Symptoms
Cold lumps can go completely unnoticed clinically. Depending on the cause and size, they may go unnoticed for a long time and are more likely to be discovered by chance. If the lumps are associated with pain, an acute cause such as bleeding or other injury is more likely to be considered.
If the nodules can be palpated after a period of pain or visualized with imaging techniques, a previous inflammation of the thyroid gland (thyroiditis) is likely. As already mentioned, blood values (hormone levels) are not necessarily altered in neoplastic (tumor-related) diseases. However, if an increase or decrease is noticeable, further diagnostics with a more detailed examination of the thyroid gland should follow. If there are oversized cold nodules that actually influence the thyroid function, the clinical picture of an underactive thyroid gland – hypothyroidism – develops.
Hypothyroidism
The thyroid gland is responsible for the iodine balance of the body and for the production of important hormones. With the help of the absorbed and stored iodine, the organ produces T3 (triiodothyronine) and T4 (thyroxine). These hormones are important components of the regulation of the energy metabolism as well as the growth control of all cells and the body itself.
They are produced in the thyroid cells, unlike the hormone calcitonin. This hormone is produced in so-called C-cells and controls the body’s calcium balance together with the parathyroid hormone, which comes from the parathyroid gland. Calcitonin is responsible for lowering the calcium level in the blood and parathyroid hormone is the corresponding antagonist.
An underfunction usually develops gradually and is not noticed by many patients at first. Performance is reduced due to the disturbed energy metabolism. Concentration and muscle weakness follow, but also a general tendency to fatigue.
The patients are often listless and often freeze because the body does not produce enough energy. The reduced energy supply also results in constipation in the digestive system. Especially older patients may be confused with a depressive phase.
The symptoms can be misinterpreted due to the lethargy and depressive character of the hypothyroidism. Memory disorders or loss of appetite can also represent common clinical signs, which can be differentiated by a blood test. The hypothyroidism also has an influence on the vital signs of the patient: the pulse and blood pressure drop permanently, unwanted weight loss occurs, the skin is rough and overall the patient makes an unhealthy impression.
Gender-specific symptoms are manifested in men by lack of sex drive and erectile dysfunction, in women by disturbances in the female cycle or nodular changes in the breast. In the case of infantile hypothyroidism, developmental disorders or delays in growth can occur, which need not be the case. The most severe form of hypothyroidism can be a so-called hypothyroid coma.At the same time the vital functions continue to decrease.
The heart sounds are difficult to perceive, the pulse slows down again. Blood pressure and body temperature are also lowered, worsening the patient’s condition. The patient continues to be conspicuous for his shallow breathing and weak to absent reflexes.
Characteristically, the patient shows myxedema. In this case, components of the connective tissue (glycosaminoglycans) are deposited in the subcutis. As these substances have a water-attracting effect, this is followed by a general bloating of the subcutis, which makes the patient appear bloated despite his often light weight.
This maximum increase in the clinical picture of hypothyroidism is rather rare, as the signs are usually interpreted early and the disease is counteracted with the help of hormone preparations. An underfunction of the thyroid gland, as it can occur with cold nodules, influences hair growth in some patients. This happens because the hormones of the thyroid gland have essential functions regarding the development of cells of all kinds of the human body.
Therefore, they also have an effect on hair growth. The under-functioning sometimes causes the hairs to have only insufficient stability – they lose strength and have a smaller diameter than healthy hair. Visually, this can be seen in a loss of density.
Patients report an increasing dullness of their scalp hair and increased brittleness. All these aspects have a negative impact on the preservation of the hair – it falls out more easily and bald spots appear. Another cause of hair loss with preceding cold nodes in the thyroid gland can be treated tumors.
The treatment of first choice for tumors is the removal of the thyroid gland and subsequent administration of thyroid hormone preparations to achieve hormonal balance. As a result of the operation, radioiodine therapy can be added to eliminate the last remnants of the thyroid gland. For this purpose the patient is injected with radioactive iodine, which destroys the remaining thyroid gland tissue. It can happen that a treatment-related hypothyroidism is triggered. This can also lead to hair loss among other symptoms.
