Diagnosis
A typical symptom pattern already gives first indications of the possible cause. The thyroid gland can be felt with the fingertips. It is located slightly below the larynx and lies at the front of the windpipe.
An enlargement is possible in the course of an inflammatory reaction. A goiter may not be visible at first glance and only become noticeable when palpated. If it is a process that has been going on for some time, the goiter can protrude clearly from the neck.
In the case of acute thyroiditis, increased inflammation values are shown in the laboratory. There is an increased blood sedimentation rate (BSG) and an increased concentration of white blood cells (leukocytosis). In the context of subacute thyroiditis, the ESRD is also greatly accelerated, while the white blood cells show only a slight increase.
The concentration of thyroid antibodies may increase. Determination of the basal TSH value in the laboratory helps to make a statement about thyroid function. The peripheral thyroid hormones T3 and T4 are usually only determined when the TSH values change.
If the TSH, as well as T3 and T4 are within the normal range, the metabolic situation is in equilibrium, i.e. euthyroid. This constellation is the most common. If the TSH is elevated, it is a latent (T3/T4 in the normal range) or manifest (T3/T4 decreased) hypothyroidism.
This is called hypothyroidism. If the TSH is lowered, the values of T3 and T4 indicate a latent or manifest hyperthyroidism. The determination of thyroid antibodies and the performance of a thyroid scintigraphy serve to differentiate Graves’ disease, the autonomous thyroid adenoma and the diffuse autonomy of a thyroid area.
To confirm Graves’ disease, certain antibodies (TRAK) must be present in addition to the clinical picture. In addition, a tissue sample (biopsy) of the thyroid gland may be useful in confirming the diagnosis. Typically, several thousand cells are obtained by fine needle puncture and examined in the laboratory.
The hypothyroid goiter can be the result of thyroid surgery or radioiodine or thyrostatic therapy. Ultrasound reveals a reduced, low-echo thyroid gland. If this is not the case, thyroperoxidase and thyroglobulin antibodies are determined to exclude Hashimoto’s thyroiditis.
Sonography is just as important as the examination of thyroid-specific laboratory values. An ultrasound examination is used to determine the volume of the thyroid gland and to search for thyroid nodes. In case of subacute inflammation, it serves to exclude other diseases.
As a consequence of acute inflammation, bacterial abscesses may develop, which can be visualized in ultrasound.In the case of newly occurring diffuse nodules, further clarification is urgently required. If nodules are present, it is useful to perform a thyroid scintigraphy. In order to exclude malignant growth or to clarify a hyperthyroid metabolic situation, the activity of individual areas can be checked.
Before the examination, weakly radioactive iodine is injected through a vein. Depending on the activity of the tissue, the radionuclide is absorbed in some areas in greater or lesser amounts. If the thyroid scintigraphy shows a cold node with a diameter of more than one centimeter, a biopsy should be performed to exclude thyroid carcinoma.
The fine needle puncture serves to clarify the removed tissue exactly. It is also used for the clarification of thyroiditis de Quervain. Typically, fine nodules, so-called granulomas, form which are examined.
The therapy of acute thyroiditis should always include bed rest. Household remedies such as cooling compresses for the neck and sufficient fluid intake also play an important role. In case of a bacterial cause, appropriate antibiotics can be used.
They are usually administered in tablet form. Cortisone preparations are used for rapid relief of symptoms. If it is a hypothyroid goiter, lifelong therapy is carried out with L-thyroxine.
Since the thyroid gland produces insufficient hormones, T4 (levothyroxine) is administered in tablet form. A stable TSH value within the normal range should be aimed for. Graves’ disease can be adequately treated with thyrostatic therapy in half of the cases within one year.
If this is not the case, a definitive therapy follows. This can take the form of radioiodine therapy. Another possibility is the initiation of thyroid surgery.
The treatment of a functional autonomy (self-sufficiency) of the thyroid gland in a hyperthyroid goiter is initially performed with thyrostatic drugs. They inhibit hormone production and are administered until a normal metabolic state is reached. Then, in the case of large nodules, part of the thyroid gland is removed.
Radioiodine therapy is performed for smaller nodules. This form of therapy is mainly used in older patients. Euthyroid strums without functional autonomy are usually treated with the help of iodide.
Additionally or alternatively, a thyroid hormone can be administered. Younger patients in particular respond well to iodine administration. The aim of therapy is to reduce the volume of the thyroid gland.
It should be monitored regularly by ultrasound. Thyroid surgery promises immediate success. However, there are some risks involved.
These include bleeding, paralysis of the vagus nerve and an underfunction of the parathyroid gland. Such a subtotal thyroid resection is considered if the drug therapy fails. Surgery is also indicated in cases of complications due to excessive thyroid growth and if a malignant nodule is suspected.
