Thyroid nodules are groups of cells that grow abnormally, taking on an oval or rounded shape. They can be single or multiple (when there are several, it is called a multinodular goitre). They can be solid, mixed or cystic (these are made up exclusively of liquid and are always benign in nature).
It is a very common situation that affects about 70% of the world population. They are more prevalent in females and the elderly (half the people over the age of 60 have nodules).
Most thyroid nodules are benign (90-95%), and there is no single cause for their appearance. Some of the associated risk factors are iodine deficiency, family history of thyroid nodules, advanced age or being a woman.
Most thyroid nodules do not cause any symptoms. Sometimes there is pain in the front of the neck, hoarseness, difficulty in swallowing solids or liquids, especially if they are very bulky.
When associated with an increase in the production of thyroid hormones, they can cause insomnia, changes in intestinal transit, tiredness, weight loss, increased heart rate, anxiety and heat intolerance.
They are often detected by chance, either by palpating a nodule in the region of the thyroid or when undergoing an ultrasound. Confirmation is reached by ultrasound scan, which permits the diagnosis and characterization of the nodules in terms of size and risk of malignancy.
When thyroid nodules are detected, it is important to find out the levels of thyroid hormones in the blood and also of the pituitary hormone that regulates the thyroid (TSH - thyroid stimulating hormone) since some of these nodules can produce thyroid hormone in an uncontrolled way, thus causing hyperthyroidism. If this occurs, the nodule is called a toxic nodule or, if there are several nodules, a toxic multinodular goitre.
In thyroiditis (inflammation of the thyroid gland) nodules or pseudo nodules may also appear, with hypothyroidism (deficiency in the production of thyroid hormones) or hyperthyroidism.
With solid nodules larger than 10-15 mm, mixed nodules larger than 15-20 mm or a suspicious ultrasound result, thyroid cancer may be suspected and a biopsy may be necessary.
In less common cases, a thyroid scintigraphy or even surgery may be necessary to identify the type of nodule.
There are situations that raise greater concern for the possibility of thyroid cancer: Nodules of a hard consistency; that have adhered to the surrounding tissue; rapid growth; compressive symptoms/signs (feeling a pressure in front of neck, feeling short of breath, difficulty swallowing); presence of enlarged lymph nodes.
Treatment depends on the type of nodules, most of which only require regular ultrasound surveillance and will never require any treatment.
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