What Is Toxic Nodular Goiter?

Nodular goiter, most of them have a history of simple goiter, and in the advanced stage, multiple nodules are formed. The incidence is higher.

Basic Information

English name

nodulargoiter

Visiting department

Endocrinology

Multiple groups

Over 30 years old

Common symptoms

no

Causes of nodular goiter

Most of them are based on simple diffuse goiter. Due to the repeated progress of the disease, the follicular epithelium changes from diffuse hyperplasia to focal hyperplasia, and some areas have degenerative changes. The lesions alternated repeatedly, and nodules of different developmental stages appeared in the gland. The lesion is actually a late manifestation of simple goiter. In patients with nodular goiter, 5% to 8% of them may develop toxic symptoms, namely Plummer's disease or toxic nodular goiter. Some nodular goiters, caused by excessive proliferation of epithelial cells, can form embryonal adenomas or papillary adenocarcinomas, as well as thyroid cancers.

Clinical manifestations of nodular goiter

1. The patient has a long history of simple goiter. The age of onset is generally greater than 30 years. More women than men. Goiter varies in degree and is asymmetric. The number and size of nodules vary, and are usually multiple nodules. There may be only one nodule at an early stage. Nodules are soft or slightly hard, smooth, and no tenderness. Sometimes the nodules are unclear, and there is only an irregular or lobulated sensation on the surface of the thyroid. The disease progressed slowly, and most patients were asymptomatic. Large nodular goiters can cause symptoms of compression, difficulty breathing, swallowing, and hoarseness. Acute bleeding in the nodule can cause a sudden increase in pain and pain. The symptoms can resolve within a few days, and the enlarged mass can be reduced in a few weeks or longer.

2. When nodular goiter develops hyperthyroidism (Plummer's disease), the patient has symptoms such as fatigue, weight loss, palpitations, arrhythmia, fear of heat and sweat, and irritability. Eyes are rare and finger tremors are rare. Elderly patients often have atypical symptoms.

3. Whether the patient has a history of receiving radiation, oral medication history and family history, whether the patient came from the region as an endemic goiter. Generally, nodular goiter has a long history, no symptoms of compression, and no symptoms of hyperthyroidism. Patients usually don't care, and inadvertently find a thyroid nodule for medical examination.

4. If it is a hot nodule, also known as a toxic nodule, the patient is more than 40-50 years old, the nature of the nodule is medium hardness, symptoms of hyperthyroidism, and even atrial fibrillation and other arrhythmia symptoms, such as bleeding You may feel pain or even fever. Compression symptoms can occur when the nodule is large, such as dysphonia, poor breathing, chest tightness, shortness of breath, and irritating cough.

5. For patients with nodular goiter from an iodine-deficient area, their thyroid function may be low, and clinically, heart rate slowing, edema, rough skin, and anemia may occur. A few patients can also become cancerous. The nodules are more common in warm nodules. They can be treated with thyroid preparations, and the enlarged glands can shrink. Cold nodules are relatively rare. Those with clinical hypothyroidism can be treated with thyroid preparations, but often require surgery.

Nodular goiter examination

1. thyroid B ultrasound

Clinical examination of thyroid B ultrasound can confirm that the thyroid nodules are substantial or cystic, with a diagnosis rate of 95%. Most thyroid nodules with cysts are benign nodules, which can be cured or reduced by suction. Patients with substantial nodules should also undergo thyroid scans or puncture pathological examinations. High-resolution ultrasound image examination can analyze nodules to 1mm lesions. Clinically, those with single nodules can often be found as multiple nodules, which are close to those seen at autopsy. Most cystic lesions are not truly cystic but have Solid tissue lesions and can show mixed echo waves.

2. Radionuclide imaging inspection

Commonly used thyroid scans include nuclide ¹³¹ and ^99m Tc, ie ¹³¹ iodine scan and ^99m scan. Thyroid nodules have different iodine uptake capabilities and different images for classification. ^99m Tc can be taken up by the thyroid like iodine, but cannot be converted. Malignant nodules cannot take up iodine, and radioactive sparse areas will appear in the malignant area. According to their iodine uptake ability, they can be divided into nonfunctional cold nodules, normal functional warm nodules, and high functional hot nodules. The disadvantage of radionuclide or ^99m Tc scanning is that it cannot completely distinguish benign or malignant nodules, but only a preliminary judgment analysis. There were reports of 22 patients who were treated with radionuclide scans, and all of them underwent surgical treatment regardless of their thyroid function. As a result, cold nodules accounted for 84%, warm nodules 10.5%, hot nodules 5.5%, of which 16% were cold nodules. 9% of warm nodules and 4% of hot nodules are malignant nodules. Therefore, cold nodules are the most malignant, but most of them are still benign nodules. Although the malignancy of hot nodules is small, but There are also malignant nodular lesions. In recent years, a normal thyroid scan method using 75 selenium-selenium methionine as a tracer has also been developed. Compared with normal thyroid tissue, there are more cell divisions, higher cell density, and lesions in the malignant nodular lesion area. Normal images appear everywhere. ^Those with cold nodules after ¹³¹ or ^99m Tc scan and normal phase development after 75 selenium-selenomethionine scan showed that the probability of malignant nodules was more than 50%. Americium-241 fluorescence scanning technology can be used to identify benign and malignant nodules through indirect measurement of iodine capacity. It is more sensitive and effective than ¹³¹ and ^99m Tc scans, but also produces false positives. In addition, there are currently inspection methods such as nuclear magnetic resonance, dry plate radiography, electronic radiographs, and temperature recorders, all of which need further application.

3. Pathological examination of thyroid puncture

Fine needle aspiration biopsy is of certain value in the diagnosis of thyroid nodules and is relatively safe. The puncture result is helpful for the indication of surgical treatment, and its cytological accuracy is 50% to 97%. However, sampling may be wrong, especially in patients with cystic changes and smaller nodules, such as lesions smaller than 1 cm, the accuracy of puncture may be difficult. Fine-needle biopsy cannot be determined, and a thick-needle biopsy may be used, and the results may be more accurate. However, after the puncture needle enters the malignant nodule cancer, cancer cells can spread to its harm, and special attention should be paid. In order to determine the nature of the nodule before surgery, an open thyroid biopsy can also be used to facilitate a comprehensive analysis.

Nodular goiter diagnosis

Thyroid nodules are mostly benign nodules, which can be single or multiple. Some have endocrine function, clinically called nodular hyperthyroidism, and some without endocrine function are general nodular hyperthyroidism, and some have hypofunction. Consider the possibility of a thyroid tumor. Simple nodular goiter is generally not difficult to diagnose, has a long history, is mostly free of compression symptoms, and generally has normal clinical manifestations. The thyroid tissue can be reduced in different degrees when the thyroid preparation is tried. The final diagnosis should rely on pathological examination to determine the nature of thyroid nodules.

Nodular Goiter Treatment

General simple nodular goiter, whether it is a single nodule or multiple nodules, if it is a warm nodule or a cold nodule, you can try thyroid preparations. Give thyroid powder (tablets) 1 or 2 times daily. Or use levothyroxine sodium (LT ₄ ) tablets 1 to 2 times a day. Those who have enlarged nodules after treatment can continue to use until they disappear completely. Those who do not disappear after treatment should be treated with thyroid nodules. The changes in thyroid function should be observed during treatment. Those who have functional autonomy for thermal nodules should also be treated mainly with surgery, and changes in thyroid function should also be observed after surgery.

A few of the cold nodules are hypothyroidism, which can be treated with thyroid preparations for 4 to 6 months. If the nodules shrink, they can be avoided from surgery. If the nodules do not shrink, they grow rapidly and involve surrounding tissues, which should be considered malignant Cancer, strive for surgical treatment as soon as possible. Surgical treatment is often thorough, and hypothyroidism often occurs after surgery, and thyroid hormone must be replaced for life.