Diagnostics
Hot lumps can be diagnosed in various ways and then classified according to their activity level. In many cases, hot nodules can be associated with the symptoms of hyperthyroidism. By means of a palpation examination (palpation), the patient or a doctor can become aware of a lump for the first time.
When talking to the patient, the symptoms of hyperthyroidism must be asked. In order to be able to exclude the typical clinical picture of Graves’ disease, which is also associated with protruding eyes (exophthalmos) and a goiter (goiter), these very abnormalities should be checked. Patients suffering from hyperthyroidism usually have an accelerated heartbeat at rest, which should be noticeable when measuring the pulse.
The patient’s blood count shows elevated thyroid gland values (TSH, T3, T4). The examiner has various options for imaging. As a harmless procedure, an ultrasound is always carried out first, and existing nodules can be visualized very well.
If the node is larger than 1 cm, scintigraphy is used. The patient is administered a radioactive contrast medium (technetium). This is not harmful and is deposited especially where the metabolism is high – in the hot nodules.
With the help of a so-called gamma camera, which can display the radiation that emanates from the contrast medium, an image is generated. The particularly colored areas are congruent with the metabolically active nodes. Scintigraphy thyroid gland of a female patient 46 years old with autonomic adenoma.
- Right thyroid lobe
- “hot” knot = strongly iodine absorbing area
- Left thyroid lobe (inconspicuous iodine uptake)
Often, nodes that were initially palpated are visualized by ultrasound in the course of further diagnostics. In principle, the final decision whether a cold, hot or metabolically normal node is present can only be made with the help of a scintigram. However, the lump may show certain characteristics in the ultrasound, which make a hot lump more likely.
If the structure is low-echo, i.e. the sound is not reflected well, a hot node could be present. In the picture this is shown as a dark area, because areas rich in echoes are shown brightly. Often there is liquid in the middle of hot nodules, which can also be called a cystic area.
This fluid is usually of inflammatory nature. In ultrasound, liquids also appear dark. The examining physician can have the blood circulation of the tissue shown in the image highlighted in color.
With the help of this function, a clearly perfused marginal area should be visible in the case of a hot lump. This is caused by the high metabolic activity of the node. If necessary, a tissue sample of the suspicious area can also be taken under ultrasound control and examined microscopically. This procedure is called biopsy. In the case of the thyroid gland, the so-called fine needle biopsy is usually sufficient.
