Thyroid nodules – focal thyroid Education of all sizes, with the capsule determined by palpation or by imaging studies. Cysts thyroid – thyroid nodules with a cavity filled with liquid contents. Units and thyroid cysts can occur long time without any symptoms, then there are various phenomena discomfort in the throat and the node becomes visible when looking at the neck. Gormonalnoaktivnye thyroid nodules entail the development of hyperthyroidism. The diagnostic algorithm for suspected node or cyst contains thyroid ultrasound, needle biopsy of Education and hormonal studies.
Nodes and thyroid cysts
Thyroid nodules – focal thyroid Education of all sizes, with the capsule determined by palpation or by imaging studies.
Thyroid cysts – thyroid nodules with a cavity filled with liquid contents.
Nodes and cysts of the thyroid gland for a long time can wear asymptomatic, with an increase in size causes “compartment syndrome” adjacent structures of the neck: irregularities in the thyroid gland, asthma, hoarseness, violation of the act of swallowing, sore throat, pain . The most dangerous complication of cysts – inflammation and suppuration, knots – malignant transformation.
10% of the world have different focal thyroid education.
The thyroid gland may develop a variety of morphological forms nodules, with most of them is benign (nodular colloid goiter, adenoma, thyroid cyst).
The nodes are the most common disorders of the thyroid gland, 4-8 times more common in women. The frequency and amount produced in the thyroid gland of nodes increases with age. The reasons for the formation of the nodes in the thyroid gland are the genetic predisposition to their development, iodine deficiency in food and water, the toxic effects of iron on varnishes and paints, solvents, gasoline, phenols, lead, radiation emission and radiation therapy.
Nodes in the thyroid gland can be single (solitary) and multiple; autonomous toxic (t. e excessively produce hormones) or calm, non-toxic.
There are both benign and malignant thyroid nodules.
The cysts range from 3 to 5% of all thyroid cancer.
Grossly thyroid gland consists of psevdodolek formed follicles (vesicles acini) and surrounded by a capillary network. Inside the thyroid follicles are lined with cells and filled with protein substance – colloid containing protogormony thyroid. Violation of the outflow of the contents of the follicle leads to the accumulation of excess fluid and increase its size, that is. E. The formation of cysts of the thyroid gland.
Thyroid Cysts can form as a result of microbleeds, degeneration or hyperplasia follicular cancer. Usually the cyst thyroid not affect its function; dysfunction occurs during the development of cysts in comparison with other thyroid diseases. The course mostly benign cysts in the extremely rare malignant thyroid cyst usually reach large sizes.
Clinical thyroid cysts behave differently: sometimes observed for years without negative dynamics, sometimes rapidly increase in size or disappear spontaneously.
Stages of development of thyroid nodules
The processes of thyroid nodules are different sequential staging, as determined by their degree of echogenicity on ultrasound:
- izoehogennoe homogeneous unit. The density of the contents of a node corresponds to the surrounding tissues of the thyroid gland. On stage inehogennosti there is a growing circulation and expansion of blood vessels surrounding the node.
- izoehogennoe heterogeneous node:
- with minor modifications fabric
- with severe tissue changes
- with hypoechoic inclusions (cystic sites)
Izoehogennoe heterogeneous nodes are formed as the depletion and destruction of thyroid cells and follicles.
- hypo- or anechoic node. Characterized by a complete destruction of the tissue site, filling the cavity with fluid and damaged cells, which leads to the formation of cysts thyroid.
- the contents of the cyst stage of the dispersal of the thyroid gland;
- stage scarring cysts of the thyroid gland.
The process of stepwise conversion of thyroid nodules is durable; its speed depends on the size of the node, the immune system, the state compensatory and adaptive mechanisms of the thyroid gland and the whole body. To speed up the process of scarring thyroid cysts sometimes resort to it sclerotization.
Symptoms of thyroid nodules
Nodes and thyroid cysts develop asymptomatic for a long time without causing any subjective feelings of patients. They are usually painless, and are small, do not cause discomfort or pressure in the neck. Small knots and thyroid cysts are often detected during routine examination or examinations for other diseases. Palpable they are defined as smooth, plotnoelasticheskoy nodules, easily felt under the skin. Compared with the nodes remaining thyroid tissue is normal consistency.
The reason for the self-treatment of the patient to an endocrinologist is usually a time when the unit becomes visible to the eye and distorts the neck. By this time, the size of the node or cyst of the thyroid gland is already more than 3 cm in diameter and can not be treated conservatively.
As the size of the node formation and compression are anatomically related structures of the neck appear typical complaint: the feeling of “lump” and sore throat, disorders of swallowing and breathing, hoarseness or loss of voice, pain in the neck. Cysts thyroid larger sizes can squeeze blood vessels. In malignant nodules increased cervical lymph nodes.
Independent toxic components due to their hyperactivity leads to the development of hyperthyroidism and its symptoms: tachycardia, palpitations, hot flushes in the body, excitement, emotional lability, exophthalmos.
Single (solitary) node, located among the normal thyroid tissue, the most suspicious in relation to cancer, than one of multiple sites, most employees manifestation of diffuse nodular goiter. Malignant nodes for their rapid growth, have a firm texture, often accompanied by an increase in cervical lymph nodes. However, in the early stages to recognize the goodness node appears on its face very difficult.
Complications of cysts and thyroid nodules
The cysts of the thyroid gland may be subject to inflammation and suppuration. Thus there is a sharp pain in the neck, fever, symptoms of intoxication, increasing the regional lymph nodes, and inflammation.
Nodes and thyroid cysts large size may put pressure on nearby organs and vessels of the neck.
thyroid nodules can degenerate into malignant tumors.
Diagnosis of thyroid nodules
When determining palpation of thyroid nodules continue to pursue its differential diagnosis.
When carrying out thyroid ultrasound confirmed the presence of education is determined by its size and structure (goiter, adenoma, thyroid cyst, and so on. d.).
To determine the cyto-morphological structure node (benign or malignant) performed fine needle puncture biopsy. During the study, the cellular composition of the node is taken with a needle and syringe and sent to a cyto-histological study.
With the help of the puncture method, you can also get the contents of the cyst of the thyroid gland. Typically, the contents of the cysts (for benign or malignant flow) hemorrhagic reddish-brown in color and contain old blood and destruction of cellular elements of the thyroid gland. Congenital thyroid cysts contain clear slightly yellowish liquid. When an abscess thyroid puncture get pus.
With the help of fine-needle biopsy of the thyroid gland cyst can not only get the material for study and identify signs of festering malignancy or cavity formation, but also to make full aspiration of fluid accumulated, as well as introduce sclerosing agent. About half of the thyroid gland cyst after emptying fallen down and cease to accumulate the contents.
In order to evaluate abnormalities in the thyroid gland is performed to determine the level of thyroid stimulating hormone (TSH, T4, T3).
When scintigraphy – a thyroid scan using radioactive isotopes of iodine I-123, I-131 or technetium Tc-99 determine the nature of the node, its hormonal activity, state of the thyroid tissue.
According to the ability of the accumulation of radioactive iodine formation of nodes and surrounding tissue are divided into:
- «warm” – components that absorb the same amount of radioiodine as extranodal tissue cancer (operating units);
- «hot» – nodes to accumulate large amount of radioactive iodine than unmodified surrounding thyroid tissue (independently functioning units);
- «cold» – nodes, does not accumulate radioactive iodine; diagnostic agent is distributed in an unchanged thyroid tissue. By “cold” nodes are thyroid cancer, however, only 10% of the “cold” nodules are malignant.
When large amounts of nodes and thyroid cysts or malignant nature of their CT scans performed.
When the symptoms of compression of the structures of the neck is performed laryngoscopy (examination of the vocal cords and larynx) and bronchoscopy (examination of the trachea).
Because of radiological techniques in the nodes and cysts of the thyroid gland are used pneumography thyroid (to clarify the sprouting of surrounding tissues), angiography (to detect violations of the vasculature), X-ray of the esophagus with barium X-ray of the trachea (to determine the germination or compression of the tumor).
The treatment of cysts and thyroid nodules
nodes and thyroid cysts less than 1 cm in diameter are subject to dynamic monitoring and dotted line in the event of an increase in their size.
The treatment of thyroid cysts begin their evacuation puncture. Benign cysts of the thyroid gland without evidence of inflammation in the case of recurrence can be punctured repeatedly. Sometimes a cyst after emptying sclerosant administered (particularly ethyl alcohol) for better adhesion of the walls. If the thyroid gland cyst quickly accumulates content per week reaching its original size, it is better to remove quickly.
The small size nodes and cysts of the thyroid gland is not accompanied by a violation of the patient’s state of health, are treated conservatively, using the same pharmaceutical remedies that are used for the treatment of diffuse nontoxic goiter: Thyroid hormone and iodine.
The process of treatment with thyroid hormones is controlled study of TSH (every 3-4 weeks), and ultrasound of the thyroid gland (1 every 3 months).
Treatment of iodine-containing drugs is carried out under ultrasound and the presence of antibodies in the blood to the tissues of the thyroid gland (in 1 month. after the start of therapy). The study of antibodies necessary to avoid autoimmune thyroiditis, sometimes emerging as a unit and they are aggravated during treatment with iodine preparations. When determining in the blood of high titer antibodies iodine canceled.
When the presence in the thyroid gland cyst signs of inflammation are being identified pathogen and its sensitivity to antibiotics and anti-inflammatory treatment is connected with antibacterial drugs.
The indications for surgical removal of benign thyroid cysts are its large size, and compression of the neck, rapid recurrence of fluid accumulation after a puncture discharge. In most cases the presence of thyroid cysts performed gemistrumektomiya (hemithyroidectomy) – removal of thyroid lobe. Thyroid function normally after such an operation is not affected.
When the presence of benign nodes in both lobes of the thyroid gland have resorted to bilateral subtotal strumectomy – resection of most of the thyroid gland.
The absolute indication for surgical removal of nodal education is its malignancy. During the operation, carried out an urgent histopathological identification of malignancy site and its forms. Upon confirmation of the presence of malignancy in the thyroid gland sometimes resorted to its total removal (total strumectomy), along with the surrounding adipose tissue or lymph nodes.
Once total strumectomy develop severe hypothyroidism, which calls for administration to a patient in the postoperative period receiving thyroid hormones. Since the removal of the thyroid gland is carried out together with the parathyroid glands, the appointed and calcium supplements.
A common complication of thyroid surgery is a dysfunction of the vocal cords.
The prognosis for thyroid nodes
The prognosis of thyroid nodules is determined by their histological form. When the structure of the benign nodules and cysts of the thyroid gland is probably full recovery. Thyroid Cysts can recur again.
The tumors of the thyroid gland moderate malignancy in the absence of metastatic screenings cured in 70-80% of patients. The worst prognosis of malignant tumors, sprouting adjacent organs and give distant metastases.
Prevention of thyroid nodules
Prevention Education sites and thyroid cysts involves a daily intake of iodine in the age limits of physiological norm, a sufficient amount of vitamins, avoiding sun exposure, exposure of physiotherapy to the neck.
Once the thyroid gland cyst cure is necessary to conduct the control of US 1 once a year. Patients with small knots and cysts of the thyroid gland must be registered and dynamic observation at the endocrinologist.