. As a result, breathing and swallowing become difficult, the patient's voice changes, and hoarseness occurs. When the node is accompanied by infection, suppuration, pain in the neck, and increased body temperature occur.

Also, a hot node can cause symptoms of hyperthyroidism or theriotoxicosis (irritability, thirst, arrhythmia, bulging eyes, etc.).

The main danger of thyroid nodules is the likelihood of their malignancy (degeneration into a malignant form).

Diagnostics

In addition to palpation examination, the patient is prescribed ultrasound, MRI, CT and radioisotope studies. Scintigraphy allows you to determine the type of nodule. A biopsy is also used to determine the nature of the node.

Treatment of nodes

Treatment for a hot thyroid nodule depends on many factors. The patient may be offered drug treatment with constant monitoring. An alternative is surgical removal of the node, which is most often used. If necessary, the patient is prescribed hormone replacement therapy after surgery.

Focal (nodular) formations in the thyroid gland are very common. This pathology is so common that it is sometimes considered a normal variant. But such a view of the nodules of thyroid tissue is still unjustified. Sometimes focal formations can significantly reduce overall health and even cause the death of the patient. Which nodes are especially dangerous? The greatest threat to the patient is:

malignant neoplasms;
autonomous adenomas;
large-sized nodes (more than 40 mm);
formations in the retrosternal goiter.

Thyroid cancer

The oncological process in the thyroid gland is the most common cancer of the endocrine organ. The tumor most often appears as a single small node (up to 1.5 cm). It is believed that of all focal formations in thyroid tissue, about 5–10% are malignant. The likelihood of cancer depends on many factors.

Increase the risk of malignant process in the gland:

lifetime incidence of radiation exposure to the head or neck;
previous bone marrow transplantation;
living in radioactive disaster zones during childhood and adolescence;
family history of thyroid cancer.

Thyroid cancer is divided into highly and poorly differentiated. The patient's life prognosis depends on the form and stage of the malignant tumor. If the neoplasm is quite aggressive, grows quickly and has already metastasized to distant organs, then the outcome of the disease may be unfavorable. Even if the operation is successful, in 7% of cases the death of the patient is recorded during the rehabilitation period, and in 20% there is a relapse of the malignant tumor.

Which node is dangerous in terms of malignancy?

Most suspicious:

formations that are dense to the touch;
tumors accompanied by enlarged lymph nodes;
nodes due to hypothyroidism (high thyroid-stimulating hormone - TSH).

During an ultrasound examination, the malignant node has an uneven contour, a hypoechoic structure, and increased blood supply.

A tumor of thyrocytes can be benign. Even then, it is dangerous for the patient. A thyroid nodule is considered an adenoma if histologically it consists of A and B cells. Such a neoplasm may be accompanied by increased thyroid function (thyrotoxicosis). In this case, the disease is classified as Plummer's disease. Toxic adenoma can lead to the development of severe complications and death.

Manifestations of thyrotoxicosis:

rapid pulse;
arrhythmia;
dyspnea;
swelling;
pain in the heart area;
anxiety;
sleep disturbance;
weight loss, etc.

Patients with Plummer disease may die due to acute heart failure. This disease is especially dangerous for elderly patients. After the age of 60, there are usually already atherosclerotic plaques in the coronary arteries. The combination of myocardial ischemia and increased thyroid function is extremely unfavorable.

Thyrotoxicosis can also develop with long-existing multinodular goiter. This disease usually occurs in regions with iodine deficiency in water, air, and soil. The population under such unfavorable conditions develops endemic thyroid diseases. Over the years, areas of thyroid tissue acquire autonomy from the influence of the hypothalamic-pituitary system.

Large thyroid nodules

Any large nodular formation in the thyroid gland can lead to disturbances in the patient’s well-being. Tumors larger than 40 mm in diameter also sometimes cause disturbances in the functions of breathing, nutrition, and blood circulation.

The likelihood of mechanical compression of surrounding tissues depends on many reasons. The individual anatomical structure plays the greatest role. The closer the node is located to the vessels and organs of the neck, the greater the risk of compression.

Large nodes disrupt operation:

trachea;
esophagus;
blood and lymphatic vessels;
nerves.

Compression of the trachea is observed relatively rarely. Patients with this complication report suffocation. The feeling of shortness of breath may increase in some poses. Thus, it is usually harder to breathe when lying on your back.

Compression of the esophagus is manifested by impaired swallowing function. The patient may complain of a “lump” feeling in the throat while eating. It can be especially difficult to swallow solid foods.

Mechanical pressure on the vessels of the neck leads to disruption of blood and lymph flow. Patients may have hyperemia and swelling of the face. In severe cases, if the arteries are affected, episodes of loss of consciousness and dizziness are observed.

Large nodes can disrupt the functioning of nerve tissue. This complication is more typical for malignant neoplasms. Compression of the recurrent nerves leads to hoarseness and difficulty swallowing (unilateral paralysis often develops).

Substernal goiter

Nodular retrosternal goiter has a non-standard location. Usually all the thyroid tissue is located above the sternum under the soft tissue. In typical cases, even a large goiter has minimal impact on breathing and swallowing food. If there is bone tissue above the thyroid gland, then even a small node may be accompanied by symptoms of mechanical compression.

Nodes of 10 mm and above appear:

suffocation;
discomfort while eating;
constant feeling of a “lump” in the throat.

Nodes in the retrosternal goiter are also dangerous because they are more difficult to detect. A simple examination by a doctor most often does not reveal this pathology. Diagnosis requires ultrasound, radioisotope scanning, tomography or barium radiography.

Diagnosis and treatment of nodes

An ultrasound doctor, endocrinologist, therapist, etc. can identify focal formations in the thyroid gland. Currently, most nodes are found by chance, that is, during preventive examinations.

Ultrasound diagnostics is considered the standard method for identifying tumors in thyroid tissue. Ultrasound is prescribed for those who have a high risk of thyroid disease. The study is also indicated for all patients with a node detected during examination.

The tumor can be detected using other methods. Thus, magnetic resonance imaging or computed tomography are extremely effective in this regard. But these expensive diagnostic technologies are usually not needed.

Scintigraphy helps to find a nodule in the thyroid gland and evaluate its functions. Radioisotope scanning is carried out only in specially equipped centers. Unfortunately, this diagnostic is not available in all regions of Russia.

Scintigraphy can reveal:

"hot" node;
"warm" node;
“cold” node;
cancer metastases;
ectopia (atypically located thyroid tissue).

“Hot” and “warm” neoplasms are actively functioning. They capture a lot of iodine and produce maximum hormones. This is how toxic adenoma and functionally autonomous nodes usually manifest themselves.

“Cold” tumors do not participate in the production of thyroid hormones at all. Sometimes this picture is given by an oncological tumor. In addition, this is how a true thyroid cyst manifests itself.

The cellular composition of thyroid nodules can be checked during a puncture biopsy. Cytological examination is recommended for all patients with focal neoplasms over 10 mm in diameter. The puncture allows you to determine further tactics.

Treatment of thyroid nodules includes observation, conservative therapy and surgery.

Surgical removal of lesions is carried out in case of cancer, functional autonomy, or compression of surrounding tissues. Also, surgery can be prescribed at the patient’s request in case of a significant cosmetic defect.

What are the dangers of nodules arising in the thyroid gland?

What are thyroid nodules and how dangerous is their presence? These are special formations that can have different sizes, structures and shapes. In most cases, they represent altered thyroid tissue. At the same time, the organ itself does not increase in size and does not change. If the node is filled with fluid, then they speak of a cyst. If there is a formation of small size, there is a very high probability of a complete absence of any symptoms of the disease. This pathological condition is determined exclusively during preventive diagnostics using ultrasound examination. Large formations can be palpated and noticeable during a routine examination by an endocrinologist.

Description of the problem

The presence of nodes in the thyroid gland, the symptoms and consequences of which do not always pose a danger to the human body, is often diagnosed among the population. In most cases, this problem is benign. Malignant formations are diagnosed only in 5% of all cases of detection of the disease. Ordinary nodes have no tendency to degenerate.

The incidence of these formations increases significantly with age. If in children or young people a nodule is found in the thyroid gland only in 1-2%, then in older men and women - already in 70%. However, it is possible to diagnose such formations during examination of the patient by palpation only in 4-7% of patients. In other cases, making this diagnosis requires a more thorough study using modern techniques.

Also, in approximately half of the patients who have thyroid nodules of significant size (palpable upon palpation), other formations are present. Additional research is also needed to identify them. Women develop thyroid nodules much more often than men. This is due to their special hormonal background. In most cases, these formations are localized in the superficial parts of the thyroid gland. That is why it is possible to identify them during palpation.

Types of thyroid nodules

With thyroid pathologies, nodes can form either in single or multiple quantities. This disease can develop in the following forms:

thyroid cancer. It can be papillary, follicular, or anaplastic. This nodular formation is usually the only one and is characterized by rapid growth. It does not have clear boundaries or a shell, which is clearly visible on ultrasound. This knot is very dense to the touch and most often painful. If the cervical lymph nodes are enlarged, we can talk about the presence of metastases;
adenoma. This is a benign formation that is surrounded by a fibrous capsule. This tumor usually grows slowly and almost never spreads to other organs or neighboring tissues. Such a node consists of normal cells (thyrocytes). This benign tumor is most often detected in women whose age exceeds 40 years;

colloidal nodes. This formation consists of follicles with a significant number of thyrocytes. In the thyroid gland, nodules of this type are most often present in the plural. They grow very slowly and do not bother humans in any way, so in most cases they are discovered by chance. This pathology does not require any treatment, because it does not pose a threat to the life and health of the patient;
cyst. It is a formation that is filled with liquid inside. Cysts are most often found in women of all ages. This formation is characterized by slow growth and the presence of a dense shell or capsule.

Stages of node development

The thyroid nodule is formed sequentially, and a clear stage pattern is visible.

This factor is clearly visible during ultrasound examination:

homogeneous (echoic) node. The density of the substances filling the formation does not differ from the surrounding thyroid tissue. This stage is characterized by increased blood flow, dilated vessels in the problem area;
heterogeneous or isoechoic node. It, in turn, may have minor tissue changes, be characterized by significant pathological transformations, or have areas of cystic degeneration.

In turn, heterogeneous nodular formations of the thyroid gland are formed against the background of the death of thyroid cells:

anechoic node. Accompanied by the destruction of the tissues that make up this formation. In this case, the cavity of the node is filled with fluid, which transforms it into a cyst;
resorption process. Characterized by the elimination of the contents of the cyst;
scarring process.

The process of converting nodes is quite lengthy. Its speed depends on many factors. First of all, it depends on the size of the node itself, the functioning of the immune system and the body as a whole.

Reasons for the problem

The causes of various types of nodules in the thyroid gland are the following factors:

90% of nodules in the thyroid gland, the cause of which is considered to be the accumulation of colloid in the follicles, is provoked by poor circulation in this area;
the formation of cysts occurs due to a combination of certain factors. These include the presence of congenital anomalies affecting the thyroid gland. Negative changes in this organ can occur due to injury, resulting in hemorrhage into the follicle. Cysts also form when the outflow of colloid is disrupted;
emotional stress and prolonged exposure to low temperature provoke vasospasm. Due to this negative process, insufficient cell nutrition is observed, and local immunity is significantly reduced. In the presence of these provoking factors, the risk of formation of nodules in the thyroid gland significantly increases (in most cases, causes of various kinds are combined);

poor environmental situation. The presence of toxic substances in the environment leads to the entry into the human body of a large dose of free radicals and carcinogens. They disrupt the structure of thyrocytes, which causes their uncontrolled division. Such exposure can provoke the formation of both benign and malignant nodules in the thyroid gland;
iodine deficiency in the human body. Provokes negative changes in the thyroid gland, the symptoms and treatment of which are well known to many;

exposure to high levels of radiation. Leads to cell mutations, which provokes the formation of malignant tumors;
inflammatory processes caused by certain diseases - tuberculosis, thyroiditis. The presence of this factor can cause swelling of the left or right lobe of the thyroid gland. As a result, pseudonodules are formed, which in appearance are very similar to tumors;
development of autoimmune diseases. The body attacks its own cells, which leads to inflammation;
pituitary adenoma. The hormonal imbalance that develops against the background of this disease leads to the development of a large number of nodes;
hereditary factors.

Symptoms of the disease

The signs of this pathology depend on the level of thyroid hormones it is accompanied by. With a reduced concentration of these substances, the symptoms of the disease are as follows:

decrease in metabolic processes in the body. Signs of this phenomenon are weight gain, decreased body temperature, inhibition of movements and reactions;
the presence of edema (especially in the morning and evening);
dysfunction of the reproductive system - unstable menstrual cycle, infertility, decreased sexual desire;
frequent diarrhea, alternating with constipation;
depression of intellectual abilities, development of depressive states;
dryness, fragility of hair, nails and skin;
low blood pressure, bradycardia.

With normal hormones, the following symptoms are observed:

discomfort in the neck area;
cough for no apparent reason;
shortness of breath if hormones are normal, but the pathological process has just begun to develop. With a more severe condition of a person, severe suffocation is observed;
sore throat;
hoarseness of voice;
having difficulty swallowing.

If the study reveals significant excesses of various thyroid hormones, the following symptoms appear:

excessive activity of metabolic processes. Accompanied by high body temperature, sudden weight loss;
protrusion of eyeballs;
increased irritability, excessive activity;
muscle tremors;
increased blood pressure;
indigestion;
increased secretion of sweat and sebaceous glands.

Diagnostics

Nodules on the thyroid gland can be detected in different ways:

palpation. When you feel the area of the neck where the thyroid gland is located, you can find many problem areas. You also need to understand that small formations will not be identified by external examination;
ultrasound diagnostics. This research technique is capable of finding even small nodules (minimum diameter 1 mm);
blood test for hormone levels and antibodies to determine the autoimmune nature of the disease;
tomography (computer, magnetic resonance). Allows you to identify nodules located in the retrosternal space;
isotope research using special radioactive substances to identify areas with excessive or insignificant activity;
biopsy of a thyroid nodule - treatment of malignant processes is impossible without this study.

Drug treatment of nodes

How to cure thyroid nodules, preventing the development of complications? Any method of therapy is used exclusively in cases where this formation is dangerous to human health. This occurs if the normal production of hormones is somehow disrupted.

Treatment of thyroid nodules without surgery involves the use of the following medications:

preparations containing thyroid hormones. When they are used, further division of the cells that make up the node does not occur. These drugs are indicated for the treatment of nodular colloid goiter;
thyrostatic drugs. Actively used in the treatment of toxic nodular goiter and adenoma;
preparations containing iodine. Compensate for the lack of this substance in the body.

Surgical intervention is indicated when malignant processes in the node are confirmed in order to prevent the fatal outcome of the disease. The operation is also carried out in the presence of a formation of significant size, when it grows too quickly.

Alternative Treatments

If there are nodules in the thyroid gland, treatment can be carried out using special techniques. One of these is sclerotherapy. It involves introducing 95% ethyl alcohol into the formed node. It destroys modified tissues. Due to the fact that the node has a dense capsule, alcohol does not enter the surrounding areas of the body. The effectiveness of this method is quite high if you follow the instructions during the procedure.

Also today, laser is widely used to eliminate nodes. During the procedure, a needle is inserted into the formation. Through it, a certain thermal energy is transferred to the tissue. Under such influence the node is destroyed. The procedure must be carried out under ultrasound control.

Cold and hot thyroid nodules - what's the difference?

“Cold” or hot thyroid nodules - this formulation is quite often used in a certain type of study, namely scintigraphy. Scintigraphy is used to examine not only the thyroid gland, but also other organs and even bones.

The basis of the method is functional imaging, made possible by injecting a certain dose of radioactive isotopes into the human body (intravenously or orally by swallowing a capsule), after which a two-dimensional image of the outgoing radiation is obtained.

In this article we will talk about the features of scintigraphy, what diseases cause hot and cold thyroid nodules, and also get acquainted with the methods of treating such nodules.

Research technique

Scintigraphy is performed to assess the functionality and structure of the thyroid gland, as well as to assess the nature of focal changes.

There are certain indications for conducting this study, namely:

suspicion of an abnormal location of the gland;
numerous nodular formations in both lobes of the thyroid gland;
the presence of thyrotoxicosis and differential diagnosis with other pathologies;
history of radiation therapy.

Other indications are considered relative and imply thyroid scintigraphy only if absolutely necessary, after prior consultation with a doctor. Before the examination, radioactive substances combined with special medications are injected into the body.

This compound reaches the thyroid gland through the natural blood flow, after which the received information is processed using a computer. Carrying out scintigraphy requires high quality equipment and extensive experience of specialists in this field of medicine.

The dose of the isotope used in the study is harmless, since it is quickly destroyed and eliminated from the body, in addition, it is stated that in most cases allergic reactions are not observed. However, side effects do occur, even if they are rare.

These include:

allergic reactions to radioactive components;
temporary fluctuations in blood pressure;
continuous urge to urinate;
nausea and vomiting;
feeling of heat on the face;
dizziness and weakness;
skin itching after injection.

It is worth noting that side effects after the study are short-lived, but if any of them occur, you should immediately inform your doctor.

Nuances of preparing for research

There are instructions for preparing for this type of study, which imply mandatory compliance with the following points:

At least 30 days before the examination, it is necessary to exclude foods rich in iodine from the diet.
20-30 days before scintigraphy, stop using thyroid hormones and antiseptics based on iodine (Lugol, Betadine).
For 1-2 months, diagnostic methods involving the introduction of radiocontrast agents containing iodine are avoided.
For 3-6 months, depending on the state of health, antiarrhythmic drugs are discontinued.
A week before the diagnosis, you should avoid drugs such as Mercazolil, aspirin, propylthiouracil, as well as nitrates (nitroglycerin, cardite and others) and sulfonamide antibiotics.

Important! There is no need to change the rules for stopping medications yourself. If the preparation rules are not followed, the results of the study may give a distorted result.

Preparation immediately before the test does not take more than half an hour. It is during this period of time that the drug manages to accumulate in the thyroid gland in sufficient quantities.

The diagnosis itself lasts approximately 20-30 minutes. Scintigraphy is a rather expensive method, the price of which is approximately 5-12 thousand rubles, depending on the drug used and the region of residence.

How to interpret the results of scintigraphy?

Scintigraphy is most often used to determine the activity of nodules in the thyroid gland. Activity refers to the ability of nodes to independently secrete hormones. As a result, the nodes are conventionally divided into “cold” and “hot”, which have different colors from each other.

“Cold” nodes do not have the ability to accumulate radioactive isotopes and indicate:

thyroid cysts;
colloid goiter;
tumor formations.

Note! Only “cold” nodes can be malignant, but according to statistics, no more than 10-15% of them are malignant.

“Hot” nodes indicate a large accumulation of the drug in these parts of the gland. This indicates the presence of cells that absorb large amounts of iodine and synthesize hormones with its help. That is, such areas work without TSH regulation, completely autonomously.

These changes occur when:

nodular toxic goiter;
autonomously functioning thyroid adenoma.

In addition to the types of nodes listed above, there are also “warm” nodes that absorb the same amount of iodine as the rest of the thyroid tissue.

Treatment of nodes

Regardless of whether the thyroid nodules are “hot” or cold, treatment is carried out only after scintigraphy and puncture biopsy of the nodes. If a biopsy of a “cold” node reveals malignant or predominantly malignant cells, then the node must be removed. In addition, if the malignancy of the nodule is confirmed during surgery, the entire thyroid gland should be removed.

If a hot thyroid nodule is detected during scintigraphy, whether surgery is needed is not discussed, since such nodes in 100% of cases are subject to surgical removal. During surgery, a significant part of the gland is removed, which leads to a persistent deficiency of thyroid hormones, and therefore, it is necessary to prescribe hormone replacement therapy.

From the photos and videos in this article, we learned about the technique of scintigraphy, we understood the interpretation of the results and the treatment of nodules.

Usually, nodules on the thyroid gland, if they are small in size, are detected by ultrasound or palpation. A small ball on the thyroid gland with clear edges is a node. On ultrasound it looks like a dark or very light spot. Enlarged nodes form a nodular goiter, which differs in structure from a diffuse goiter.

The seal can be located in the left or right lobe of the gland.

Benign formations of the left, right lobe or isthmus are distinguished by perinodular, that is, blood flow located around the node.

Causes of disturbances in the structure of the thyroid gland

The problem is mainly caused by a lack of iodine, which contributes to the growth of colloidal nodes that are benign in nature.

What other reasons for the formation of nodes do endocrinologists identify?

A certain percentage of the disease consists of formations resulting from irradiation. Radiation is a common cause of the formation of malignant nodes in children undergoing fluoroscopy in the area of the thymus and tonsils.

The factor of genetic diseases is of great importance. The presence of tumors in members of the same family is often the cause of their occurrence in descendants; there is a description of hereditary diseases complicated by changes in thyroid tissue.

Several more causes of neoplasms in the thyroid tissue:

Types of thyroid nodules

One or more nodes may form on the thyroid gland; they are divided according to the nature of tissue destruction.

Nodes are:

Oncological and benign nodes

Oncological damage to thyroid tissue is a mutation of cells due to damage to the genetic component of DNA. Reasons that cause mutation: radiation, heredity, exposure to chemicals on the body. The altered cell begins to divide uncontrollably, forming a node.

A benign formation leads to degeneration of the gland tissue and loss of its functionality. Large tumors compress the trachea, blood vessels and esophagus, and the patient develops symptoms such as difficulty swallowing and breathing. Benign tumors do not metastasize.

Diagnosis of thyroid tumors

Ultrasound is one of the main diagnostic examinations that allows you to determine the size of the gland, the presence of seals, and also determine whether the node is hot or cold. A hot thyroid nodule absorbs iodine in large quantities and causes thyrotoxicosis. A cold node that does not absorb iodine is the most dangerous in terms of oncology. The safest is considered to be a warm node, which absorbs an equal amount of iodine as the thyroid gland.

The cellular composition of the seals is determined by tissue biopsy. A biopsy is performed on patients with a detected lump larger than 2 cm. When a needle is inserted, the injection site hurts no more than with a regular injection.

Studies for which patients with lumps on the gland are referred:

cardiogram;
X-ray;
blood test for hormones;
Analysis of urine;
scintigraphy;
CT scan.

Symptoms of endocrine gland nodules

A person can detect a lump on their own if it exceeds 1 cm and begins to cause certain symptoms:

If these symptoms appear, you should contact an endocrinologist for diagnosis and treatment.

Treatment of endocrine gland nodes

Therapy for nodules depends on the diagnosis, the location of the formation in the right or left lobe of the thyroid gland or in the isthmus, the age and weight of the patient.

Benign tissue changes are preferably treated with medications and synthetic hormones. Cold lumps with a tendency to malignancy are not recommended to be treated with hormones; they are removed surgically; the left or right lobe, or in special cases the entire gland, can be removed. After removal of the thyroid gland, patients are prescribed hormone therapy for life.

A colloid formation that has arisen due to increased blood flow in a certain area of the endocrine organ does not require treatment. Patients are advised to eat food fortified with iodine and periodically visit an endocrinologist. The colloidal node does not affect a person’s well-being and does not degenerate into an oncological disease.