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A benign thyroid goiter according to ultrasound has a capsule. What is a nodular goiter of the thyroid gland? Signs and symptoms

A goiter is an enlargement of the thyroid gland. In the case when there are nodular formations in the thyroid gland, they speak of nodular goiter. Nodular goiter is the most common pathology of the thyroid gland, occurring in 5% of the population, and according to experts, if we take into account the hidden forms of nodular goiter, sometimes detected by chance during an examination for another reason, this figure can safely be doubled. Women are four times more susceptible to nodular goiter than men.

Nodular goiter is a group of diseases united by a common feature - the presence of nodes in the thyroid gland. The fact is that the thyroid gland tissue is formed by many follicles, each follicle is a microscopic cellular ball containing a substance in colloidal form inside. A thyroid nodule is an enlarged follicle - single, multiple (multinodular goiter), several enlarged follicles fused together, a follicular cyst or a tumor arising from a follicle (adenoma, including malignant).

Causes of nodular goiter

The causes of nodular goiter are still unknown. It is generally accepted that living in areas with a reduced iodine content in water (endemic goiter) matters, but medical statistics indicate that thyroid nodules form in people living in areas with a normal iodine content not much less often. Therefore, low iodine content is far from the only cause of nodular goiter.

The enlargement of follicles and the formation of cysts occurs in response to changes in the body, which increase the load on the thyroid gland. This happens with various diseases, hereditary predisposition, as well as the influence of certain environmental factors, especially stress. Some experts consider forms such as colloidal proliferating nodular goiter to be an age-related change in the thyroid gland.

Types of nodular goiter

Depending on the origin, composition and cause of nodular goiter, the following types are distinguished:

Endemic nodular goiter;
Solitary node (single thyroid nodule);
Multinodular goiter (many thyroid nodules);
Congolomerate nodular goiter (a conglomerate of nodes welded together);
Diffuse nodular goiter (nodes formed in the enlarged thyroid gland);
True thyroid cyst;
Follicular adenoma of the thyroid gland (benign tumor);
Malignant tumor of the thyroid gland.

Degrees of nodular goiter

Depending on how enlarged the thyroid gland is, the degree of nodular goiter is determined. Previously, a classification of the degrees of nodular goiter was adopted according to O.V. Nikolaev, in 1994 the World Health Organization proposed a new classification. However, in clinical practice, both the Nikolaev classification and the WHO classification are currently used, so we will present both.

Degrees of nodular goiter (and goiter in general) according to Nikolaev:

0 degree – the thyroid gland is not visible and not palpable;
1st degree – the thyroid gland is not visible, but palpated;
Grade 2 – the thyroid gland is visible during swallowing;
3rd degree - the thyroid gland increases the contour of the neck, making it thick;

4th degree – obvious goiter that disrupts the configuration of the neck;
Grade 5 – the thyroid gland reaches enormous sizes and compresses neighboring organs.

The degrees of nodular goiter (and goiter in general) according to WHO definition:

0 degree - no goiter
Grade 1 - the size of the lobes (or one lobe) is larger than the distal phalanx of the patient’s thumb. The goiter is palpable but not visible.
2nd degree - the goiter is palpable and visible to the eye.

As a rule, there are no symptoms of nodular goiter. This applies to a greater extent to the most common form, nodular colloidal proliferative goiter, as well as to thyroid cysts. In this case, the only symptoms of nodular goiter are the formations themselves, nodes and cysts; as a rule, nothing bothers the patient. If the nodes reach a significant size, there may be complaints of a cosmetic defect or a feeling of neck compression.

If we are talking about diffuse nodular goiter, then the symptoms of nodular goiter coincide with the symptoms of thyrotoxicosis: nervousness, weight loss with an increased amount of food taken, tachycardia, etc.

In general, we can say that in all cases, except for colloidal proliferative nodular goiter and follicular cysts of the thyroid gland, the symptoms of nodular goiter correspond to the symptoms of the underlying disease that caused the formation of nodules.

The diagnosis of nodular goiter is made on the basis of examination of the thyroid gland. The following methods are used for this:

Blood test for thyroid hormone levels;
Fine needle biopsy of the thyroid gland (FNP);
Radioisotope scan of the thyroid gland;
Computed tomography (CT) or magnetic resonance imaging (MRI) of the thyroid gland is the most expensive, but also the most informative examination methods.

Treatment of nodular goiter

Treatment of nodular goiter is carried out depending on the cause of the appearance of nodules in the thyroid gland. Most experts believe that treatment of nodular goiter in the form of nodular colloidal proliferative goiter is not required; in this case, dynamic monitoring of the condition of the thyroid gland is prescribed, and treatment is prescribed only when the nodes show a tendency to grow in a short time.

Treatment of nodular goiter can be medicinal or surgical; the choice of method is made by the attending physician. Drug therapy is carried out with drugs that suppress excessive production of thyroid hormones. One of the effective methods for treating nodular goiter is to inject radioactive iodine preparations into the thyroid gland, which helps to reduce or even disappear the nodules and restore the normal size of the gland.

Surgical treatment of nodular goiter consists of removing the nodes, and if there are special indications, for example, a malignant tumor, removing one lobe or the entire thyroid gland.

Treatment of nodular goiter with folk remedies

Before you start treating nodular goiter with folk remedies, you should definitely visit an endocrinologist, since in some forms treatment can only be surgical, and by self-medicating, you can waste precious time.

Treatment of nodular goiter with folk remedies is an excellent way to maintain health in the interval between taking medications, or with the colloid proliferative form of the disease, when drug treatment is not required.

In general, treatment of nodular goiter with folk remedies is aimed at correcting the iodine content in food. A good way to do this is in the recipes below:

1. Take 1 kg of fresh chokeberry berries, mix with 1 kg of sugar, grind thoroughly. Take the resulting mixture 3 times a day, 1-2 tsp.

2. Eat 50-100g of seaweed every day, or take a teaspoon of its powder.

Video from YouTube on the topic of the article:

Nodular goiter is a pathological disorder of the thyroid gland. The disease begins to develop in a latent form without symptoms. Over time, subcutaneous nodules appear in the neck area. In medicine, there are several types and degrees of nodular goiter. The disease is treated with medication and surgery. We'll look at it in more detail in the article.

What is a nodular goiter?

– these are diseases of the endocrine system, combined into one group. In the inner sphere of the thyroid gland, peculiar nodules form. They differ in morphology and origin. The disease is diagnosed more often in the fair half of humanity, causing a lot of trouble. First of all, appearance suffers. A defect in the form of a tumor is observed in the neck area if the disease progresses.

Nodules with a diameter of 1 cm are determined by palpation. In the first stages of development, the disease occurs in a latent form, without making itself felt. The disease is detected by ultrasound examination. The development of nodular goiter can lead to thyroid cancer. In addition to a cosmetic defect, there may be compression syndrome- state of suffocation. The patient feels the presence of a foreign body in the neck area. Shortness of breath, sore throat, hoarseness in the voice appears.

The presence of nodular goiter affects the disruption of metabolic processes, leading to the occurrence of concomitant diseases. To avoid the development of the disease, it is necessary to periodically undergo examination of the thyroid gland.

Reasons for development

Signs of the presence of nodular goiter appear in approximately 50% of the population. Scientists continue to debate the reasons for its appearance. The main factor in the development of the disease is considered gene mutation. The disease appears more often with age-related changes. Women are predisposed to the disease due to hormonal changes in the body associated with pregnancy, breastfeeding, and menopause. People living in regions with a lack of iodine in the atmosphere are also at risk.

Today, scientists identify a number of reasons that influence the occurrence and development of the disease:

the presence of radiation and toxic substances in the air;
genetic pathologies, in particular Klinefelter and Down syndromes;
deficiency of vitamin and mineral reserves;
neurological disorders;
hormonal changes;
side effect from using drugs;
viral and microbial infections in chronic form;
poor nutrition;
bad habits.

The determining factor in the development of nodular goiter is radiation. Once in the body, radiation causes disruption of metabolic processes. People living in areas where radioactive elements are released suffer.

Types and degrees

In medicine there is a distinction several types of nodular goiter:

Endemic– the appearance of nodes as a result of iodine deficiency. The disease occurs in a moderate form. Nodules do not always grow.
Solitary– presence of a single node.
Multinode– development of a large number of nodes that constantly “multiply”.
Conglomerate- a lot of knots connected to each other by fabric.
Diffuse nodular– the volume of thyroid tissue increases evenly.
Hashimoto's goiter– initial stage of development hypothyroidism– lack of thyroid hormone.
Thyrotoxicosis– the appearance of nodes due to increased thyroid function.

The complicated form of nodular goiter comes in 3 types:

True cyst– a benign tumor of small size that develops in colloidal fluid.
Follicular adenoma- a benign neoplasm that envelops the node.
Malignant tumor– a neoplasm caused by abnormal cell growth.

Nodular goiter varies in degree of development:

Degree 0. The disease occurs in a latent form. The nodes are not palpable or visually visible, which makes timely diagnosis difficult.
Degree 1. The nodes are not visible, but are detected by palpation. The patient may feel one or more nodules. The first degree is also characterized by a slight enlargement of the thyroid gland due to iodine deficiency.
Degree 2. The nodes can be easily felt. When swallowing, they are visible visually. There is pain in the neck area when tilting the head. The patient's appetite decreases. Frequent diseases of the respiratory system occur. Irritability and hand trembling appear.
Degree 3. The neck increases in size. The disease manifests itself in all forms. Metabolism is disrupted. With poor appetite, body weight increases. The patient suffers from constant intestinal disorders. Complications of grade 3 goiter include shortness of breath, hypertension, and cardiac arrhythmia.
Degree 4. The disease is progressing. Against the background of the above symptoms, neck deformation is observed. Its shape is disrupted, acting as a cosmetic defect.
Degree 5. The most complex form of nodular goiter. The thyroid gland increases to its maximum size, squeezing neighboring organs. Disorders of the cardiovascular, respiratory and digestive systems progress. In addition, reproductive function suffers. There is a sharp decrease in brain activity.

The World Health Organization has simplified the classifier for determining the degrees of nodular goiter:

Degree 0– absence of goiter.
Degree 1– the goiter is palpated, but not visible.
Degree 2– the goiter is palpated and visually examined.

In practice, endocrinologists use both classifications.

Symptoms

Enlargement of the thyroid gland with the appearance of nodes in the early stages is painless. The only sign of the disease are the nodules themselves. Serious symptoms occur as the disease progresses:

discomfort in the neck and throat area;
the appearance of hoarseness in the voice;
difficulty breathing;
dry cough;
a state of suffocation similar to an asthmatic attack;
constant headaches with a sensation of noise;
the appearance of pudendal vein syndrome as a complication of goiter;
depression;
increased weakness;
trembling of fingers;
gastrointestinal disorder;
increased skin dryness;
hair loss;
peeling and brittleness of nails;
poor sleep;
development of hypo- and hypertension;
feeling of heaviness in the heart area;
poor appetite with increasing body weight, and vice versa, a constant feeling of hunger against the background of sudden weight loss;
increased blood glucose levels;
decreased performance.

Children suffering from thyroid diseases grow poorly and lag behind in intellectual development. In the fairer sex, the menstrual cycle is disrupted and spontaneous miscarriages may occur, which leads to infertility. Reproductive function in men also suffers due to the development of nodular goiter. There is a decrease in libido and potency.

The presence of severe pain at the location of the node indicates a possible hemorrhage, a rapid increase in its size and other inflammatory processes. In this case, urgent hospitalization is necessary.

Diagnostics

If you have symptoms indicating the development of a goiter, you should visit endocrinologist. The examination takes place in stages:

Visual examination of the patient. The doctor determines the approximate size of the nodes by palpation.
The patient undergoes general tests, blood biochemistry and hormone tests.
, which allows you to determine the exact size of the formations. The location and density of nodes is determined.
If the diameter of the node is more than 1 cm, it is prescribed fine needle biopsy. The content of education is examined.
Needle biopsy– study of the liquid environment of neoplasms, allowing to distinguish a benign tumor from a malignant one.
Radioisotope scan of the thyroid gland - scintigraphy. The procedure helps to identify diffuse and focal changes, as well as determine the size of the goiter and its characteristics. This diagnostic method is the most accurate compared to ultrasound.
X-ray of the gland. It is prescribed to identify possible complications.
Tomography- a study that allows you to analyze the internal structure of the thyroid gland.

To diagnose grade 0 and 1 goiter, it is enough to undergo tests and an ultrasound scan. If a goiter of grade 2 or higher is detected, you will have to undergo a comprehensive examination.

If the diagnosis does not reveal malignant neoplasms, the prognosis will be favorable. Thanks to modern treatment methods, nodular goiter is completely eliminated in most cases.

Treatment

If the thyroid gland functions normally and the nodes do not grow, then no treatment is required. Usually the doctor gives recommendations on proper nutrition, maintaining a healthy lifestyle, and taking vitamins. In this case, the patient must be periodically observed by a specialist for possible progression of the disease.

Let's watch the video. An endocrinologist will talk about how nodular goiter is recognized. How the radioactive environment affects the development of the disease. Modern methods of examination and treatment.

If the functionality of the thyroid gland is impaired, drug treatment is prescribed. Therapy involves taking thyroid hormones: L-Thyroxine, Thyroidin, Thyreotom.

Radioiodine therapy provides for the provision of the gland with radioactive iodine, which must be retained by the endocrine organ. The patient swallows for a certain period of time isotope - I-131, which travels through the blood to the thyroid gland. This method allows you to reduce the number of nodes by up to 80%.

If the goiter “goes beyond reasonable limits,” namely: it is observed cosmetic defect, and signs are revealed compression syndrome, produced surgery.

There are 3 types of surgical interventions:

Hemiteroidectomy– removal of a small portion of the gland.
Subtotal resection– removal of most of the organ.
Thyroidectomy– complete removal of the gland.

Most operations are carried out endoscopic method- through small punctures. Self-absorbing threads are used as sutures. After a certain time, there are practically no traces of the operation left. Sometimes during endoscopy it becomes necessary to perform a traditional operation. A 6-8 cm incision is made and removal begins. A conventional operation allows you to eliminate nodes with maximum accuracy.

The modern method of treating nodular goiter is radiofrequency ablation. This is a new technology aimed at destroying thyroid nodules. The procedure is performed in a hospital under local anesthesia. During the rehabilitation period, an increase in the size of the nodes may be observed, but within 2-3 months they decrease. After six months, the thyroid gland returns to normal.

Traditional medicine

Treatment of goiter at home is used in the early stages of the disease. Plants containing iodine can be prescribed in combination with drug therapy. In any case, you should initially consult an endocrinologist.

Folk remedies are effective in replenishing iodine deficiency. Sea kale- This is a storehouse of vitamins and microelements. By consuming 100 grams of the plant daily, the body will not suffer from a lack of iodine.

An alternative is a mixture of chokeberry. Grind fresh berries with sugar - 1 kg each. Take 3 times a day, 1-2 tablespoons. The tasty product has a beneficial effect on the activity of the endocrine organ.

Can cook infusions. A mixture of 6 traditional medicines is considered an effective method. The method is very effective, but its production requires time. We will need 6 0.5 liter cans. Place the herb in each container:

Celandine grass - 250 g.
A mixture of elecampane root and birch bark in a ratio of 50:100 in grams.
Wheatgrass roots and dry woodlice, 100 g each.
Crushed walnut shells with partitions - 300 g.
Calendula flowers – 100 g.
Dandelion roots, shepherd's purse and burdock - 50 g each.

Next, fill the contents of all jars with vodka - 250 ml in each. We cover the container and send it to a dark place for 20 days. After the time has passed, mix the infusions sequentially from jars 1 to 6. Add 0.5 liters of unrefined oil to the mixture. Leave for a week, shaking occasionally. Take the medicine one hour before meals, 50 grams.

The restoration of thyroid function is indicated by good nail color and the absence of hair loss. Traditional healers recommend taking several courses of such treatment.

Any harmless herb can cause harm. Be sure to consult an endocrinologist.

Diet

A balanced diet in the presence of goiter will help replenish energy reserves and stabilize the gastrointestinal tract. It is recommended to consume slow carbohydrates (all kinds of cereals, wholemeal pasta, etc.), which provide an average daily calorie content of 3500 kcal. We remove fatty and heavy foods, coffee, strong tea, chocolate, spices, spicy foods and alcohol from the diet.

Sample menu for the day:

Breakfast. Mix milk with 50 g of cottage cheese. Boil 1 hard-boiled egg. For a side dish, boil buckwheat – 50 g. The volume of the first meal should be 150 g.

Lunch. We eat one green apple and a light vegetable salad - 100 g.

Dinner: Prepare vegetable soup with rice. Portion - 400 g. Additionally, we eat 50 g of boiled meat. Wash it down with apple compote – 180 g.

Afternoon snack. We snack on crackers – 50 g, washed down with rosehip decoction – 180 g.

Dinner. Boil fish or fish balls - 60 g. For garnish, prepare stewed carrots and semolina porridge in milk, 200 g each.

The food is quite filling. At the same time, body weight remains normal. Vegetable salads can be alternated with seaweed. The daily menu is developed based on the calorie table.

The energy value of foods per day may vary, depending on the diagnosis. For example, with endemic goiter you need more iodine, with hypothyroidism you need to consume more proteins.

Possible complications

Nodular goiter reduces the functionality of the thyroid gland. The body loses its immunity. If the disease is not treated promptly, concomitant diseases may develop:

hypo- and hypertension;
peptic ulcer;
heart failure;
chronic bronchitis;
obesity;
compression syndrome;
neuralgia;
oncology.

The development of nodular goiter can cause cancer of the thyroid gland and other organs, the activity of which is disrupted due to the development of the disease.

Prevention

The main goal of prevention is to prevent the occurrence and development of nodular goiter. It is necessary to consume more seafood containing iodine. This concerns, first of all, children and women, in particular expectant mothers. Switch to proper nutrition, and it is better to give up bad habits. From time to time it is necessary to undergo an ultrasound of the thyroid gland.

Nodular goiter appears unnoticed. The patient learns about the diagnosis when the disease begins to progress. The endocrine system plays an important role in the body. Destabilization of its functions has a negative impact on the body as a whole. The appearance of weakness and systematic malaise is the first signal to contact an endocrinologist.

What is a nodular goiter?

In order to understand what it is - nodular goiter, it is necessary to understand what diseases are included in the structure of this concept.

ICD 10 revision proposes the following classification:

nodular colloid goiter;
follicular adenoma;
hypertrophic handicap of AIT with the formation of false nodes (pseudo thyroid nodes);
solitary cyst;
thyroid cancer.

Thus, we can say that the term nodular goiter includes all local formations of the thyroid gland that have a capsule. If more than 1 node is detected on the surface of the gland, one should speak of a multinodular form of the disease.

Causes of nodular goiter

The etiology of the disease certainly depends on its morphological form. So colloid goiter is a non-toxic, euthyroid form (nodular non-toxic goiter of the thyroid gland), the only cause of which is a lack of iodine in the food consumed, as well as water and air. This form often occurs against the background of diffuse damage and is called diffuse nodular goiter of the thyroid gland.

Follicular adenoma and cancer are tumor diseases, with the difference that adenoma is benign and responds well to treatment. The clear cause for the occurrence of the tumor has not yet been clarified, but a number of factors have been identified that create the prerequisites for its development:

hereditary predisposition;
low standard of living in areas with poor ecology in the area of hazardous industries and work in them;
neck injuries;
hormonal and metabolic disorders;
iodine deficiency.

Cysts are formed as a result of organic damage to organ tissue. Hemorrhage from a small vessel leads to tissue saturation with blood. A capsule is formed on top of it as a protective mechanism to delimit healthy areas, thereby forming a false cyst. A false cyst is also called an empty capsule formed as a result of degeneration of the colloid node.

A pseudonodule develops as a result of an autoimmune lesion when the body produces antibodies against its own cells. In this case, certain areas are more susceptible to the action of immunoglobulins and cause hypertrophy of individual follicles. The cause of autoimmune diseases in most cases is a genetic defect of the immune system and hereditary predisposition.

Symptoms of nodular goiter

As a rule, patients do not experience significant symptoms of nodular goiter. This is due to the fact that the area of overgrown tissue does not exhibit excessive hormonal activity, so the level of hormones in the peripheral blood does not change and the function of the gland does not suffer.

Mechanical and cosmetic symptoms of nodular goiter depend on its degree:

0 degree – the node is not palpable;
1st degree - upon palpation a formation is detected, but it is not visually visible;
2nd degree - a serious deformation in the neck area is visible to the naked eye.

Nodular goiter 1st degree rarely gives mechanical complications, since its size is insufficient to deform neighboring organs, however, hemorrhage into the tissue of the node is quite possible, which can cause pain.

Nodular goiter 2nd degree- this is, firstly, a visible cosmetic defect, which is one of the main problems of this pathology, and secondly, it is a real threat of compression of surrounding tissues, which in exceptional cases can lead to death.

Compression of the esophagus and pharynx leads to disruption of the swallowing process and the sensation of a lump in the throat. Subsequently, this can lead to significant exhaustion, since it becomes physically impossible to eat enough food.

Pressure on the trachea causes significant difficulty breathing. First, shortness of breath of a mixed nature develops (both inhalation and exhalation are difficult), and then periodic attacks of suffocation develop, which without specialized help can have negative consequences.

Most often, the cause of pain is compression of the nerve trunks by an overgrown node. In the area of the thyroid gland there are branches of the vagus nerve, which innervates many internal organs and areas of the body, so the localization of pain can be very diverse, including pain in the oral cavity.

In rare cases, nodular lesions lead to an increase or decrease in the hormonal activity of the gland. Symptoms in this case may not be very specific, but appear with grade 0 nodes and be the only sign of the disease.

A decrease in thyroid hormones manifests itself as follows:

weakness, fatigue, decreased performance and resistance to stress, depression, apathy, loss of appetite;
decreased body temperature, chills, increased sensitivity to acute respiratory diseases;
menstrual dysfunction, decreased libido and potency.

Elevated hormone levels manifest themselves exactly the opposite:

irritability, aggressiveness, insomnia;
increased body temperature, increased appetite, weight loss;
tachycardia.

Diagnostics

To diagnose this disease, taking an anamnesis is of great importance. It is necessary to provide the doctor with information about living or long-term stay in an area endemic for iodine deficiency in the air and water. In addition, it is advisable for the patient to be informed about any thyroid diseases, autoimmune and hormonal disorders in relatives.

It is important to indicate as accurately as possible the moment the goiter appears and the intensity of its development (after what time it increased, by how much). Complaints of coughing, choking, changes in voice and difficulty breathing are not insignificant; you must inform your doctor about any discomfort, even if it seems that they do not relate to the underlying disease.

During external examination, grade 0 and 1 nodes are not visible in the normal position of the neck, so it is necessary to examine the area when tilting the head back. Palpation allows you to evaluate the consistency of the gland, as well as palpate single or multiple nodes.

In the initial stage of the disease, in the presence of a multinodular goiter, by palpation it can be determined as a variant of the anatomical structure of the gland, therefore ultrasound is always used to make the correct diagnosis.

Ultrasound examination of the thyroid gland can detect even the smallest lumps less than 1 cm in diameter. Nodes larger than 1 cm are an absolute indication for a biopsy with sampling of material for histological examination. This procedure is necessary to exclude a malignant neoplasm, as well as for a morphological assessment of the formed node.

The thyroid gland is not always located in the usual place for everyone; sometimes it has a retrosternal localization. In this case, the ultrasound will be uninformative, since the bone interferes with the transmission of waves. Application radiography, as well as CT and MRI will allow you to visualize the gland even in such a hard-to-reach place.

Computer and magnetic resonance imaging are additionally used for symptoms of mechanical compression of nearby organs and allow visualization of compression of the trachea, esophagus and nerve trunks.

The most modern and sensitive diagnostic method is scintigraphy, which, using intravenous administration of labeled iodine isotopes, allows one to visualize the functional activity of the thyroid gland in general and the node in particular. When the iron captures the isotope, it begins to “glow,” as it were, which indicates its normal functioning. “Cold” areas indicate a focus of hormonally inactive tissue, and “hot” areas indicate excessive production of hormones.

From laboratory tests, it is most advisable to determine the level of T3, T4 and TSH in venous blood. Their change is not a pathognomonic sign of nodular goiter, but confirms the presence of pathology in the thyroid gland, and in some cases makes it possible to differentiate nodular goiter from a number of other endocrine diseases.

Treatment

How to treat nodular goiter depends on its origin.

Treatment of colloid goiter

This type of nodule is not an absolute indication for surgical treatment, therefore the main principles of treatment are dynamic observation and drug therapy with iodine preparations.

The indication for surgical treatment is the lack of effect of drug therapy, as well as the volume of the node, which creates discomfort and a pronounced cosmetic defect. Removing a colloidal node is a fairly simple operation, but only if all existing nodes have reached a certain size. Otherwise, removal may not be complete and the disease will soon recur.

If, after a long postoperative remission, the disease begins to progress again, a second operation is no longer performed. The use of radiation therapy with radioactive iodine isotopes is highly effective, but is contraindicated during pregnancy and lactation. The essence of the procedure is the complete destruction of thyroid cells and is used in exceptional cases.

Autoimmune pseudonodules suggest treatment without surgery. The doctor monitors hormone levels over time and, if necessary, prescribes replacement therapy, since the risk of developing hypothyroidism is high.

Treatment of nodular goiter of the thyroid gland associated with a tumor, exceptionally operational. During the operation, the obtained material is subjected to urgent histological examination. If the tumor is benign, then its complete removal and further observation by an endocrinologist is quite sufficient in order to prevent the development of a relapse. Radiation therapy with radioactive iodine is always added to the treatment of malignant neoplasms. At the request of the doctor, additional use of suppressive therapy with Levothyroxine sodium is possible.

Traditional methods of treatment

Treatment of nodular goiter at home is not a replacement for the main treatment, but its continuation and intensification.

Half of the existing problem can be solved on your own by adjusting your diet. You need to add iodine-rich foods to your diet:

iodized salt;
seafood (fish, etc.);
seaweed;
spinach;
fruits, vegetables, herbs;
dairy products.

You should monitor the amount of calories you consume, trying not to go beyond your age and gender norms, and also adhere to the general principles of proper nutrition.

Treatment of nodular goiter with folk remedies opens up an unlimited number of methods, among which you can always find the right one. The most widespread are various tinctures, decoctions and juices, for example:

tincture of white cinquefoil root;
potato juice;
walnuts with honey;
horse sorrel tincture;
infusion of hawthorn flowers.

All these products are quite easy to prepare, they do not require strict concentration and lend themselves well to combination with each other.

Prevention

In most cases, it is impossible to purposefully protect against the disease, so prevention includes general measures to improve health, normalize nutrition and timely treatment of diseases, especially the endocrine system.

People at risk require special attention - these are people living in areas endemic for iodine deficiency, with a family history (relatives with a similar pathology), as well as pregnant and lactating mothers. Such people need a preventive examination by an endocrinologist and an ultrasound of the thyroid gland at least once a year, as well as the use of iodized salt and food rich in iodine.

It should be remembered that a thyroid examination is not included in the mandatory list of preventive medical examinations, so you must consult a doctor yourself.

Forecast

Of the entire series of diseases united by the term “nodular goiter,” thyroid cancer has the most unfavorable prognosis. Although removal of the gland is an effective treatment method, it cannot provide a 100% guarantee that the disease is cured. In addition, removal of the organ leads to lifelong replacement therapy with synthetic thyroid hormones, which to a certain extent reduces the quality of life.

Autoimmune pseudonodes are a lifelong disease that requires constant monitoring and subsequent use of corrective medications, so we cannot say about a favorable prognosis, but there is no acute risk with this variant of the disease.

Follicular adenoma also requires constant monitoring, since there is a fairly high risk of malignancy, but at the same time it does not require treatment other than surgery.

Colloid goiter is the most favorable pathology, since the risk of complications or malignancy is extremely low, and treatment has no side effects. However, iodine deficiency diseases significantly change lifestyle, as they require constant dieting and giving up bad habits.

Videos on the topic

Nodular goiter is a clinical concept that unites focal formations of the thyroid gland of various structures.

Nodules are more often detected in regions with low iodine supply. In goiter-endemic areas, their prevalence reaches 30–40% in some categories of the population. Women over 40 are the most vulnerable. Symptoms of nodular goiter may be absent or associated with dysfunction of the gland (hypothyroidism, thyrotoxicosis), compression of surrounding tissues.

Types of nodular goiter

There are several classifications of nodular goiter.

Depending on the number of foci, the following are distinguished:

solitary node (single thyroid nodule);
multinodular goiter (two or more thyroid nodules);
conglomerate nodular goiter (a conglomerate of nodes welded together).

Depending on the thyroid function, there are:

nodular toxic goiter (hyperthyroidism);
nodular nontoxic goiter (euthyroidism or hypothyroidism).

Degrees of nodular goiter:

nodular goiter of the 1st degree - the goiter is not visible, but is well palpated;
nodular goiter of the 2nd degree - the goiter is palpable and visible upon examination.

Nodules are a manifestation of various diseases that occur with different frequencies.

Structure of diseases:

nodular colloid goiter with varying degrees of proliferation (90% of cases);
follicular adenoma of the thyroid gland (7–8% of cases);
thyroid cancer (1–2% of cases);
other diseases (less than 1%).

Etiology and pathogenesis of nodular goiter

The etiology of follicular adenoma and thyroid cancer has not been sufficiently studied.

Risk factors:

cancer in relatives;
multiple endocrine neoplasia in relatives;
irradiation of the head and neck in childhood.

The cause of colloid goiter with varying degrees of proliferation is long-term residence in regions with insufficient iodine content in food and water. Iodides are necessary for normal functioning of the thyroid gland.

As a result of microelement deficiency in the diet, the following occurs:

decreased intrathyroidal iodine concentration;
autocrine production of growth factors;
activation of angiogenesis.

These are the body's protective reactions aimed at preventing hypothyroidism in conditions of iodine deficiency. However, if the lack of a microelement persists for a long time, the negative consequences of such an adaptation also appear - hyperplasia of thyrocytes.

Cells acquire excessive proliferative activity. Their slow growth and reproduction leads to the formation of first focal changes in the thyroid gland, and then nodular formations.

Constant cell proliferation increases the risk of somatic mutations. The most common manifestation of such variability is activating mutations in the thyroid-stimulating hormone receptor.

As a result, thyrocytes acquire functional autonomy. They acquire the ability to produce hormones without the influence of the central organs of the endocrine system (pituitary gland and hypothalamus). The main regulator of the thyroid gland, the feedback principle, is disrupted.

Nodular goiter with signs of autonomy may not disrupt the euthyroid status for a long time or may even develop into hypothyroidism. At this time, the activity of the nodes is balanced by the functional inactivity of the remaining parts of the gland. This stage is called compensated autonomy.

In the future, under the influence of unfavorable factors, autonomy may enter the stage of decompensation. The clinical manifestation of this will be thyrotoxicosis of varying severity. The cause of adverse changes is most often the use of iodine-containing drugs.

Diagnosis of nodular goiter

To determine treatment tactics, it is necessary not only to identify a nodule in the thyroid gland, but also to determine its morphology and functional activity.

Examination methods:

preoperative;
intraoperative;
postoperative.

The main preoperative methods for diagnosing nodular goiter: examination, palpation, ultrasound, fine-needle aspiration biopsy of nodular tissue, determination of hormonal status (TSH and thyroid hormones), radioisotope scanning.

Examination and palpation help identify symptoms of nodular goiter during the patient’s initial visit or medical examination.

Nodules up to 1 cm in diameter are practically not palpable. In rare cases, such a node can be detected without ultrasound when localized in the isthmus region.

Medium-sized nodules (1–3 cm in diameter) are easily palpable. During the examination, you can evaluate the density of the node, its pain, adhesion to surrounding tissues. Such nodular formations do not change the shape of the neck. In rare cases, the contours of the node are visualized with the head tilted back.

Nodules more than 3 cm in diameter deform the neck. They are clearly visible when located superficially. Upon palpation, large nodular formations are detected, most often painful due to overstretching of the thyroid capsule.

During the examination of the patient, the doctor also receives data on the presence of clinical manifestations of hypothyroidism or thyrotoxicosis.

Ultrasound examination of the thyroid gland is indicated for suspected nodular goiter and to monitor treatment. Ultrasound has a high sensitivity (94%) for detecting nodular goiter.

Typical ultrasound picture of nodular colloid goiter with varying degrees of proliferation:

one or more nodes in one or both lobes;
formations of a round or oval shape with clear contours;
any echogenicity (low, high, average);
the structure is homogeneous or mixed with anechoic zones (areas of hemorrhage and degeneration in cystic nodular goiter);
hyperechoic inclusions (calcifications).

Oncology allows us to suspect the presence of nodes of irregular, uneven shape, without clear contours.

During ultrasound, it is possible to determine the severity and nature of vascularization of the node. This indicator allows us to indirectly judge the risk of an oncological process.

In a benign process, avascular formations, perinodular blood flow, and nodes with hypervascularization are more common. The last type of blood flow is characteristic of formations with functional autonomy.

For thyroid cancer, intranodular blood flow is considered the most typical.

Fine needle aspiration biopsy - removal of cells from a node without surgical intervention. The doctor makes a puncture under ultrasound guidance and aspirates tissue samples of all suspicious formations.

Indications for fine needle aspiration biopsy:

nodular formation more than 1 cm in diameter;
growth of the node by more than 0.5 cm in 6 months;
the appearance of indirect signs of the oncological process.

Fine needle biopsy morphologically confirms the clinical diagnosis. The main task of the study is to identify or exclude an oncological process.

Hormonal status is determined in all patients with thyroid nodules. Most often, patients experience euthyroidism (normal levels of TSH and thyroid hormones).

In elderly patients, subclinical or manifest thyrotoxicosis is detected quite often (up to 5%). The cause of hyperfunction of the thyroid gland is the autonomy of the node.

In 0.1–3% of all cases, nodular goiter of the thyroid gland is accompanied by the development of hypothyroidism. The cause of decreased function is long-term iodine deficiency in the diet. Subclinical hypothyroidism manifests itself only in laboratory tests (increased TSH). Manifest hypothyroidism leads to weight gain, edema, constipation, depression, and bradycardia.

Radioisotope scintigraphy is performed to study the functional activity of nodular formations. A clinical situation where this method plays a critical role is the need to identify or exclude the functional autonomy of nodes.

During the study, autonomous formations excessively accumulate the radioactive element and appear “hot” on the scintigram.

If the node does not stand out against the background of the rest of the tissue during scintigraphy, then it is considered benign and devoid of functional activity.

“Cold” nodes do not accumulate the radioactive element. This picture is typical for oncological processes and hypothyroidism.

Intraoperative and postoperative diagnostic methods are relevant only if surgical treatment is chosen.

During surgery (intraoperatively), ultrasound examination and urgent histological examination of tumor tissue can be performed. Typically, these methods are used when adenocardoma is suspected. Data obtained during surgery determine the extent of surgical intervention.

In the postoperative period, a histological examination of the thyroid tissue is required.

According to statistics, in 5–10% of cases, the data of fine-needle aspiration biopsy do not coincide with postoperative histology.

Treatment of nodular goiter

Tactics in relation to thyroid nodules:

surgical treatment;
observation.

The decision on the need for radical treatment is made jointly by the endocrinologist and the surgeon. Before the operation, medicinal treatment of hormonal disorders (thyrotoxicosis, hypothyroidism) is carried out.

Indications for surgery:

thyroid cancer according to biopsy;
benign tumor (adenoma) according to biopsy;
functionally active node;
a node more than 4 cm in diameter;
compression of the surrounding tissues of the neck;
cosmetic defect.

In all other cases, conservative tactics are chosen. Observation consists of regular ultrasound of the thyroid gland (1–4 times a year), fine-needle aspiration biopsy as indicated, and determination of hormonal status (1–2 times a year).