Diagnosis and treatment of goiter and nodules

Following the simple physical examination by a physician, a blood sample is taken to determine whether there is a sufficient amount of thyroid-stimulant hormone (TSH) in the bloodstream. This hormone is an indicator of whether the thyroid is functioning normally. To determine the actual size of the nodules and/or the thyroid, ultrasonography (an ultrasound exam) is performed. This exam is completely painless. Further examination methods for the recognition of nodules are:

  • Thyroid scintigraphy
    An examination required for all nodules, which appear to have a minimum diameter of 1 cm. The patient will receive receive a capsule or a liquid containing a weak radioactive substance which accumulates in the thyroid. On the gamma-camera monitor, the radiologist can see whether the nodule has absorbed any more or less iodine than the rest of the thyroid tissue. If certain regions of the thyroid illuminate in “warm” colours such as red or yellow, that points to a “hot” nodule. If the colours are rather “cold” (blue or violet), then a cold nodule is present.
  • Fine-needle puncture (biopsy)
    In order to rule out or prove the malignancy of nodules, a tissue sample is extracted with the aid of a small needle.

 

How are goiter and nodules treated?23

Not every goiter and nodule requires treatment. Depending of their type and size (in some cases), their development should merely be regularly observed.24 In general, there are three different goiter therapy methods. The choice of therapy depends on each individual patient’s diagnosis. The primary aim of treatment is the shrinkage of the enlarged thyroid and the nodules.

  • Treatment with medication(s)
    For goiters and nodules which occur due to an iodine deficiency, treatment with iodine tablets alone or in combination with levothyroxine can be effective. When goiters and nodules are accompanied by hyperthyroidism (for instance, as in the case with “hot” nodules), additional medication are applied.
  • Radio-iodine therapy
    Radioiodine is administered on a one-off basis, in the form of a capsule or as a liquid It then enters the thyroid, via the bloodstream, where it is stored — and prompts the shrinkage of the thyroid tissue due to the short-range radiation.
  • Thyroid surgery
    When the occurrence of a malignant growth in the thyroid is detected, the whole thyroid gland should be removed via surgery and if a goiter or nodules cause immense discomfort the thyroid gland can be partially/completely removed. Following such a procedure, treatment with substitution therapy (levothyroxine) is required to replace the lacking thyroid hormone production.

 

Regardless of the particular therapy — and also to help prevent thyroid disorders — you should always ensure adequate iodine intake in your diet.

Did you know?

Iodine can commonly be found in sea fish, seafood, bread, cheese, cow’s milk, eggs, yoghurt and seaweed.2

References

  • 22Becker K.L.: Principles and practice of endocrinology and metabolism. Lippincott Williams & Wilkins; Third edition (2001)
  • 23Meikle A.W.: Endocrine replacement therapy in clinical practice. Humana Press; 1 edition (2003)
  • 24Becker K.L.: Principles and practice of endocrinology and metabolism. Lippincott Williams & Wilkins; Third edition (2001)