Hypoechoic nodes on the thyroid gland. Nodules and nodular formations on the thyroid gland Hypoechoic formation of the thyroid gland without blood flow

Echogenicity is the ability of individual organs to conduct ultrasound waves. Depending on their location, tissue density, permeability varies. It is customary to distinguish isoechoicity, hypoechogenicity, hyperechogenicity and anechoicity. When an ultrasound examination of the thyroid gland reveals darker inclusions than the organ itself, this condition is usually called hypoechogenicity.

What is a hypoechoic thyroid nodule?

Hypoechoic formations of the thyroid gland are detected during ultrasound examination of the organ. This term can mean such entities as:

1. Thyroid cyst with clear liquid contents.
2. Benign tumors.
3. Proliferation of vascular areas.
4. Fibrocystic adenoma.

All these forms of nodes are heterogeneous, have different structures and manifest themselves differently. As a rule, there are no symptoms at first. And according to statistics, this pathology is more common among the female population.

Some hypoechoic thyroid nodules may resolve on their own. Therefore, it is imperative to carry out a repeated examination with ultrasound.

If the thyroid tumor does not decrease and begins to cause specific symptoms, this may indicate dangerous pathological processes. In this case, patients are prescribed additional examination methods, such as blood tests for hormones, MRI, CT, and radiography. In some cases, a biopsy is indicated if the doctor suspects cancer.

Types of echogenic formation of the thyroid gland

There are the following types of hypoechoic formations of the thyroid gland:

1. Diffuse goiter - determined by enlargement of the organ. As a rule, multiple cystic neoplasms can be traced. They are different in structure and can be hypoechoic or hyperechoic. To exclude cancer, it is necessary to carefully examine each cyst and, if necessary, prescribe additional diagnostics.
2. Hypoplasia is a disease of the thyroid gland in which the organ decreases in size. It occurs due to various reasons, but ecology, lifestyle and heredity play a special role.
3. Cyst - characterized by the appearance of formations of various shapes with viscous transparent contents. On ultrasound examination they have smooth borders. When it is detected, it is important to examine nearby tissues and organs in order to exclude a necrotic process.
4. Malignant and benign tumors are also diagnosed using ultrasound.

Thyroid adenoma can have any structure, be hypo-, an- or hyperechoic. Identified by the thick rim in the figure.

Endocrine organ cancer does not have clear boundaries and is often characterized by small inclusions of various origins. If an ultrasound examination reveals something similar, the patient is prescribed a histological diagnostic method and other examination methods.

How does a hypoechoic thyroid nodule manifest?

Hypoechoic formation of the thyroid gland can represent any pathological process of this organ, and therefore is determined by very specific symptoms.

The patient may be concerned about:

1. Weakness, malaise, decreased performance.
2. Constant drowsiness, lethargy and apathy.
3. Dry skin.
4. Abnormal stool, which often results in constipation.
5. Shortness of breath develops, it is especially pronounced during physical exertion.
6. Strong and sudden change in weight.
7. Difficulty swallowing and may experience some pain.
8. Hoarseness of voice.
9. Breathing problems.
10. In some diseases of the thyroid gland, its noticeable increase can be observed.
11. Nervous system disorders are observed. This is expressed by irritability, unstable mood, tearfulness, and a tendency to stress and depression.

Consequences of hypoechogenicity of the endocrine organ

A hypoechoic tumor in the thyroid gland poses a significant threat to life. Since the pathogenesis of formation can be malignant.
Even if cancer is not confirmed by ultrasound, benign tumors of the endocrine organ also negatively affect overall health. This is expressed by breathing problems, the nervous system is disrupted, metabolic processes suffer, lymph nodes enlarge and the risk of inflammatory diseases increases.
In some cases, when treatment is severely neglected, surgery may be prescribed with total removal of the organ and even the parathyroid gland.

The thyroid gland is one of the most vulnerable parts of the endocrine system. Autoimmune processes and functional activity disorders (hypothyroidism and thyrotoxicosis) are widespread. In addition, thyroid tissue is prone to the formation of nodes. Such neoplasms appear especially often in residents of iodine-deficient regions. Nodules in the thyroid gland are detected through a medical examination and ultrasound.

During the consultation, the endocrinologist carefully palpates the area of ​​the anterior surface of the neck. Thanks to this technique, fairly large neoplasms (from 1 cm in diameter) can be detected. The doctor can assess their size, mobility, and density. Ultrasound provides much more information. Ultrasound finds smaller nodes (from 1-3 mm). In addition, during ultrasound diagnostics, the specialist receives information about the internal structure of the tumor, blood supply, and the presence of a capsule.

Echogenicity of thyroid nodules

Echogenicity is one of the characteristics that neoplasms have according to ultrasound diagnostics. No other techniques (palpation, tomography, radiography, scintigraphy) allow us to judge this parameter.

Based on ultrasound results, all nodes are classified into:

• hypoechoic;
• hyperechoic;
• isoechoic.

Echogenicity shows the ability of a tumor to reflect ultrasound waves in comparison with surrounding tissues. Isoechogenic nodes are equal in this ability to the rest of the thyroid gland, hyperechoic neoplasms reflect ultrasound better, and hypoechoic ones reflect ultrasound worse.

On an ultrasound machine monitor, hypoechoic areas appear darker; low tissue ability to reflect ultrasound waves is associated with a high water content. Hypoechoic neoplasms may contain colloid inside, shed blood, tissue fluid, for example, such nodes include overstretched follicles, cysts, hematomas, etc. A hypoechoic node may also be partially represented by a cellular component. Such an ultrasound conclusion does not even exclude a tumor (benign or malignant).

After additional examination, the patient may be diagnosed with:

• nodular colloid goiter;
• true cyst;
• benign cystic fibrous tumor (adenoma);
• thyroid cancer.

The causes of each of these diseases include external and internal factors.

Nodular colloid goiter usually forms in patients who live for a long time in regions of goiter endemia with low iodine content in water and food. Patients are also united by a hereditary predisposition to the disease. Besides, nodular colloid goiter more often occurs in women after childbirth and breastfeeding.

True cysts are congenital. They appear due to defects in the formation and formation of the thyroid gland. The cause of the cyst is believed to be adverse effects during fetal development.

Adenomas (oncological tumors) are formed due to genetic predisposition, exposure to toxic substances and ionizing radiation. The reasons for the appearance of such tumors are not fully known.

Symptoms of a hypoechoic node

Signs of thyroid nodules do not occur in all patients with neoplasms. Even large tumors may not manifest themselves for a long time. Complaints appear if the node compresses surrounding organs and tissues. In this case, the patient may feel choking and a lump in the throat when swallowing solid food. Some patients notice changes in the contours of the neck.

A hypoechoic thyroid nodule has the same symptoms as isoechoic and hyperechoic ones. It is impossible to determine echogenicity during examination and analysis of patient complaints.

Diagnostics

If a hypoechoic node is found on ultrasound in a patient, then further in-depth diagnostics is required. A comprehensive examination allows you to establish an accurate diagnosis and prescribe treatment.

• hormonal profile (thyroxine, triiodothyronine, calcitonin and thyrotropin);
• analysis for antibodies (to thyroid peroxidase, etc.);
• fine needle aspiration biopsy.

Hypothyroidism, thyrotoxicosis or euthyroidism can be determined by hormone levels. In addition, the concentration of calcitonin determines the likelihood of medullary cancer.

An antibody test shows whether there is autoimmune inflammation in the thyroid tissue.

A fine-needle biopsy allows you to obtain material from a node without surgery. Histologists examine the collected tissue under a microscope. In 95% of cases with a hypoechoic node, only normal cells are found, in 5% - cancerous.

Treatment of neoplasms

Hypoechoic formation of the thyroid gland does not always require active interventions.

• the node is less than 4 cm;
• there are no symptoms of compression of surrounding tissues;
• According to the puncture results, no malignant cells were found.

The operation is prescribed for:

• large benign nodes;
• toxic nodes;
• follicular adenoma;
• thyroid cancer;
• compression of the neck organs;
• pronounced cosmetic defect.

In some cases, the patient may benefit from treatment with radioactive iodine. This tactic is most appropriate for toxic nodes and some forms of cancer.

Medicines are also sometimes prescribed for patients with hypoechoic nodes, for example, hormone therapy is required for hypothyroidism. For thyrotoxicosis, thyreostatics are prescribed. If a patient has signs of iodine deficiency, then medications with this trace element are included in the treatment regimen.

The most common method for diagnosing the condition of thyroid tissue is ultrasound. Its diagnostic value lies in its accessibility, high reliability and ease of implementation. The use of ultrasound devices is based on such a characteristic of all living tissues as echogenicity. Identification of hypoechoic ones indicates structural disorders, and a careful study of diagnostic data allows one to predict the course of the disease with high accuracy.

What is echogenicity

A key characteristic of organs examined using ultrasound is their ability to reflect ultrasound waves - echogenicity. The degree of reflection depends, first of all, on the density and morphological structure of the tissue, therefore the echogenicity of different organs is not the same. The dependence of acoustic properties (the ability to reflect, absorb waves) and the morphology of an organ is based, first of all, on the amount of the liquid component: the higher the water content in the tissues, the lower the echogenicity. The degree of reflection of ultrasonic waves during diagnostics is displayed on a computer monitor using color - the more intense the gray color a certain area is painted, the less ability it has to reflect waves.

Examination of a healthy thyroid gland shows a characteristic unchanged structure reflecting normal echogenicity (isoechoicity). If a pathological focus has formed in the endocrine tissue (nodule, calcification, tumor, cyst), a regional change in acoustic properties is recorded. Studying the nature of this change allows us to determine the size, structure, and etiology. Inclusions containing fluid, tumor cells or scar tissue will be reflected in different colors on the monitor.

Types of pathological echogenicity

Depending on the acoustic properties, the pathological inclusion can be:

• hypoechoic (with reduced reflectivity)
• hyperechoic (with increased reflectivity)
• isoechoic (ultrasound waves are reflected in the same way as from healthy tissue)
• anechoic (reflection of ultrasound waves does not occur).

Foci with high density and, accordingly, low water content are hyperechogenic. This is most often due to the predominance of the connective tissue component or calcium deposits. Some benign and malignant tumors (adenoma, papillary cancer), and inclusions of calcifications (calcifications) are hyperechoic.

Hypoechogenicity is characteristic of inclusions with a high fluid content and due to which they weakly reflect ultrasonic waves. These lesions are displayed during diagnosis in the form of darkening of various shapes and sizes. These can be colloid nodes, inflammatory foci in autoimmune thyroiditis, cysts, pathological foci in Graves' disease. Not the entire lesion, but part of it may have pathological echogenicity. For example, an isoechoic formation with a hypoechoic rim is often found in one or another lobe of the thyroid gland. This indicates the presence of a node in the initial stage of its development.

The anechoic focus is displayed in black on the monitor, which means complete absorption of ultrasonic waves (no reflection). Formations with a capsule filled with fluid have this property - true and false cysts, cystic growths.

Characteristics of hypoechoic formations

A decrease in acoustic density occurs due to the destruction of follicles and hormone-producing cells, inflammatory processes, and vascular growths. An accumulation of fluid or colloid forms in the pathological focus, resulting in the development of nodular or cystic lesions. Their signs such as volume, structure, localization depend on the nature of the pathological process.

Cyst

During ultrasound diagnostics, a cyst is defined as a rounded anechoic or hypoechoic formation in the thyroid gland with a homogeneous or heterogeneous structure (more dense inclusions). The lesion is clearly separated from the surrounding tissues (has a capsule) and is colored dark gray or black. Either one cyst or several in the form of clusters can be detected. The size of the cyst ranges from a couple of millimeters to several centimeters. Large cysts are accompanied by goiter syndrome of varying severity and require additional diagnostics to determine the morphological characteristics - biopsy.

Colloidal node

Another fairly common hypoechoic lesion is the colloid node. It is formed as a result of the death of follicles or hyperplasia of endocrine tissue and the accumulation of colloid - a gel-like substance with hormones, synthesized by thyrocytes. The colloid contains a large amount of liquid, therefore it has reduced echogenicity and is colored dark gray in the ultrasound picture. This formation is benign. In most cases, it has a fuzzy outline, so differential diagnosis is made with a malignant tumor that has similar characteristics on ultrasound.

Causes of hypoechoic formation

The appearance of structures with low echogenicity in the thyroid gland is in most cases associated with a lack of iodine in the body. Under conditions of iodine deficiency, endocrine cells (thyrocytes) produce an insufficient amount of hormones, which leads to a compensatory increase in blood flow in the thyroid gland and its hyperplasia - proliferation. With the growth of follicles, which in a healthy organ are a structural and functional unit, accumulation of colloid occurs in them - a product of the synthesis of thyrocytes. Due to the large amount, the outflow of colloidal masses in some areas becomes difficult, and a node or cyst is formed. The frequency of diagnosing hypoechoic formations in the right and left lobes of the thyroid gland is approximately the same.

The development of cysts can also be associated with an inflammatory process, organ injuries, and congenital pathology. Among the diseases in which hypoechoic nodes appear in the thyroid gland are:

• chronic autoimmune thyroiditis
• hypothyroidism
• chronic intoxication
• thyrotoxicosis
• Pendred's syndrome.

Treatment methods

Depending on the disease against which pathological foci have formed in the endocrine tissue, therapy may be different. After a comprehensive examination, including, in addition to ultrasound, blood tests, Doppler ultrasound, computed tomography, biopsy (if necessary), the endocrinologist draws up an individual treatment plan. If the formation is small in size, does not cause inconvenience to the patient and does not affect thyroid function, drug therapy (replacement, suppressive, symptomatic) is used.

Large cysts or nodes can put pressure on tissue and cause the development of decompression syndrome, which makes it difficult to swallow, speak, and in severe cases, breathe. Such lesions require surgical intervention. A puncture of the formation with suction of its contents or a more radical operation - hemistrumectomy, in which the node or cyst is removed along with the affected lobe, can be performed. After the operation, the patient is under the supervision of the treating endocrinologist and receives replacement or symptomatic therapy.

A hypoechoic formation of the thyroid gland is an area of ​​the organ in which fluid has accumulated or a malignant neoplasm has appeared. They discover it during. If the size of the changed zone exceeds 10 mm, the patient is referred to. Be sure to prescribe to determine the level of hormonal activity of the thyroid gland. Based on the results of diagnostic procedures, a decision is made on the advisability of drug therapy or surgical treatment.

What is echogenicity

The ultrasound method is based on the ability of body tissues to transmit and reflect ultrasound waves. Depending on the thyroid gland, the sensor records hyperechogenicity (increased), hypoechogenicity (decreased), and lack of response (). On the screen of an ultrasound machine, areas of different densities differ in darkness.

The norm is considered to be uniform echogenicity of the thyroid gland. When an organ changes, liquid content accumulates inside cells, or malignant nodes appear, the acoustic parameters change.

Types and possible causes of hypoechoic areas

Uneven darkening, which the sonologist sees on the monitor, indicates the presence of abnormal areas in the organ. Thus, a hyperechoic formation in the thyroid gland is a sign of a denser area than normal tissue. Most often this is a fibrous node. On a computer screen it looks uniform, has a clear outline and rim. The nature of such compaction is benign.

A hypoechoic thyroid nodule is a structure within which fluid has accumulated or has occurred. When scanned, these appear as dark spots. During palpation, the endocrinologist is not always able to detect them.

Echo-negative structures of the gland do not reflect the sensor signal. Anechoicity is detected in intranodular vessels and vessels of normal glandular tissue. There is also no reflection of sound inside cavities of the normofollicular type - vesicles of cystic and tumor origin, filled with contents.

The diagnosis of “hypoechoic formation” is not a guide to treatment. It, together with other results, is used to determine the disease. Ultrasound diagnostics only identifies abnormal areas and determines their size. But the detection of a hypoechoic formation means that there are nodes in the gland, cancer, hyperthyroidism, and destruction of the organ occurs as a result.

The term “nodes” refers to all voluminous neoplasms in an endocrine organ. This can be either thyroid cancer or non-cancerous structures - fibrous compactions. Often, large neoplasms are found in patients who complain of difficulty swallowing or breathing, or compression in the neck. Small nodules are detected by chance when a person undergoes a routine examination.

A goiter of the thyroid gland (in particular) develops as a result of the body. For the majority of those diagnosed with the disorder (95%), goiter does not pose a risk of cancer.

Cysts are immature gland cells that are filled with fluid. These formations are safe.

Additional examinations

Often, despite the hypoechoic formation, tests are normal. In such situations, doctors recommend checking the condition of the gland twice annually and monitoring hormonal levels.

The presence of deviations in the results of laboratory diagnostics is a sign that the formation in the gland has formed as a result of a metabolic disorder; drug correction of the condition is required.

Possible symptoms accompanying formations

People who have small areas of decreased echogenicity in the gland often feel normal. Sometimes small cysts resolve. But large nodes make themselves felt by a feeling of squeezing of the throat, the presence of a foreign body. May be of concern:

• soreness;
• attacks of suffocation;
• hoarseness;
• painful difficulty swallowing.

Why are hypoechoic nodes dangerous?

Identification of areas of reduced echogenicity in the thyroid gland requires monitoring the condition of the gland. Cancers grow in size very quickly. They cause compartment syndrome and in later stages metastasize to the brain, lungs, and other organs.

Cystic formations can grow to large sizes (more than 3 cm). The neck is deformed, the movement of lymph is disrupted.

Autonomic toxic formation often provokes hyperthyroidism. With this pathology, a person suffers from attacks of rapid heartbeat, increased sweating, and body heat. Irritability is observed, and exophthalmos may occur ().

Thyroid treatment methods

What tactics are chosen when an area of ​​reduced echogenicity is detected depends on several factors:

• number of identified nodes;
• size of formations;
• concomitant pathologies;
• age.

The presence of several small nodes (up to 10 mm) allows us to limit ourselves to observing them. You need to do an ultrasound and consult with an endocrinologist at least once every six months.

The specialist may recommend filling the cystic formation (10-30 mm) with sclerosant. If tests show a lack of hormones, treatment with L-Thyroxine and (Iodomarin, Iodine balance, Microiod) will be prescribed. Monitoring must be done every 3 months.

Large benign nodes are recommended to be removed. The remaining part of the gland replaces the lost one and produces hormones in sufficient quantities.

Malignant formation requires immediate surgical intervention. fully. The patient is prescribed (L-Thyroxine, Euthyrox) and drugs containing calcium - Calcium D3, Calcemin.

Thyroid nodules– rounded foci of proliferation of thyroid tissue. These formations may have a capsule separating them from the surrounding tissue or be filled with colloidal fluid. 95% of thyroid nodules are benign and are not life-threatening.

Mostly the nodes do not manifest themselves in any way and do not cause changes in well-being. In some cases, they can produce thyroid hormones, causing symptoms of thyrotoxicosis: protrusion of the eyeball, excessive sweating, weight loss, fatigue, nervousness. Occasionally, large nodes cause compression of the neck organs, which is manifested by a feeling of a lump in the throat and difficulty swallowing.

Statistics. Thyroid nodules are a fairly common occurrence, and the frequency of their detection increases with age. Thus, among young people, single formations in the thyroid gland are detected in 2-3%, and in 70% of people over the age of 60 years. In men, nodes occur 2-3 times more often than in women. This pattern is associated with hormonal levels and lifestyle: addiction to alcohol and smoking.

Most often, nodes form in the outer surface of the thyroid gland. Thanks to this feature, they are easily palpable, and in thin people they can even be seen with the naked eye.

Thyroid gland – the most important endocrine organ that regulates metabolism. It produces iodine-containing hormones - triiodothyronine, thyroxine, as well as calcitonin, synthesized in C-cells.

The thyroid gland is shaped like a butterfly. It is located on the front surface of the neck and covers the pharynx, trachea and esophagus.

The gland consists of the right and left lobes and the isthmus. 30-40% of people have an additional pyramidal lobe, which is directed upward from the isthmus.

The parenchyma (functioning tissue) of the gland consists of special epithelial cells - thyrocytes. They form the walls of small vesicles - follicles, which produce thyroxine and triiodothyronine. A follicle is a structural unit of an organ, a closed vesicle containing a colloid inside.

Colloid– homogeneous viscous pink liquid. Most of it is made up of the protein thyroglobulin, which is a precursor to thyroid hormones. When the function of the organ is impaired, the follicle becomes overcrowded, which can lead to the development of nodular colloid goiter.

The thyroid gland needs large amounts of blood to obtain iodine. Therefore, this organ has a developed system of blood vessels. The top of the thyroid gland is covered with a capsule of connective tissue. Its processes grow deep into the organ, dividing the gland into segments.

Thyroid nodules are formed by the uncontrolled proliferation of thyrocytes, vascular cells or connective tissue.

Causes of thyroid nodules.

• Colloid accumulations in follicles causes the appearance of 90% of nodes. It can develop due to circulatory problems in one of the lobes of the gland.
• Cysts. The reason for their appearance may be:
  • congenital anomaly
  • hemorrhage into the follicle due to injury to the gland
  • disruption of colloid outflow.

A strong cyst shell is formed from epithelial cells or connective tissue. It protects the pathological focus from healthy tissue. There may be liquid or viscous contents, blood or pus inside.

• Nervous stress and hypothermia lead to local vasospasm. As a result, the nutrition of individual areas of the thyroid gland is disrupted and local immunity is reduced. Against this background, the processes of cell division are disrupted.
• Bad ecology causes the entry of free radicals and carcinogenic substances into the body. They disrupt the genetic apparatus of thyrocytes and lead to their uncontrolled division. This process can be the beginning of a benign or malignant tumor.
• Iodine deficiency in the environment and food leads to a compensatory increase in certain areas of the thyroid gland. By increasing its volume, the gland tries to capture more iodine from the blood.
• Increased radiation levels. The most dangerous areas are areas adjacent to the nuclear testing area, areas affected by the Chernobyl accident, professions associated with ionizing radiation, as well as radiation therapy to the neck area. Radiation disrupts the process of chromosome division and provokes mutations in cells, leading to the appearance of malignant tumors.
• Inflammatory processes(tuberculosis, thyroiditis). The inflammatory process can cause swelling of individual lobes of the gland. Thus, pseudonodules are formed, which externally resemble tumors.
• Autoimmune diseases. The attack of immune antibodies on the thyroid gland leads to inflammatory edema (infiltration) of its individual areas.
• Pituitary adenoma. This brain tumor produces thyroid-stimulating hormone, which stimulates the division of thyroid cells and can cause the appearance of multiple thyroid nodules - nodular toxic goiter.
• Hereditary predisposition. Nodules in the thyroid gland are a feature of its development that is inherited.

Types of nodes

Based on the number of nodules, they are divided into:

• Unit nodule – one nodule has formed in the thyroid gland
• Multiple nodes – 2 or more nodes detected

Types of thyroid nodes by structure

• Thyroid cancer(papillary, medullary, follicular, anaplastic). Usually this is a single node consisting of malignant cells. A cancerous tumor is characterized by rapid growth, the absence of a membrane and clear boundaries. It is very firm to the touch and usually painless. Cancer may be accompanied by enlarged cervical lymph nodes. This indicates the appearance of metastases in them.
• Adenoma– a benign tumor of a round shape, surrounded by a fibrous capsule. The tumor develops relatively slowly and does not spread to other organs. It consists of normal thyrocyte cells that produce hormones, which is often accompanied by a decrease in the function of the rest of the gland tissue. A benign tumor appears in people over 40 years of age. In women it is detected 3-4 times more often than in men.
• Colloidal nodes They are follicles with a large number of thyrocytes and a significant volume of colloid. Such nodes can be either single or multiple. They are characterized by slow growth. Most often they do not cause symptoms and are discovered incidentally. Colloid nodes rarely develop into cancer and in 90% of cases do not require treatment.
• Cyst. A cavity surrounded by a capsule and filled with liquid contents. More common in women. It can appear at any age, but over the years the likelihood of its occurrence increases significantly. Cysts are characterized by slow growth. Small cysts are dense to the touch. As they increase in size, the shell becomes thinner and when palpated, fluctuations in the liquid contents are noticeable.

Symptoms of thyroid nodules

Symptoms that occur when a large node compresses surrounding tissues

• Voice changes causes a large node over 2-3 cm, especially located in the pyramidal lobe of the thyroid gland. A large knot compresses the larynx. Hoarseness often occurs with malignant thyroid nodules, when the tumor grows into the vocal cords.
• Swallowing disorder when squeezing the esophagus and a feeling of a lump in the throat when squeezing the esophagus and trachea by a large node.

Symptoms associated with elevated levels of iodine-containing hormones

Symptoms of thyroid nodules depend on the size of the nodule and the amount of hormones it produces. Small nodes that do not secrete hormones do not manifest themselves in any way and are accidentally discovered during an ultrasound scan. They appear as areas that are different in color from the rest of the gland tissue. Ultrasound diagnostics can detect nodes larger than 5 mm.

Diagnosis of thyroid nodules

The doctor is particularly wary in the following cases:

1. Examination by a doctor
   

   According to modern concepts, the formation of nodules in the thyroid gland is caused by disturbances in intracellular processes in the organ. Based on the doctrine of bioregulation, domestic scientists have developed a new class of medicines - citamines. Cytamines contain regulatory peptides - substances that regulate intracellular processes and ensure the normal functioning of organs and tissues. A specific set of peptides is suitable for each organ. To normalize the functioning of the thyroid gland, a thyroid bioregulator – Tyramine – has been developed.

   Tyramine helps improve the functioning of the thyroid gland in case of various disorders of its functions, normalizes energy metabolism, and also:

   • Improves the metabolism of thyroid cells, as a result of which the level of production of thyroid hormones is normalized, which has a positive effect on the metabolic processes of the body as a whole.
   • Accelerates the restoration of thyroid function after operations and after extreme stress loads.
   Tyramine is recommended for use as a prophylactic agent in areas where thyroid disease is endemic.

   

   At the appointment, the endocrinologist takes a medical history and examines the patient. During the examination, the patient may be asked to lie on a couch to allow the neck muscles to relax as much as possible. Another option is for the patient to sit and the endocrinologist to feel the thyroid gland with the thumbs of both hands.

   What does the doctor pay attention to during examination?

2. • increase or decrease in the volume of the thyroid gland
   • elasticity and size of the gland
   • pain in certain areas of the thyroid gland
   • number of nodes and their size
   • knot density - elastic or hard
   • mobile or fused to surrounding tissues
   • are there any changes in the skin over the node - swelling, redness, dilatation of superficial vessels
   • protrusions on the front of the neck
3. • patient's age is younger than 14 and older than 70 years
   • radiation therapy given in childhood
   • thyroid disease in close relatives
   • fast growing node
   • dense “rocky” compaction
   • enlarged cervical lymph nodes
   • a node fused to the trachea or muscles
   • voice, breathing, swallowing problems
   • knot size more than 1 cm

These signs may indicate the malignant nature of the node. Therefore, if at least one of the listed symptoms is present, a thorough examination is carried out to determine the nature of the neoplasm.

4. Laboratory tests

   Patients with thyroid nodules need a blood test to determine the following hormones:

   • triiodothyronine or free T3 hormone (FT3)
   • thyroxine – free T4 hormone (FT4)
   • thyroid stimulating hormone (TSH)
   • calcitonin
   • antibodies to TPO (thyroid peroxidase)

   Hormone	Norm	Indicators indicating pathology
   Triiodothyronine free or hormone T3	3.2-7.2 pmol/l.	Promotion. With thyrotoxicosis caused by the synthesis of hormones in the nodes, the levels can exceed the norm by 5-7 times. T3 increases during inflammatory processes in the thyroid gland and adenoma. Decline T3 is observed in malignant neoplasms and cysts.
   Free thyroxine– hormone T4	9-22 pmol/l	Promotion. With thyrotoxicosis, the hormone level increases 3-4 times. This can happen when the nodes produce iodine-containing hormones. These are toxic adenoma, toxic multinodular goiter, autonomously functioning thyroid nodes. Decline T4 can indicate large nodes, cysts, malignant tumors, autoimmune lesions.
   Calcitonin	pg/ml	Promotion its level even by 5-10% may indicate medullary thyroid cancer and other cancers. Calcitonin levels increase during pregnancy.
   Thyroid-stimulating hormone (TSH) hormone of the anterior pituitary gland	0.4-4.0 honey/l	Promotion TSH indicates that the function of the thyroid gland is reduced and it does not produce enough hormones. This may indicate thyroid cancer. Decline TSH can be caused by: toxic adenoma, toxic multinodular goiter, autonomously functioning thyroid nodes.
   Antibodies to TPO (thyroid peroxidase) AT-TPO, or microsomal antibodies		Excess the norm speaks from the autoimmune nature of the node and nodular toxic goiter. However, other hormones may be normal.

   
   The results of the analysis can be affected by excessive physical activity, a diet low in protein, pregnancy, taking glucocorticoids, dopamine receptor antagonists, clomiphene, amiodarone, lithium carbonate, aspirin, furosemide, etc. TSH levels decrease when goiter is treated with thyroid hormones.
5. Thyroid scintigraphy

   Scintigraphy– a method for examining the thyroid gland after administration of radioactive iodine preparations. The gland tissue absorbs isotopes, and a special gamma camera allows you to determine where they are concentrated.

   • Increased concentration radioactive substance in a limited area of ​​the gland indicates that the node is actively absorbing iodine and synthesizing hormones. This is the so-called "hot" node– adenoma or multinodular toxic goiter.
   • Reduced concentration isotope compared to surrounding tissue says that “cold” node. There are no hormone-producing cells in it. This picture is observed with a cyst, malignant tumor, colloid nodular goiter, thyroiditis.
   A contraindication to thyroid scintigraphy is pregnancy. Radioactive isotopes can cause abnormalities in fetal development.
   
6. Ultrasound of the thyroid gland

   Ultrasound of the thyroid gland is prescribed to all patients when a nodule is detected, an increase or decrease in the volume of the thyroid gland. During the procedure, the number, size and exact location of the nodes, as well as the condition of the gland itself, are determined.

   Signs of thyroid nodules on ultrasound

   • Contours of the gland not even - a bulge on the border of the organ at the site of formation of the node.
   • Gland structure not homogeneous - the node may absorb ultrasound better or worse than the surrounding tissue.
   • Anechoic formations– nodes in the thyroid gland that are not capable of reflecting ultrasound. They appear as dark spots on the screen. These can be cysts with clear contours and fluid inside or colloidal nodes.
   • Hypoechoic formations – structure poorly reflecting ultrasonic waves. These can be cysts, clusters of blood vessels, swollen areas soaked in liquid. On the monitor screen they appear as dark spots.
   • Hyperechoic formations – a dense knot containing little fluid. It reflects ultrasound well and looks like a bright spot. This could be an adenoma, areas of calcium deposits, or papillary cancer that has not been encapsulated.
   Different types of thyroid nodules on ultrasound
   1. Adenoma
      • hyperechoic light node
      • hypoechoic dark rim around the node - an area of ​​edematous tissue that weakly reflects ultrasound
      • a small number of blood vessels inside the node
   2. Cyst
      • anechoic round node - a dark round formation with clear contours
      • hyperechoic light thin rim – dense connective capsule of the cyst
      • absence of vessels inside the node
   3. Tumor with signs of malignancy
      • formation is round or irregular in shape with signs of germination into surrounding tissues
      • hypoechoic dark node without clear contours (some types of malignant tumors may have clear contours)
      • a large number of capillaries inside and along the edges of the node
      • heterogeneity of the node - areas of calcification, necrosis or fluid accumulation.
      Based on the results of ultrasound, it is difficult to determine whether a thyroid nodule is a malignant tumor. A definitive diagnosis can only be made based on the results of a biopsy.
7. Fine needle biopsy and biopsy microscopy

   Biopsy- This is the removal of a small number of tissue cells for examination under a microscope. A needle is inserted into the assembly and, by pulling the plunger of the syringe, a sample is obtained for microscopy. This manipulation is repeated 2-3 times to obtain material from different parts of the node. The procedure is carried out under ultrasound control.

   The resulting material is applied to a glass slide and sent to the laboratory. There, a sample of cells (punctate) is examined under a microscope.

   No preliminary anesthesia is performed. A biopsy is no more painful than a regular injection, and the presence of medication in the tissue sample can skew the results.

   Indications for biopsy:

   1. nodes more than 1cm
   2. some nodes less than 1 cm:
      • the patient has relatives with thyroid cancer
      • the patient underwent radiation therapy
      • signs of cancer on ultrasound
   Contraindications
   • acute mental illness of the patient
   • categorical refusal to carry out the procedure
   Possible biopsy results

   The sample may contain: colloid, blood, pus, follicular epithelial cells, atypical (altered) cells. Based on the research, the doctor makes cytological report.

   • uninformative material – it was not possible to make an unambiguous diagnosis
   • inflammatory focus - there are signs of inflammation in the node
   • benign node - consists of normal, unchanged cells
   • follicular neoplasia – there is a possibility of follicular cancer
   • thyroid cancer – malignant cells were found in the sample
   Based on the biopsy conclusion, the endocrinologist determines treatment tactics.

Treatment of thyroid nodules

Treatment with medications

Group of drugs	Mechanism of therapeutic action	Representatives	Directions for use
Thyroid hormones	Used to treat nodular colloid goiter. The drug is used to induce a state of thyrotoxicosis. Under such conditions, the production of thyroid-stimulating hormone decreases and the division of thyroid cells that make up the node stops.	L-thyroxine	Take in the morning on an empty stomach 30 minutes before meals. The dose is about 150 mcg/day. Allowed for patients whose nodes do not synthesize hormones due to iodine deficiency. This treatment is contraindicated for toxic adenoma and multinodular toxic goiter.
Thyrostatic drugs	Used for the treatment of adenoma and nodular toxic goiter. They disrupt the addition of iodine to thyroid hormones. The drugs inhibit the synthesis of iodine-containing hormones (T4 and T3) and relieve the manifestations of thyrotoxicosis, but do not affect the size of the node.	Espa-carb	Initial dose 20–60 mg Maintenance therapy 20–60 mg The drug is taken once a day for 6-18 months.
		Thiamazole	Initial dose 0.02-0.04 g 3-6 weeks Maintenance dose 2.5-10 mg per day for 1.5-2 years.
		Propycyl	The initial dose is 75-100 mg/day in 4 doses. Maintenance dose 25-150 mg/day.
Iodine preparations	Treatment of nodular euthyroid goiter resulting from iodine deficiency. The drugs ensure a normal supply of iodine and stop the growth of cells in the node.	Iodide 200	Take 50-200 mg per day after meals with plenty of water.
		Potassium iodide 200	200-500 mcg per day in 2-3 doses. The drug is taken after meals.

For thyroid nodules, self-medication is unacceptable. Drugs can only be prescribed by an experienced endocrinologist after examination. Incorrect treatment can provoke tumor growth.

When is surgery needed to remove a thyroid nodule?

Surgery to remove thyroid nodules called a thyroidectomy. The extent of surgery depends on the size of the node and the results of the biopsy.

Indications for surgery to remove thyroid nodules

• nodule measuring 3 cm or more
• malignant cells detected during biopsy
• “cold” nodes that do not synthesize hormones according to scintigraphy results
• rapid growth of nodes in combination with questionable biopsy results

Contraindications

• severe heart failure and decompensated heart defects
• bleeding disorders
• age over 75 years

Method of performing surgery to remove thyroid nodules

The operation is performed under general anesthesia. The surgeon makes an incision in the lower third of the neck. The thyroid gland is separated from the blood vessels and laryngeal nerve and the damaged part is removed.

The cyst is removed along with the membrane. A large nodule is removed along with one lobe of the thyroid gland so that the remaining part continues to produce hormones. If cancer cells are detected, the thyroid gland is removed completely, sometimes along with surrounding tissue and lymph nodes. Otherwise, cells that extend beyond the tumor can cause metastases.

After the blood supply is restored, cosmetic sutures are applied to the skin. If the operation was successful and there were no complications, then after 3-4 days the patient can return home.

Nutrition for thyroid nodules (diet)

Proper nutrition for thyroid nodules can stop the growth of tumors and prevent the appearance of new elements. It is necessary that the body receives enough iodine, zinc, copper and cobalt.

• sea ​​fish - tuna, halibut, cod, herring
• seafood – shrimp, squid, mussels, crabs
• seaweed – cytozera, fucus, kelp
• fruits and berries – chokeberry, strawberry, raspberry, blueberry, gooseberry
• vegetables are consumed raw and boiled. Particularly useful are zucchini, pumpkin, green peas, eggplant, beets, leeks, cauliflower and Brussels sprouts, black radish, and parsnips. Potatoes no more than 1-2 pieces per day.
• dried fruits, except smoked
• any cereals in the form of porridges cooked in water, muesli
• wholemeal bread up to 100 g per day
• eggs 1-2 per week
• sprouted grains – oats, wheat, barley
• oils – olive, corn, sesame, sunflower. Melted butter up to 20 g per day
• herbal teas from wormwood, yarrow, hops, ginseng, rosea radiola, eleutherococa
• honey 1-2 tablespoons per day

For thyroid adenoma and toxic nodular goiter, limit fish, algae, and seafood that contain a lot of iodine. These foods increase T3 and T4 levels.

Limit or completely eliminate

• meat and sausages
• smoked products
• margarine and combined fats
• fried foods, stewed in their own juices and baked are allowed
• canned food – meat, fish, vegetables
• dairy products except one-day kefir
• seasonings ketchup, mustard, mayonnaise, adjika
• pickled vegetables with plenty of salt
• sugar and any confectionery

These products disrupt the functioning of the endocrine glands and contribute to the appearance of malignant cells in the thyroid nodules.

Physiotherapy for the treatment of thyroid nodules

Thyroid nodules are a contraindication for most physiotherapy procedures, like any other benign or malignant neoplasms. Physiotherapeutic treatments accelerate metabolism and cell growth processes. Therefore, physical procedures can provoke the proliferation of malignant cells in the nodes. Only laser therapy is allowed, which is used to destroy nodes.

Destruction of a node with a laser or interstitial laser photocoagulation. The laser beam heats local areas of tissue and evaporates moisture from the cells. Thus, the knot tissue “dries out”.

Indications

• benign thyroid nodules
• nodular and multinodular euthyroid goiter
• nodular toxic goiter
• thyroid cancer
• the patient’s refusal to undergo surgery or the presence of contraindications to its implementation

Contraindications

• severe mental illness
• blood system diseases
• acute inflammation of the respiratory tract
• exacerbation of chronic diseases.

Traditional methods of treating thyroid nodules

Propolis oil solution. Mix one teaspoon of crushed propolis with 100 g of refined vegetable oil. Heat the mixture in a water bath for 10 minutes and strain. The oil solution is rubbed into the thyroid gland every evening. This remedy restores the supply of microelements, improves blood circulation in the gland and helps to reduce the node.

Mistletoe infusion taken from a birch tree. 1 teaspoon of crushed mistletoe is poured into 250 ml of cold water in the evening. In the morning, the infusion is filtered, it is drunk throughout the day and used for lotions. This remedy fights malignant cells and prevents the malignant degeneration of nodes. The plant is toxic, so it is important not to exceed the dose and not ingest it for more than 2 weeks.

Licorice tincture contains substances similar to steroid hormones. They have an anti-inflammatory effect and stabilize the synthesis of thyroid hormones. The infusion also has a calming effect, which is important for patients with hyperthyroidism. 1 teaspoon of licorice root is poured into a glass of vodka and left for 10-14 days in a dark place. Take 30 drops 3 times a day in a tablespoon of water. The course of treatment is 20 days.

Traditional methods of treatment can improve the general condition and normalize the functioning of the thyroid gland. However, treatment with traditional methods cannot replace surgery to remove a thyroid nodule. When a pathology is detected, it is necessary to follow the doctor’s recommendations to prevent the node from degenerating into a malignant tumor.