THYROID NODULES: IS IT NECESSARY TO REMOVE OR NOT?

Although very common, the nodules of the thyroid gland does not always cause symptoms. They are sometimes discovered by chance. Then he must be taken into account and decide if a surgical removal of the thyroid is necessary or if a simple oversight is sufficient. It's a real problem. The purpose of this article is simply to give some guidance.

The circumstances of discovery

The circumstances of discovery of one or more thyroid nodules are extremely varied. It may be a remark by a relative who think your neck has "inflated" lately.It may be an incidental finding during routine examination of the thyroid gland by a doctor. It may be a discovery after ultrasound examination had been requested in the balance disturbances in thyroid hormone levels in the blood. It can be, but more rarely, a painful thyroid gland or compressing the trachea (breathing difficulty) or the recurrent laryngeal nerve (nerve of speech, resulting in a change of voice).

A nodule or nodules?

There may be one or several nodules touching one of the two lobes of the gland or its entirety. These nodules can be large and of different nature: solid nodules or cysts fluid "hot" or "cold". They can also be benign or cancerous.When the thyroid gland is the seat of many nodules were told that there was a multinodular goiter. The best test to specify the number, size and location of nodules on ultrasound of the gland.

Hot or cold nodules nodules?

The hot or cold nature of a nodule is determined by its ability to fix iodine in a review by scintigraphy. Scintigraphy is a measure of radioactivity emitted by the thyroid gland after intravenous injection of radioactive iodine. If the nodule fixed highly radioactive iodine, is said to be "hot." Otherwise it is said to "cold." This distinction is important because hot nodules are sometimes associated with excessive secretion of thyroid hormone in the blood (which can be confirmed with a dosage of hormones in the blood). These nodules are sometimes annoying when the secretion of the hormone is too high and has physiological effects. These hot nodules are rarely cancerous. In contrast, cold nodules are most often cancer patients (about 10% of cases).

Benign or malignant nodules nodules?

Thyroid cancer is a rare cancer, a fairly good prognosis, which is found mainly in cold nodules when they are unique. The problem is to know where these nodules are cancerous or not? A cold nodule is suspicious when he recently increased in volume during ultrasound monitoring or that its contours are irregular, still ultrasound. It is not always the case, and often it resorts to a puncture of the nodule with a needle under anesthesia locally for a microscopic examination of cells collected. This is called cytology. The results, when conditions are good sampling techniques are threefold: Benin, suspicious or malignant.

Should we operate or not?

Surgery is not always necessary in problems of nodules. Cases that are not discussed are those where the cancerous nature of the nodule is proven (at biopsy) or strongly suspected (ultrasound and biopsy suspicious). The operation involves removing the entire gland and remove the ganglia neighbors. In cases where there is not some kind of cancerous nodule, it is practice for the operation a microscopic analysis of it. If this review confirms cancer, you remove the entire thyroid and lymph nodes are collected. If it does not confirm cancer, it only removes the lobe containing the nodule (and of course it is verified by a closer examination that takes several days that the nodule is Benin in the analysis). Removing all or only half thyroid (thyroid understand both lobes) is important because in the first case it will take thyroid hormone every day and lives to replace the missing gland. Moreover, it is often suggested when a cancer was found, according to the total removal of the gland, radiation therapy by injection of radioactive iodine, which will destroy any thyroid cells that might have been left by the surgery. When the nodules are considered mild can simply monitored every six months with possibly taking thyroid hormone by mouth, which inhibit the secretion of natural hormones and evolution of the nodule. If the nodule is large, however it will be preferable to have surgery because of cytology is less reliable then. Similarly, if the nodule appears Benin but it is experienced as embarrassing, it will be possible to operate. Hot nodules are rarely operate except in the case of hormone hypersecretion causes physiological disorders. The problem of multinodular goiter is a little different.They are rarely malignant but also because of their heterogeneity, they are especially difficult to monitor and can become compressed by their size. The decision to operate will be made after a comprehensive review of the record, and the opinion of the endocrinologist and surgeon.