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Thyroid nodule

Saturday, 25 September 2010

Today's topic will be about "Thyroid nodule". First let me give a brief introduction about the thyroid gland. 
The thyroid gland is the biggest gland in the neck. It's function is to secrete hormones responsible for regulating the body's metabolism. It is situated in the front of the neck, below the larynx. The gland consists of two lobes (right and left) connected by a tissue called "isthmus".

The thyroid problems are common including goiters, thyroiditis, hyperthyroidism, hypothyroidism and solitary thyroid nodules. 

Solitary thyroid nodule is a solid or fluid-filled nodule present in the thyroid gland. It is present in about four percent of the population of the United States. The vast majority of thyroid nodules are benign and do not require removal. A small percentage are cancerous and should be removed surgically. There are two high-risk groups for cancer: 

1. The first group of those with a family history of thyroid cancer
2. The second group consists of those who have been exposed to low-dose irradiation to the head and neck. 

Most nodules are asymptomatic but can be visible when you feel them or look at it. Some nodules can produce extra thyroid hormones which gives a picture similar to hyperthyroidism:
weight loss - palpitations - nervousness - insomnia.

There are types of thyroid nodules, which are:
1. Colloid nodule (commonest)
2. Follicular adenoma (benign)
3. Simple cyst (fluid-filled)
4. Toxic adenoma (produces more thyroid hormones --> Hyperthyroidism)
5. Thyroid cancer (malignant)

In order to know the exact type of the thyroid nodule present, an investigation called "Fine needle aspiration for cytology" is done. Other investigations include:
1. Ultrasound: differentiates between solid and cystic nodules and to detect nonpalpable nodules.
2. MRI and CT scan: unnecessary except for very large and substernal lesions.
3. Thyroid isotope scanning: indicates functional activity.

When the type of the nodule is identified, the managment can be discussed with the doctor. 
If it is a colloid nodule, then no surgery is indicated unless there is cosmetic disturbance or presence of symptoms as dyspnea.
Lobectomy is indicated for follicular adenoma and for nodules that enlarge on suppressive doses of thyroxine or cysts that enlarge after 3 aspirations or complex on ultrasound.

If you feel any thyroid nodule, get it examined by a doctor.
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