Therapy
The treatment of thyroid nodules always depends on the size and quantity.If it concerns one or a few very small lumps, usually no therapy is necessary. However, it is recommended to have the lumps examined regularly. However, if the lumps are larger and benign, symptoms may occur, and in some cases surgery may be necessary.
(Not only the size and whether the lump is benign or not – which can be found out by a biopsy – is important, but also that the hormones are in a healthy balance. If the hormone balance is not correct, medication must be taken. Another therapy for hot lumps (a lump that produces additional hormones independently of normal hormone production and can thus lead to hyperactivity) is the administration of iodine or radioiodine therapy, which causes the proliferating tissue to die.
However, cold nodules cannot be treated in this way, as the iodine would accumulate here. Drug therapy is only used if the nodule does not produce any hormones. Surgery is another way to remove and treat nodes in the thyroid gland.
However, this option is usually only used if the nodule is very large and goiter-like, if it is a large growth, or if the nodule is malignant. There are two different types of surgery: firstly, there is a complete removal of the thyroid gland (subtotal thyroidectomy) – usually in the case of malignant growths or if the node is so large that the organ can no longer be preserved. However, there is also the possibility to remove only one of the two lobes (hemithyroidectomy).
Prognosis
As a rule, the prognosis for benign nodules is good. Under- or hyperthyroidism may occur if not treated. Normally, however, the disease can be kept well under control.
Cancer
A thyroid carcinoma (Struma maligna) is a malignant growth in the tissue of the thyroid gland. Younger people and especially women are often affected by the disease. Most tumors originate from the thyroid follicles, the thyroid cells.
There are different types of thyroid cancer. Depending on which form you are suffering from, the chances of recovery are better or worse with early detection. First, a distinction is made between follicular and papillary tumors.
Follicular means that there are small tumors or only a single node on the thyroid gland. These carcinomas like to spread into the blood and thus spread the metastases frequently and early in the lungs and bones. They are also the most common type of thyroid cancer.
In papillary carcinomas, whole foci of small tumors are found. A small part of the carcinomas are so-called C-cell carcinomas, which are also called medullary carcinomas. They have their origin in the C-cells, which produce the hormone calcitonin in the thyroid gland.
This hormone lowers the blood calcium level by helping to increase the excretion of calcium and reduce the breakdown of osteoclasts from the bones. This form of thyroid cancer often metastasizes very early into the lymphatic system of the body. It should also be mentioned that most tumors are differentiated in the thyroid gland.
This means that they still resemble the thyroid epithelium. Undifferentiated carcinomas in the thyroid gland usually occur at an advanced age and are extremely aggressive, as their structure no longer resembles the actual tissue of the thyroid gland. The lifetime of these patients is very often very limited.
It is assumed that the iodine deficiency has a not inconsiderable influence on the development of thyroid carcinoma. However, the exact causes are not yet known. In addition, it is noticeable that people in a radioactive environment fall ill with this disease much more frequently.
One example is the Japanese city of Hiroshima, where many people fell ill with thyroid cancer after the atomic bomb was dropped. It cannot be ruled out that genetic factors play a role here as they do in some other cancers. Thyroid carcinoma is treated by means of an operation, if this is possible.
The entire thyroid gland is always removed. Depending on whether the surrounding lymph nodes are affected or not, these are also removed. Patients are also treated with radioiodine therapy if they have an iodine-storing carcinoma.
Metastases, if any, can be removed or treated by radiation or chemotherapy and in the best case by surgery. If the entire thyroid gland is removed, the hormones normally produced by the organ must be artificially supplied to the patient.With advanced carcinomas, a complete cure is often no longer possible. However, efforts are made to prolong the life of the patient as much as possible.
In some cases extremely good results are achieved. The symptoms are not always completely clear. Malignant changes are often discovered at a very late stage, usually by the patient himself, as lumps on the thyroid gland can be felt.
Some people also have the feeling of having a lump in their throat. They may also experience difficulty breathing and swallowing as well as hoarseness. The diagnosis is made by the doctor on the basis of the patient’s medical history and, above all, an examination with ultrasound, a biopsy and thyroid scintigraphy.
It is important to distinguish benign tumors from malignant ones. Differentiated thyroid carcinomas often have a fairly good prognosis. Most patients survive the 10-year rate. Unfortunately, the prognosis is much worse for undifferentiated carcinomas. However, it always depends on the time of tumor discovery and in which stage the disease is located.
