Thyroid nodules often look worse than they really are, and only in the fewest cases do they pose a threat to the person affected. They are much more common in developing countries than in wealthy industrialized nations and also vary widely in the way they develop.
What is a thyroid nodule?
A thyroid nodule refers to the morphological change in the thyroid gland, which is located in the neck and is responsible for important metabolic processes as well as the storage of iodine and the production of vital hormones. In this regard, medicine speaks of so-called cold and hot nodes, which are distinguished from each other by various characteristics. Thus, a hot node works independently and bypasses the thyroid gland and its so-called thyrotropic control circuit, which controls the release of hormones from the thyroid gland into the blood. A cold thyroid nodule, on the other hand, refers to abnormal tissue that forms in the thyroid gland but does not produce hormones.
Causes
In most cases, a thyroid nodule indicates a deficiency of iodine, which must be obtained through the diet. Therefore, they also often occur in countries with a deficient basic diet, where a regular intake of iodine, which is contained in eggs or fish, for example, cannot be guaranteed. But also in some southern states of Germany an iodine deficiency has been present in parts of the population for many years. In the rarest cases, the thyroid nodule turns out to be a cancerous tumor that proliferates in the thyroid gland and is initially indistinguishable from a harmless, benign thyroid nodule.
Symptoms, complaints, and signs
Thyroid nodules do not always cause symptoms at the beginning. If the organ is still fully functional, smaller growths cause only mild difficulty swallowing and occasionally hoarseness. However, if the permanent pressure exerted by the nodule on the thyroid gland leads to hyperthyroidism or hypothyroidism, various health problems may result. In the case of hyperthyroidism, diarrhea, weight problems and sweating are the main symptoms. Affected individuals usually experience intense malaise, which occurs in episodes and subsides during periods of rest. An underactive thyroid leads to fatigue, constipation and depressive moods. Externally, thyroid nodules are usually not recognizable. Only large growths can be felt from the outside. Occasionally they can be seen as a bump under the skin. When touched, the swollen nodules hurt, and cold sweats and dizziness may occur immediately. If the thyroid nodules are not treated, further symptoms may develop. Further growth inevitably leads to organ dysfunction, which in the long run also affects hormonal processes in the body. Thyroid failure can lead to hair loss, chronic fatigue and altered skin appearance. In addition, mental illnesses may occur, most of which are associated with further discomfort.
Diagnosis and course
Thyroid nodules are usually noticed late or not at all by the affected person, which is due to the fact that they often do not cause any pain or other discomfort. Only when they reach a certain size – by pressing on the nearby trachea and esophagus – can they cause difficulty swallowing and breathing, a feeling of pressure, and the famous “lump in the throat.” Because of this, they are usually discovered purely by chance during routine examinations and then examined for their respective nature and classification. Cold nodes can lead to more serious problems exclusively due to excessive growth. Hot nodules, on the other hand, can degenerate into hyperthyroidism due to their autonomous release of hormones, which can manifest itself in diarrhea, rapid heartbeat, nervousness and weight loss. The consequence of a malignant thyroid nodule is metastasis, which inevitably leads to death if left untreated.
Complications
An untreated thyroid nodule can primarily cause hormonal problems. Hot nodules then lead to diarrhea, rapid heartbeat, nervousness, or weight loss, for example. Cold nodules often result in a narrowing of the trachea. This can lead to shortness of breath, shortness of breath and other breathing problems.If the thyroid nodule occurs in association with polycystic thyroid disease, this may lead to the development of hypothyroidism. Furthermore, a nodule on the thyroid gland may cause difficulty in swallowing. Depending on the size of the growth, aspiration of food debris may occur, causing respiratory distress and, rarely, pneumonia. Another possible complication is chronic hoarseness, which is most common if the thyroid nodule is left untreated for an extended period of time. A malignant thyroid nodule will spread further metastases as it progresses, leading to death if left untreated. Surgical removal of a thyroid nodule can cause bleeding, inflammation, and occasionally damage to the thyroid gland. Radioiodine therapy can cause side effects including loss of appetite, nausea, sore throat, and temporary stomach irritation. Last, there is a risk that the agents and materials used may cause allergic reactions.
When should you go to the doctor?
In case of thyroid nodules, it is always necessary to see a doctor. There can be no self-healing in this disease, so medical treatment is always necessary. The doctor should be consulted if the affected person suffers from swallowing difficulties. These usually occur without a particular reason and especially permanently. Furthermore, permanent hoarseness can also strongly indicate the thyroid nodules and should also be examined if it occurs over a long period of time without a particular reason. Furthermore, the thyroid nodules can also cause diarrhea, constipation, or a very strong fatigue of the affected person. These complaints also indicate the thyroid nodules and should always be investigated. In some cases, severe dizziness or severe hair loss may also indicate the thyroid nodules and should be investigated. The first examination and consultation can be done by a general practitioner or by a family doctor. For further examination or treatment, a specialist is usually necessary. Whether the life expectancy of the affected person is reduced by the thyroid nodules cannot be universally predicted.
Treatment and therapy
Two main procedures are generally used in the treatment of thyroid nodules. First, especially if the nodule has already reached such a size that it is pressing on the trachea and esophagus, surgical removal is recommended. This is performed without exception in the case of a cancerous finding, although experts still disagree on whether a complete removal of the thyroid gland is necessary or whether a selective removal of the affected tissue is sufficient. In the case of very large cold nodules that are already causing discomfort, surgery is also usually advised to prevent damage to the delicate esophagus and trachea. The other variant of control, which, however, works only for hot nodules, is the use of radioiodine therapy. This involves administering radioactive iodine to the patient, either in the form of injections or capsules, which is deposited in the thyroid nodule, where it causes the newly formed tissue to decompose and die.
Prevention
The best prevention of a thyroid nodule is a balanced diet containing iodine, which provides the thyroid gland with sufficient iodine to perform its functions at a satisfactory level. An additional intake of iodine in the form of tablets is a worthwhile supplement to protect against thyroid nodules, especially in children, but it cannot replace a balanced diet. A thyroid nodule is usually a relatively harmless phenomenon, but it can certainly lead to more serious complications and complaints and should therefore – also with regard to a rare but quite possible cancer – definitely be examined by a doctor.
Aftercare
The diagnosis of a thyroid nodule is not a cause for concern in every case. Inconspicuous thyroid nodules less than one centimeter in size often do not require annual follow-up. A check-up every five years is sufficient for these nodules. In the case of more pronounced thyroid nodules, however, regular check-ups are advisable in order to differentiate between ‘hot’ and ‘cold nodules’. In addition, the size of the nodules is checked during the examinations and the development of potentially dangerous cold nodules is counteracted.If the nodes grow significantly, surgery may be necessary. Alternatively, in mild cases, the specialist prescribes medication to curb the enlargement. Another reason for follow-up is early detection of malignant changes in the cellular tissue of the thyroid gland. If the patient suffers from pain or difficulty swallowing due to changes in the thyroid gland, a visit to the doctor is recommended. If necessary, a biopsy is taken to examine the structure of the cell tissue more closely and to exclude malignant changes or to detect them at an early stage. Such growths are rare in small nodules. For this reason, such screening only makes sense in the case of conspicuous nodes with a size of one centimeter or more. Even in this group of patients, the risk of cancer is very low, with a rate of about 1.5 percent in women and 0.5 percent in men.
Here’s what you can do yourself
The thyroid nodule cannot be reduced in size by self-help in everyday life. Here only the operation or a possibly indicated radioiodine therapy help. If the thyroid nodule has proven to be benign with a high probability after careful diagnosis, it can also remain in the neck and be observed. Self-help in everyday life in this context also means taking part in this observation, but not constantly palpating the nodule. Swallowing or breathing difficulties that occur anew, in addition to increasing size, are a renewed reason to visit the doctor. Regular monitoring of thyroid hormones in the patient’s blood is also useful. Often the nodule is associated with a feeling of tightness in the throat area. This may be better managed if the patient does not wear tight scarves and shawls. Difficulty swallowing is also possible due to the mechanical obstruction of the knot in the neck area. In this case, it helps to eat food in small bites, chew well, and make sure to drink enough fluids. Those who take thyroid hormones should definitely pay attention to regularity. Often it is a psychological problem for patients to have a lump in the neck area. This can be due to aesthetic reasons with visible nodes, but also the fear of an undetected cancer. In many cases, surgery is then the right decision.
