How Is Goitre Treated
Treatment depends on the underlying cause of the goitre.;Simple goitre, where there is no thyroid hormone imbalance and no problems arising from the size of the thyroid, is unlikely to cause problems. In case the goitre is large and symptomatic , it may be appropriate to consider surgery , though this will result in the patient requiring lifelong thyroxine replacement.
Treatment of overactive and underactive thyroid is explained in articles on hyperthyroidism and hypothyroidism, respectively.
How Common Are Thyroid Nodules
Thyroid nodules are very common, especially in the U.S. In fact, experts estimate that about half of Americans will have one by the time theyre 60 years old. Some are solid, and some are fluid-filled cysts. Others are mixed.
Because many thyroid nodules dont have symptoms, people may not even know theyre there. In other cases, the nodules can get big enough to cause problems. But even larger thyroid nodules are treatable, sometimes even without surgery.
How Are Goiters Treated
Depending on the test results, a goiter might not need to be treated. If it does, treating the thyroid disease causing the goiter usually will decrease or control the enlargement.
Surgery might be needed if the thyroid keeps getting bigger even with treatment and causes discomfort or a very large lump in the neck.
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Where Thyroid Cancer Starts
The thyroid gland is in the front part of the neck, below the thyroid cartilage . In most people, the thyroid cannot be seen or felt. It is shaped like a butterfly, with 2 lobes the right lobe and the left lobe joined by a narrow piece of gland called the isthmus.
The thyroid gland has 2 main types of cells:
- Follicular cells use iodine from the blood to make thyroid hormones, which help regulate a persons metabolism. Having too much thyroid hormone can cause a fast or irregular heartbeat, trouble sleeping, nervousness, hunger, weight loss, and a feeling of being too warm. Having too little hormone causes a person to slow down, feel tired, and gain weight. The amount of thyroid hormone released by the thyroid is regulated by the pituitary gland at the base of the brain, which makes a substance called thyroid-stimulating hormone .
- C cells make calcitonin, a hormone that helps control how the body uses calcium.
Other, less common cells in the thyroid gland include immune system cells and supportive cells.
Different cancers develop from each kind of cell. The differences are important because they affect how serious the cancer is and what type of treatment is needed.
Many types of growths and tumors can develop in the thyroid gland. Most of these are benign but others are malignant , which means they can spread into nearby tissues and to other parts of the body.
Ultrasound Testing & Manual Exams
There are really three different ways to test or evaluate your thyroid nodule.;
The first is with a manual exam, usually performed by your doctor.;
This is an easy way to test whether or not you need further testing.;
Your doctor can do this when you visit him/her in the office.;
This test is usually done by manually feeling or palpating the thyroid gland while the patient is taking a drink of water.;
The second is with ultrasound testing, usually performed by an ultrasound technician and read by a radiologist.;
Ultrasound testing can help you to understand if your thyroid nodule looks suspicious or not.;
There are certain factors, or characteristics, which, if present, may increase your risk of having thyroid cancer.;
These factors include:;
- The presence of absence of calcification – Microcalcifications found within thyroid nodules may suggest the presence of thyroid cancer.;
- The shape of the nodule – If your thyroid nodule is taller than it is wide then that is a risk factor for thyroid cancer.;
- The vascularity of the nodule – The presence of vascularity by Doppler ultrasound is also suspicious for thyroid cancer.;
- The margins of the nodule – Nodules which have irregular borders, which look ‘infiltrative’ , or which have speculated margins are all suspicious.;
Your ultrasound report should include this information and you can request this information from your primary care doctor or your radiologist.;
The third is with a biopsy, usually guided by an ultrasound.;
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How Should I Prepare
Once the imaging is complete, the clear ultrasound gel will be wiped off your skin. Any portions that are not wiped off will dry quickly. The ultrasound gel does not usually stain or discolor clothing.
After an ultrasound examination, you should be able to resume your normal activities immediately.
A radiologist, a doctor trained to supervise and interpret radiology exams, will analyze the images. The radiologist will send a signed report to the doctor who requested the exam. Your doctor will then share the results with you. In some cases, the radiologist may discuss results with you after the exam.
Ultrasound examinations are very sensitive to motion, and an active or crying child can prolong the examination process. To ensure a smooth experience, it often helps to explain the procedure to the child prior to the exam. Bringing books, small toys, music or games can help to distract the child and make the time pass quickly. The ultrasound exam room may have a television. Feel free to ask for your child’s favorite channel.
How Big Is Too Big
When it comes to thyroid nodules, the size matters quite a bit.;
Studies have shown time and time again that larger thyroid nodules tend to turn into thyroid cancer at a higher rate compared to smaller thyroid nodules.;
The magic number in terms of size is 1 cm or 10mm.;
But size isn’t the only thing that matters.;
It has been shown that even small thyroid nodules can be cancerous if they have certain and specific findings on thyroid ultrasound.;
The number of nodules and their size are not predictive of malignancy, as a nodule smaller than 1 cm is as likely as a larger nodule to harbor neoplastic cells in the presence of suspicious US features.
For this reason, you never want to judge the risk of thyroid cancer based on the size of your nodule alone.;
You will notice that while the size is certainly a risk factor, you should also look at other risk factors including whether or not the nodule is causing symptoms, your age, and what the nodule looks like on ultrasound.;
As a patient, though, you can use the size of your nodule as a quick and dirty way to assess whether or not you should be worried.;
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How Do I Know If I Have Thyroid Nodules
Most thyroid nodules do not produce any symptoms. However, if you have several nodules, or large nodules, you may be able to see them. Although rare, nodules can press against other structures in the neck and cause symptoms, including:
Hyperfunctioning thyroid nodules can lead to overproduction of thyroid hormones, also known as hyperthyroidism. Symptoms of hyperthyroidism include:
What Are The Symptoms Of Hyperthyroidism
The symptoms of hyperthyroidism can vary from person to person and may include
- Nervousness or irritability
- Imaging tests, such as a thyroid scan, ultrasound, or radioactive iodine uptake test. A radioactive iodine uptake test measures how much radioactive iodine your thyroid takes up from your blood after you swallow a small amount of it.
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Symptoms Of Thyroid Goiters
Most thyroid goiters don’t cause symptoms, but they will if the goiter continues to grow. In fact, small thyroid goiters may more commonly be detected by routine examination of the patient’s neck by a doctor or by some type of screening x-ray or scan for some other reason. The symptoms occur as the goiter becomes big enough that it presses on other structures in the neck.
Larger thyroid goiters most commonly produce symptoms of
- A mass or lump in the neck.
- Uncomfortable pressure sensation on the breathing tube
- A sense of feeling like you need to swallow something or difficulty swallowing
- Excess production of the thyroid hormone, thyroxine which include:
- Unexplained weight loss
- Rapid or irregular heart rate
Enlarged Thyroid Vs Painful Thyroid
It’s important to differentiate between an enlarged thyroid gland and a painful thyroid gland.;
This one single symptom is unique to very few conditions and can easily help you figure out a diagnosis.;
Your thyroid gland is an organ and is susceptible to inflammation and infection, just like other parts of your body.;
This condition occurs very rarely, however, because for the most part your thyroid is protected from the rest of your body.;
This is one of the very few conditions which cause pain in the thyroid gland when touching it.;
Subacute thyroiditis can also result in an enlargement of the thyroid gland but it’s almost always associated with pain.;
This pain is important because it can easily help differentiate other, more serious, conditions which cause an enlargement of your thyroid gland.;
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How Do Doctors Diagnose Hashimotos Disease
Doctors diagnose Hashimotos disease based on
- medical history and physical exam. Your doctor will start by taking a medical history and performing a physical exam. In addition to asking about symptoms, the doctor will check your neck for a goiter, which some people with Hashimotos disease can develop.
- blood tests. Your doctor will order one or more blood tests;to check for hypothyroidism and its causes. Examples include tests for
- the thyroid hormones T4 and T3
- thyroid-stimulating hormone, or TSH
- thyroid peroxidase antibodies , a type of thyroid antibody that is present in most people with Hashimotos disease
You probably wont need other tests to confirm you have Hashimotos disease. However, if your doctor suspects Hashimotos disease but you dont have antithyroid antibodies in your blood, you may have an ultrasound of your thyroid. The ultrasound images can show the size of your thyroid and other features of Hashimotos disease. The ultrasound also can rule out other causes of an enlarged thyroid, such as thyroid nodulessmall lumps in the thyroid gland.
What Is A Thyroid Goiter
Thyroid goiter is a condition where there is an abnormal enlargement of your thyroid gland. The photo here shows how many thyroid goiters look, which is like the neck is swolen and fat. When you touch it, you can tell it isn’t fat since it is firm and doesn’t move much. Most thyroid goiters are painless, but they may produce symptoms due to their size itself. The most common symptom from a thyroid goiter is a lump in the neck. Other symptoms from a large thyroid goiter may include a sense of a lump in the throat, difficultly swallowing, difficulty breathing and even in extreme cases, voice changes and even vocal cord paralysis.
World wide, the most common cause of thyroid goiter is in locations where iodine in the diet is low or non-existent. This was similarly the case in the United States where thyroid goiter was commonplace until the contemporary iodination of table salt. Since then, the incidence of thyroid goiters have drastically been reduced in the United States.
Today, in the United States, thyroid goiter is more commonly associated with too much production of thyroid hormone , too little production of thyroid hormone , or multiple nodules within the thyroid gland itself .
There are two autoimmune conditions that can be causes of thyroid goiter.
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How Can A Thyroid Ultrasound Help With Diagnosis
An ultrasound can give your doctor a lot of valuable information, such as:
- if a growth is fluid-filled or solid
- the number of growths
- where the growths are located
- whether a growth has distinct boundaries
- blood flow to the growth
Ultrasounds can also detect a goiter, a swelling of the thyroid gland.
What Are The Risks Of Removing The Thyroid Gland
Behind your childs thyroid gland runs the recurrent laryngeal nerves that help to move the vocal folds and the parathyroid glands which help regulate their bodys calcium levels.
Some of the major risk factors following the removal of the thyroid gland are:
- A hoarse/breathy voice.
- Low calcium levels.
After surgery your child will need to take a medication to supplement the thyroid function and in some cases a medication to keep calcium levels elevated.
Other risk factors include:
- A scar on the neck.
- Fluid collection under the skin.
- The need for future procedures such as removal of the lymph nodes from the neck.
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What Is The Treatment For Thyroiditis
Treatment for inflammation of the thyroid gland depends on the type of thyroiditis and the symptoms.
- Treatment for thyrotoxicosis includes beta blockers to decrease palpitations and decrease tremors;
- Treatment for low thyroid hormone includes thyroid hormone replacement;
- Treatment for thyroid pain includes anti-inflammatory medications such as aspirin or ibuprofen. Steroids such as prednisone may be used if pain is severe.;
Hyperthyroidism Diagnosis And Treatment
A blood test measures levels of thyroid hormone and thyroid-stimulating hormone in your blood. The pituitary gland releases TSH to stimulate the thyroid to produce its hormones. High thyroxine and low TSH levels indicate that your thyroid gland is overactive.
Your doctor might also give you radioactive iodine by mouth or as an injection, and then measure how much of it your thyroid gland takes up. Your thyroid takes in iodine to produce its hormones. Taking in a lot of radioactive iodine is a sign that your thyroid is overactive. The low level of radioactivity resolves quickly and isnt dangerous for most people.
Treatments for hyperthyroidism destroy the thyroid gland or block it from producing its hormones.
- Antithyroid drugs such as methimazole prevent the thyroid from producing its hormones.
- A large dose of radioactive iodine damages the thyroid gland. You take it as a pill by mouth. As your thyroid gland takes in iodine, it also pulls in the radioactive iodine, which damages the gland.
- Surgery can be performed to remove your thyroid gland.
If you have radioactive iodine treatment or surgery that destroys your thyroid gland, you will develop hypothyroidism and need to take thyroid hormone daily.
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Other Causes Of Hyperthyroidism
Hyperthyroidism can also result from thyroid nodules. These are lumps that develop inside the thyroid and sometimes begin producing thyroid hormones. Large lumps may create a noticeable goiter. Smaller lumps can be detected with ultrasound. A thyroid uptake and scan can tell if the lump is producing too much thyroid hormone.
How Is A Thyroid Biopsy Performed
A thyroid biopsy, also called a fine needle aspiration , uses a small needle to take a little sample of the cells in the thyroid nodule. The possible outcomes from a biopsy are:
Non-diagnostic: Non-diagnostic is a technically failed biopsy. There were not enough cells taken during the biopsy so the cytologist was not able to determine anything. These usually need to be repeated.
Benign: Most thyroid nodule biopsies come back benign, meaning your doctor is highly re-assured that it’s not cancerous. Patients can almost always avoid surgery unless the nodule is large and pushing on adjacent structures like the airway.
Indeterminate:; Indeterminate means there was enough cells taken during the biopsy, but the cytopathologist was not sure if it is benign or malignant. Indeterminate results occur in about 20% of thyroid biopsies. This is a gray zone and means that the risk of cancer is about 10-30%. These nodules require additional work-up such as a repeat biopsy, molecular marker test, or surgical removal.
Suspicious for Malignancy or Malignant: Results categorized in these two categories are a strong indicator that there is cancer present and usually require surgical removal.
Patients usually wait one week for the cytopathologist to examine the cellular characteristic of the biopsy sample. If your doctor is reassured that it’s benign based on the biopsy result, further work-up is stopped and serial ultrasound surveillance is recommended usually once a year.
Who Is At Risk For Hyperthyroidism
You are at higher risk for hyperthyroidism if you
- Are a woman
- Are older than age 60
- Have been pregnant or had a baby within the past 6 months
- Have had thyroid surgery or a thyroid problem, such as goiter
- Have a family history of thyroid disease
- Have pernicious anemia, in which the body cannot make enough healthy red blood cells because it does not have enough vitamin B12
- Have type 1 diabetes or primary adrenal insufficiency, a hormonal disorder
- Get too much iodine, from eating large amounts of foods containing iodine or using iodine-containing medicines or supplements
What Are The Symptoms Of Goiter
The main symptoms of goiter include:
- A swelling in the front of the neck, just below the Adam’s apple
- A feeling of tightness in the throat area
- Dizziness when the arms are raised above the head
Other, less common symptoms include:
- Difficulty breathing
- Difficulty swallowing
Some people who have a goiter may also have hyperthyroidism, or overactive thyroid. Symptoms of hyperthyroidism can include:
- An increased resting pulse rate
- Rapid heartbeat
- Sweating without exercise or increased room temperature
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