Diagnostics | Cold knot on the thyroid gland

Diagnostics

The notion of a cold node in the thyroid gland is derived from the findings of a scintigraphy. A scintigraphy is a method of nuclear medical imaging. It involves injecting the patient with radioactive but non-harmful substances that are stored in certain tissues, for example in the thyroid gland.

Using a so-called gamma camera, the radiation emitted by the radioactive substance can then be displayed in an image. If the thyroid gland is displayed in this way and there is a colorless area in the otherwise colorful image, this is called a cold node. Cold, because the colorlessness means inactivity of the area in question, and nodes, because the structures are mostly round.

Furthermore, the attending physician can examine the thyroid gland with the help of sonography (ultrasound) or by means of palpation. Ultrasound is a particularly good way to visualize cysts, since the sound cannot penetrate the fluid in the cyst and thus cast a shadow. When differentiating the origin of other abnormalities, the possibilities of a sonographic examination are limited.

If the node can already be palpated or is even visible from the outside, this indicates an advanced finding. Laboratory parameters can also provide information about the cause of existing nodules. If the thyroid parameters T3 (triiodothyronine) and T4 (thyroxine) are reduced, but the TSH (thyroid stimulating hormone; Thyroidea = thyroid gland) is normal or increased, the hypothyroidism is caused by the organ itself and there is extensive damage to the thyroid tissue. If the thyroid hormones are inconspicuous, the limitation is limited – there may still be cysts, scarring or tumors.

Therapy

Anyone who feels a lump on their own should see a doctor as soon as possible. Such an abnormality does not always have a bad cause, but it is important to check what kind of change is behind it. Often a cold lump is a chance finding, which is discovered in the course of other examinations.

If the lump is visualized by sonography or scintigraphy during further diagnostics, a malignant disease must be excluded in any case.Often biopsies are performed for this purpose, i.e. tiny tissue samples are taken and examined for fine tissue. In the case of the thyroid gland, fine needle biopsy is usually used to take a tissue sample. In any case, one should remain calm and have the findings clarified by a doctor.

In any case, one should remain calm and have the findings clarified by a physician. If there is an underactive thyroid, it should always be treated with medication to avoid long-term problems. The dose of the prescription hormone preparations must be adjusted individually for each patient.

Initially, small doses are administered, which can be gradually increased to the desired therapeutic value. This is the best way to avoid side effects. The subjective perception of the patient plays an important role in adjusting the medication between 50 and 150 micrograms per day.

The TSH level is also checked after one and a half to two months. This gives a longer-term guideline value for the correct administration of medication. Special care is required for very young patients.

Depending on age, hormone levels may fluctuate. Deficiency symptoms such as growth retardation or weight loss should also be monitored. A control of blood values at reduced intervals is more important in people who are still growing than in adults.

However, adults should also have their thyroid hormone levels checked regularly. If the clinical picture of hypothyroid coma develops, a more complex treatment is required. Since life is acutely threatened in this case, the patient must be admitted to an intensive care unit immediately.

The vital functions must be monitored continuously and the body temperature must be normalized, since patients usually suffer from hypothermia. Drug treatment is carried out with the help of glucocorticoids (cortisone) and glucose, as well as with an intravenous administration of L-thyroxine, a thyroid hormone. Cold nodes in the thyroid gland do not always have to be the reason for surgery.

In many cases, a resulting condition, for example hypothyroidism, can be controlled by medication. It is also often the case that the lump remains clinically completely silent and no symptoms develop, even if nothing is done in the long term. However, if the cold nodule exists due to a malignant tumor disease, this nodule or even the entire thyroid gland must be removed.

This can be done in various ways. The removal of the individual parts as well as the entire organ is possible, but not always necessary. Especially in the case of benign tumors, it is often necessary to remove only the nodule with a certain safety margin.

Before starting the operation, some questions should be answered, which influence the procedure during the operation from the beginning. For example, it must be clear whether only the node is to be removed, or more extensive tissue sections. While total resection (removal) is not necessary for various other thyroid diseases, total removal is almost always indicated for thyroid cancer.

Rarely is the risk of tissue preservation taken. There is almost always the risk that the smallest tumor components will be overlooked due to their minimal size and later lead to a recurrence (disease recurrence). The operation is performed under general anesthesia.

Access to the operating area is from the front through a cross-section directly on the neck. This is often made in a skin fold, in order to achieve a better optical result when healing later on. The skin layers, connective tissue and neck muscles are cut through to reach the thyroid gland.

If the thyroid gland is now gradually removed from the surrounding tissue, it is important to ensure that haemostatic measures are taken throughout, as the organ is well supplied with arteries and veins. A hemithyroidectomy, a hemiplegic removal of the thyroid gland, can be used in the case of early detection of papillary thyroid carcinoma (see above). Various complications can arise during the removal of the thyroid gland.

On the one hand, the larynx or trachea can be damaged by gross negligence, but this should not happen with experienced surgeons. On the back of the thyroid gland there are four so-called epithelial corpuscles, the so-called parathyroid glands, which must be preserved in any case.This is because parathyroid hormone is produced in them, which plays an important role in the body’s calcium balance. Due to the small size of the parathyroid glands, very careful attention must be paid to their function.

If not enough surrounding tissue can be preserved in situ, there is the possibility of transplanting the epithelial corpuscles into the arm. There they are connected to the blood supply and can continue to perform their tasks. The Laryngeal Recurrent Nerve should also be used with extreme care.

On its way to the larynx, this nerve runs very close to the windpipe and thus also passes through the area of the thyroid gland. In the larynx, it controls almost all existing muscles. In the event of damage, there are various limitations such as permanent hoarseness or shortness of breath.

If cold nodes in the thyroid gland do not have a devastating cause or if there is no serious hypothyroidism, alternative remedies can also be used. Homeopathy is also understood as a supportive form of treatment that can be used in addition to conventional medical measures in order to achieve the greatest possible success. For example, a slight hypothyroidism, which has developed due to cold nodes, can be brought under control by homeopathic remedies.

Graphites and pulsatilla have a slowing effect on the metabolism, which also stimulates digestion, cleanses skin changes or helps women to regulate their cycle. Barium carbonicum and alumina can be administered in cases of nervousness and reduced mental performance, whereas potassium carbonicum and silicea have a positive effect on people who tend to be more tired or have a tendency to edema. Some alternative practitioners are of the opinion that lumps in the thyroid gland are an expression of mental conflicts and indicate special character traits.

They are considered to be a phenomenon of psychosomatics and the result of unwanted stimuli. In the knot the patient’s soul is relieved. If the knot is not dangerous, this concept advises against an operation, because the patient is deprived of a means of self-regulation.