Dr. Ertan Beyatlı

What should be done for Thyroid Nodule?

(Update: ) - general subjects

What is a Nodule?

Thyroid Nodule is an abnormal tissue growth in the thyroid gland that is in the form of a lump different from the normal thyroid tissue and can be in the size of pea, chickpea, chickpea, hazelnut or sometimes walnut or orange.

As the thyroid gland grows with the nodules, this disease Nodular Goiter also called.

The importance of a nodule for the patient and the doctor

  • Whether there is cancer in the nodule
  • Whether the nodule has the ability to secrete excessive hormones
Thyroid nodules

One in Two People in the Community Has a Thyroid Nodule

Thyroid nodules in the community very common is a disease. Some of the nodules are noticed by hand and their rate is around 7% in the society. Iodine deficiency and the frequency of nodules that can be noticed by hand in the regions with 25% of that population. The frequency of small nodules that cannot be detected by hand is higher, and when the thyroid glands are examined with ultrasound or scanning is performed, the nodule is detected in 50-60% of the population. This means that almost one in two people has a nodule. Nodular goiter is seen 2-3 times more in areas with iodine deficiency.

Nodule Frequency Increases With Age

Nodule frequency increases with age and in women according to men 4 times more is found. During pregnancy, there is an increase in the diameter of the thyroid nodules and an increase in the frequency of new nodule formation.

Why Does a Nodule Occur?

Why the thyroid nodule is formed not yet known. However, genetic-inheritance plays an important role in nodule formation. Thyroid nodules are common in the same family. Therefore, if one of your family members has a nodule, it is likely that you have it too.

Which Doctor Should Apply?

If there is a nodule Endocrinology first It is necessary to consult a specialist. You can find endocrinologists in Medical School hospitals and other large hospitals. Endocrinology specialization is done on internal medicine specialization. During this specialization, thyroid diseases, diabetes, obesity, osteoporosis, short stature and other hormone diseases are specialized. If an endocrinologist is not available at your location, consult an internal medicine specialist. The endocrinologist plans your treatment after evaluating your nodule with the necessary examinations.

What Does a Hot or Cold Nodule Mean?

A nodule being hot or cold scintigraphy examination is a situation set forth with. Thyroid scintigraphy  technetium 99 It is attracted by a radioisotope substance called (Tc 99). This drug administered intravenously goes to the thyroid gland.

  • Cold Nodule (Hypoactive). If the nodule does not hold this material, the nodule is seen as a gap in the scintigraphy film. These nodules that do not contain the medication are called "cold nodules".
  • Hot Nodule (Hyperactive). Nodules holding the given drug appear in black on scintigraphy. These nodules that hold the technetium are called "hot nodules".
  • Warm Nodule (Normoactive). If the nodule holds medication similar to other thyroid tissue, this nodule is called a "warm nodule".

Cancer rate is higher in cold nodules than in warm nodules. However, there may be cancer in warm nodules. For this reason, all nodules should be biopsied whether it is hot or cold. Although the biopsy is done twice, there is no point in performing a re-biopsy unless there is an abnormal development in benign cases.

What Does a Cystic Nodule or Solid Nodule Mean?

Fluid accumulates inside some of the nodules and cystic nodule is called. Hard nodules that do not contain liquid solid or hard nodule is called. Whether a nodule is cystic or solid thyroid ultrasound is understood with.

What Does a Single Nodule or Multiple Nodules Mean?

Sometimes a single nodule in the thyroid gland (Solitary Thyroid Nodule), sometimes there may be more than one nodule (Nodular or Multinodular Goiter). Whether it is a single nodule or multiple nodules in the thyroid gland cancer rate 5%' Truck.

What is the Frequency of Cancer in Nodules?

About half of the nodules are found as single nodules in the thyroid gland, while the remaining half are found as multiple nodules. In other words, while some patients have a single nodule in their gland, sometimes there are more than one nodule.

When the thyroid ultrasound is performed in patients with a single nodule during manual examination, smaller additional nodules can also be detected. Whether it is a single nodule or multiple nodules in the thyroid gland cancer in 5% of all nodules there is a risk of becoming. Although the incidence of cancer is low (0.23%) in hot nodules, there is still a risk of cancer. Cancer risk is higher in cold nodules (up to 5%).

Cancer Probability is High in Which Thyroid Nodules?

Some conditions that increase the suspicion of cancer in a patient with a nodule are as follows:

  • advancing meal difficulty eating, deepening voice, or difficulty breathing increases the suspicion of getting cancer. However, non-cancerous nodules may cause deepening of the voice by pressing the nerve. It should be kept in mind that not every deepening of the voice arises from the nodule.
  • For the head or neck in previous years radiotherapy (radiotherapy) cancer tendency increases in patients with nodular goiter and those with a family history of thyroid cancer.
  • Nodular goiter is four times more common in women than men. However, thyroid cancer more common in men.
  • Being a male, developing nodules before the age of 20 and after the age of 60 creates a risk for cancer.
  • Slow or sudden onset pain or tenderness may be due to bleeding into the nodule or cyst, or the pain may also develop due to inflammation of the thyroid gland, indicating a non-malignant event. However, sometimes there may be pain in the cancer that has spread.
  • Neck in a patient with nodular goiter swelling of the lymph nodesIf the nodule is hard, does not move and grows rapidly, it increases the suspicion of cancer.
  • Patients with nodules Levothyroxine (Euthyrosx, Tefor or Levotiron) the nodule is getting bigger while using the medicine cancer suspicion increases. Biopsy should be performed again in these nodules.
  • Nodule in children detection increases the risk of cancer. For this reason, a biopsy should be done.

Features of nodules considered to be benign:

  • Having a benign nodule or goiter in the family
  • Multiple nodules smaller than 1 cm in diameter in the thyroid gland
  • The nodule is the same size
  • The nodule being a simple cyst and a warm nodule
  • Shrinkage of the nodule with drug therapy (Levothyroxine)
  • Graves in the family or Hashimoto's disease being
  • Soft, flat and mobile nodule
  • Having more or less thyroid hormones in the blood
  • Randomly detected nodules less than 1 cm in diameter by ultrasound
  • Nodule that occurs during pregnancy
  • Soft nodules
  • Hashimoto-type thyroid inflammation in the patient with nodule

Characteristics of Nodules with Suspected Cancer

  • A single nodule that adheres to hard and soft tissues (does not move)
  • Rapid growth of the nodule (especially when taking medication)
  • Shortness of breath and deepening of the voice
  • Paralysis of the vocal cords and hoarseness
  • Nodule in the child, nodule in the male
  • Nodule occurrence before the age of 20 or after the age of 60
  • Suspected cancer in biopsy
  • Hard nodule greater than 2 cm in diameter
  • Cyst with a diameter of 4 cm Cold nodule on scintigraphy
  • Previously head and neck radiotherapy
  • Lymph node swelling in the neck
  • Enlargement of the nodule while using Levothyroxine (Euthyrox, Tefor or Levotiron) medication
  • Having thyroid cancer in the family

Fine Needle Aspiration Biopsy Should Be Performed on All Nodules

Fine needle aspiration biopsy (FNAB) or in English, fine needle aspiration biopsy (FNAB)

Thyroid needle biopsy is the most effective and sensitive examination used in the diagnosis and treatment of thyroid nodules. A needle biopsy must be done to understand whether there is cancer in a nodule. It cannot be determined whether there is cancer or not with other examinations.

Ultrasound guided fine needle aspiration biopsy TIIAB
Ultrasound guided fine needle aspiration biopsy TIIAB

Evaluation of the thyroid nodule should first be started with biopsy. This is true for all nodules, whether single or multiple. If there is more than one nodule in a gland, it is necessary to perform a biopsy from all nodules separately. Our rule is to biopsy all accessible nodules. No exam or person can guarantee that there is no cancer in a nodule that is not biopsied. Therefore, nodules that cannot be reached by palpation (manually) should also be biopsy under ultrasound.

Thanks to the fine needle aspiration biopsy, the number of patients undergoing surgery has decreased by 50%. Biopsy an experienced doctor done by and again an experienced pathologist must be evaluated by.

As a result of the pathological examination of the cells taken by biopsy, it is usually reported as cancer in 4% of the patients, suspicious for cancer in 10%, insufficient sample in 17% (no part in the biopsy) and 70% as benign nodules.

As can be seen, the rate of cancer in nodules is low. However, sometimes there is no piece in the needle biopsy. In this case, it is necessary to repeat the biopsy 2 or 3 more times. The possibility of getting results increases with repeated biopsies. Some of the nodules that cannot be removed are cystic nodules. Since these are liquid, the cells come less. Some of the nodules that cannot be removed are small nodules.

Biopsy of thyroid cancers papillary, medullary and anaplastic types of cancer are easily recognized by the pathologist. But follicular cancer tour cannot be diagnosed by biopsy. The pathologist is therefore ''follicular tumor'' as the report writes. Surgery is performed in patients who have a pathology report as cancer, cancer suspicion or follicular nodule. If the nodule is not very large in benign cases, surgery is usually not performed and followed up.

If a nodule is benign in the first biopsy but grows gradually, and especially if it grows while taking Levothyroxine (Euthyrox, Tefor or Levotiron) drug, a re-biopsy is necessarily performed. Biopsy is also performed in people with swollen lymph nodes in the neck.

How Is Thyroid Needle Biopsy Performed?

Patients should not use aspirin, Plavix or rheumatism medications before biopsy or should stop them a few days before the biopsy. These drugs increase bleeding. In addition, those who have blood diseases such as hemophilia or those who use blood thinners such as Coumadin or those who take any herbal remedies should tell their doctor about these medications.

It does not matter if you are hungry or full while performing a biopsy. Before the biopsy is done, an appointment is made and you will go to the place where the biopsy will be done at the appointment time.

Thyroid biopsy How TIIAB is performed
Thyroid biopsy How TIIAB is performed

Thyroid needle biopsy can be done in two ways, with or without ultrasound. Ultrasound is not required for large nodules. In small nodules, the location of the nodule is determined better with the help of ultrasound. Thyroid biopsy is usually done with normal plastic syringes that you all know, used when taking blood from your arm. A separate instrument is not used and surgery is not performed (ie it is a simple and short procedure).

In daily practice, there are patients who do not come for biopsy for fear that this is an operation, and there are patients who are extremely stressed and very excited. After the biopsy, these patients'It was so easy, I was scared in vainThey say '' and go to his house.

The patient to be biopsy is first placed on the examination table and asked to give his head a little back. Thus, the thyroid gland and the nodule are better recognized. The patient is instructed not to swallow during the biopsy. The location of the nodule to be biopsied is first determined thoroughly by hand and the skin area to be biopsied is cleaned with an alcohol cotton. Then the injector needle is inserted into the nodule and the plunger of the injector is retracted to allow the tissue or nodule cells to come. The needle is then removed. As soon as the needle is withdrawn, the biopsy area is pressed for 10-15 minutes with a cotton ball to stop the bleeding. Thus, bleeding and swelling are prevented.

Small tape can then be attached to the biopsy area. If there is a feeling of discomfort in this area later, ice can be applied, but this is not necessary in 99% of patients. The biopsy pieces in the syringe are then sprayed onto small pieces of glass called slides and then spread. These glasses are sent to the pathology laboratory for examination.

During the biopsy no need to numb. Anyway, there is not much pain and there is no need for it.

After the biopsy, you are asked to sit gently getting up from the bed. After sitting for about five minutes, you get up and can go to work or home. There may be a very mild pain due to the needle being stuck while performing the biopsy. This pain is the same as when blood is taken from your arm. Therefore, you do not need to be afraid. If you do not have a biopsy and there is cancer in the nodule Do not forget that you will cause the cancer to spread as there will be a delay in treatment. Biopsy should definitely be done before surgery in patients who will undergo surgery. If it is understood that the nodule is cancer before the surgery, the surgery is performed accordingly.

Which tests are done in a patient with nodular goiter?

Hormone Tests

T3, T4 and TSH hormones, anti-TPO and anti-Thyroglobulin antibodies, calcitonin hormone, thyroid ultrasound and thyroid scintigraphy can be performed in a person with nodules. The calcitonin hormone level in the blood can also be measured to catch a type of cancer called medullary thyroid cancer early.

thyroid_sintigirafisi

Thyroid Ultrasound

Thyroid ultrasound cannot distinguish whether the nodule is cancer or benign. Ultrasound only helps to determine if a nodule is cystic or hard. There is also the possibility to detect small nodules that are not palpable with ultrasound.

Nodule features that may cause cancer suspicion in thyroid ultrasound are as follows:
1. Irregular nodule edge
2.High blood flow in the nodule with Doppler ultrasound
3. Small calcium deposits (microcalcification) in the nodule

Another point to be stated for thyroid ultrasound is the experience of the physician performing ultrasound in identifying the nodule. Thyroid ultrasound should be done by experienced physicians.

What Kind of Complaints Does Thyroid Nodule Make?

Your nodules most do not show any symptoms or complain.  Nodules are often detected by the patient or doctor. spotted randomly and rarely causes difficulty in eating, shortness of breath, deepening of the voice or forking, or neck pain. However, most of them have no symptoms.

Rarely, if there is bleeding into the nodule, it causes pain and tenderness. Such bleeding can cause spontaneous disappearance of the nodule and often cause cyst formation. Sometimes, nodules are discovered incidentally during lung and brain CT scans or during ultrasound examination of the neck vessels.

Although the diameter of the nodule reaches 4-5 cm, there are many patients who do not have any complaints.

How Does a Benign Thyroid Nodule Progress?

  1. Has a very slow growth tendency
  2. Within three years, half of benign nodules may increase in volume by 30%. Nodules grow more than other parts of the thyroid gland, and this growth is unrelated to age, sex, nodule diameter, and whether the nodule is hot or cold.
  3. Within a year, less than 20% of nodules will grow.
  4. In 20% of the nodules, there is spontaneous shrinkage.

Although nodules are benign, they can grow even if they are malignant, so the important thing is the nodule enlargement that occurs while taking drugs such as Levothyroxine (Euthyrox, Tefor or Levotiron). Nodules usually appear initially as either benign or cancerous. The transformation of benign nodules into cancer is very rare. For this reason, there is no need for a question or concern such as "What if the needle has entered the non-cancerous side of the nodule?" As patients sometimes ask.

Will the Benign Nodule Later Turn into Cancer?

In a benign nodule in a biopsy, it does not turn into cancer. Nodules are initially benign or cancerous. However, if the nodule grows rapidly despite drug treatment and if there is swelling in the lymph nodes, cancer is suspected and a biopsy is performed again.

What Does Cystic Nodule Mean?

10-20% of cold nodules are cystic nodules. Cystic nodule means a nodule containing fluid. This liquid may be chocolate, straw-yellow or bloody in color. This color is not important in terms of cancer in the cyst. The fluid inside the cystic nodules can be drained with a needle. After emptying with a needle, the diameter of the cystic nodule decreases in nearly 50% of the patients and the fluid does not accumulate again. However, in 20-30% of patients, fluid accumulates again.

Thyroid hormone drugs Levothyroxine (Euthyrox, Tefor or Levotiron) treatment is not very successful in the treatment of cysts. Not much cancer is seen only in fluid-filled cysts. The risk of cancer increases in half cystic and half hard nodules. Recurring cystic nodules are usually larger than 4 cm in diameter and need to be surgically removed.

Thyroid Nodules Treatment

Treatment with Levothyroixine in Benign, Cold and Single Nodules

After the biopsy is understood that the thyroid nodule is benign, if it is not a hot nodule and the TSH hormone is not very low and it is the only nodule, treatment is performed with the synthetic T4 drug Levothyroxine (Euthyrox, Tefor or Levothyron). With this drug treatment, in nodules with a small diameter, With Hashimoto's disease Good response can be obtained in coexisting nodules and newly formed nodules. This drug reduces the secretion of the TSH hormone, preventing the growth of the nodule and allowing it to shrink. But; In hardened nodules larger than 2.5 cm in diameter and cystic nodules, there is not much response to treatment with these drugs. It is best to perform surgery for such nodules.

How Long Does Drug Treatment Take?

The drug used in the treatment of nodules can be given for a year or more. Your doctor will decide this based on your situation. The drug, namely Levothyroxine (Euthyrox, Tefor or Levotiron) is given with TSH between 0.3-1.0 U / L. If the diameter of the nodule does not shrink at the end of this period, drug treatment is discontinued and followed without medication. If the diameter of the nodule is reduced with this treatment and this reduction is also revealed by manual examination or ultrasound, the drug dose is reduced and the drug is continued to keep the TSH between 0.3-1.0 U / L.

If the nodule grows during medication biopsy is done again and sick  is operated.

If there is no heart disease and the drug does not cause side effects, some patients can be given drugs for a long time. However, the elderly are not given much, as the side effects of the drug will be high.

Drug therapy is not given to people whose TSH hormone levels have fallen below normal. If medication is taken in people whose TSH hormone has fallen below normal, palpitations, sweating and weight loss occur. Levothyroxine (Euthyrox, Tefor or Levotiron) tablets or similar drugs that we use in the treatment of nodular goiter, we start with a small dose (1/4 tablet) (such as 25 mg / day), increase 4-5 daily by tablet (25 mg) every 1-1.5 days. We go up to the tablet dose.

Some patients may experience symptoms such as palpitations within 2-3 weeks with a daily dose of tablet medicine. In such patients, it would be beneficial to reduce the drug dose and repeat hormone tests, as well as adding Dideral or Tensinor to the treatment.

Levothyroxine (Euthyrox, Tefor or Levotiron) drug dosage  Every 3-4 months It is adjusted by looking at serum T3 and TSH levels. During treatment, T3 should be within normal limits and TSH should be between 0.3-1.0 U / L. If the nodule grows during drug therapy, the patient should be operated on.

Since there is a risk of osteoporosis in menopausal women, if medication is to be used, it is tried not to decrease the TSH hormone below the normal value. As long as the TSH hormone is within normal limits, the drug will not harm your bones.

An important issue that should be noted here is the fact that examination of the diameter of nodules by different people or evaluation by ultrasound by different people during treatment and observation can lead to false results. Therefore, the nodule should be evaluated by the same physician during the treatment and follow-up ultrasounds should be performed by the same laboratory.

How to Use Levothyroxine Medication?

The Levothyroxine (Euthyrox, Tefor or Levotiron) medication you use is usually hungry in the morning It is taken half an hour before a meal. While using this medicine, try not to use any other medication at the same meal. It is also important to use your medicine at the same time every day. If you start taking the medicine on an empty stomach, inform your doctor. In this case, it may be necessary to increase the dose of the drug.

While taking these medicines, do not take iron pill, calcium pill, pulp capsules and soy medicine or soy protein at the same time. These medications impair the absorption of Levothyroxine (Euthyrox, Tefor or Levotiron). If there are complaints such as palpitations, sweating, and weight loss after starting the medication, it means the medication is too much. In this case, consult your doctor immediately.

Patients Using Medication Should Go to Controls: Patients using medication should go to the controls on the dates recommended by the doctor to investigate whether the nodule shrinks, whether pressure symptoms appear and whether there are changes in hormones. If it is determined that the nodule is enlarged during these follow-up or controls, a re-biopsy is performed. If there is too much decrease in the TSH hormone, the drug dose is reduced. If you are going to donate blood during the controls, take your medicine after giving blood. During the controls, thyroid hormone examinations and thyroid ultrasound are performed to better understand the change in the size of the nodule.

How Is Thyroid Nodule Treated During Pregnancy?

A pregnant woman with a thyroid nodule is treated like a non-pregnant nodular goiter patient. However, thyroid scintigraphy is not performed during pregnancy, only thyroid ultrasound is performed.

Thyroid nodules should be examined with biopsy during pregnancy. If cancer is detected as a result of biopsy, thyroid surgery is performed either in the second 3 months of pregnancy or after birth. Your doctor will decide this based on the type of cancer. Postpartum surgery is usually performed, except for some types of cancer.

How Are Hot Nodules Treated?

Biopsy should also be done in hot nodules. Even if the cancer rate is low in hot nodules, it does not mean that it will not happen. For this reason, as mentioned before, a biopsy should be performed whether the nodule is warm or cold.

If a hot nodule is smaller than 2.5-3 cm and thyroid hormones are normal, it is followed up only at regular intervals without any medication or treatment. The purpose of follow-up is to perform thyroid hormones and thyroid ultrasound at regular intervals. If hormones increase during follow-up, radioactive iodine therapy is applied or hormones are brought to normal with drugs and surgery is performed.

In 20-30% of hot nodules, especially those larger than 2.5-3 cm in diameter, there is a high probability of developing excessive thyroid hormone secretion, in other words, hyperthyroidism. Therefore, hot nodules larger than 2.5 cm in diameter should be treated with radioactive iodine therapy or surgery, even if they do not secrete excessive hormones.

Treatment with the thyroid hormone drug Levothyroxine (Euthyrox, Tefor or Levothyron) cannot be performed in hot nodules. If thyroid hormone medication is taken in these patients, thyroid hormones in the blood increase and the nodule starts to work hard.

If a person with a warm nodule is elderly or has heart disease, radioactive iodine therapy is prescribed even if their hormones are normal. Because the hot nodule can start to secrete excessive thyroid hormone at any time and worsen heart disease.

In the elderly and patients with low TSH hormone blood, that is, thyroid gland overactivity at the beginning (hyperthyroidism), drugs such as Propycil or Thyramazol are given and then treatment with radioactive iodine is performed.

Multiple Nodules in the Thyroid Gland (multinodular goiter)
Having more than one nodule in the thyroid gland is called "multinodular goiter" in medical language. The word "multi" means a lot. Multinodular goiter with more than one nodule in the thyroid gland is especially detected in areas with iodine deficiency and generally in elderly people.

In these patients, thyroid scintigraphy can be performed to understand whether the nodules are hot or cold. Sometimes all of the nodules can be cold nodules, while one can be hot and the other cold. Hormones are controlled by making T3, T4 and TSH hormones.

In people with more than one nodule in the thyroid gland, if their thyroid hormones are normal and the diameter of the nodules is small, most of these patients do not have any complaints. In a goiter that did not have a nodule in the past, new nodules emerge over the years and multinodular goiter may develop.

Just like patients with a single nodule in the thyroid gland, a needle biopsy must be performed from the nodules in patients with more than one nodule in the gland. In these patients with a large number of nodules, the cancer rate is around 5% as in a single nodule. A biopsy is attempted from all nodules in the thyroid gland. If cancer is suspected or cancer is detected in the biopsy, surgery is performed immediately. If the biopsy is benign, it can be followed.

Some of these patients have normal thyroid hormones. If they eat iodized salt, the nodules may start to secrete excess hormones; Therefore, they should eat non-iodized salt. Patients with normal hormones are followed up with thyroid hormones and thyroid ultrasound every 4-6 months.

Although treatment with drugs such as Levothyroxine (Euthyrox, Tefor or Levothyron) may cause an increase in thyroid hormones in most people with more than one nodule in their gland, patients with young, small goiter and normal TSH hormone use Levothyroxine (Euthyrox, Tefor) for a while. or Levotiron) drug.

If the diameter of the nodules is small (less than 2.5 cm), follow-up is usually done at intervals of 4-6 months without giving medication. If the nodules grow during these follow-ups, they are operated. If the patient's TSH hormone is low (less than 0.1) Levothyroxine (Euthyrox, Tefor or Levothyron) drug is not given because it will be harmful. For this reason, surgery is the preferred treatment method.

If the TSH hormone is low in patients with multinodular goiter, that is, if the gland is working too much, drugs that inhibit the production of thyroid hormone such as Propycil or Thyromazol are given and then surgery is performed.

Sometimes these patients may have high thyroid hormones, in other words, the thyroid gland may be overworked. Then, hormones are brought to normal with drugs such as Propycil or Thyromazol, and then radioactive iodine therapy or surgery is performed.

Which Nodules Should Be Operated?

Thanks to thyroid needle biopsy, there has been a great decrease in the number of patients to be operated. It is not necessary to be operated immediately because there is a nodule. If the nodule is small (less than 2.5 cm in diameter) and the biopsy is benign, these patients can be followed up without surgery. It is useful to have your nodule checked by contacting an endocrinologist.

Thyroid Nodules
Thyroid Nodules

The nodules that need to be operated on are:

  1. Nodules with cancer or suspected cancer in biopsy.
  2. Nodules found to be follicular tumors in biopsy.
  3. Nodules detected as Hurthle cell tumor in biopsy
  4. Nodules that continue to grow even though Levothyroxine (Euthyrox, Tefor or Levotiron) drug is used, and nodules that reappear while using these drugs.
  5. Cystic nodules larger than 4 cm.
  6. Cystic nodules in which fluid accumulates despite the fluid being drained with the needle.
  7. Large benign nodules that put pressure on the esophagus or windpipe
  8. If there is a nodule with Graves' disease
  9. Hot nodules larger than 2.5 cm in diameter
  10. Benign firm nodules greater than 3 cm in diameter
  11. In case the nodule gets into the rib cage (Plunging goiter, Plonjan Goiter)

Nodular Goiter Surgery

For more detailed information about Goiter Disease, you can check my article here: What is Goiter?

In nodular goiter, the amount of gland to be removed during surgery varies according to the number of nodules and whether the nodule is benign or malignant. For this reason, a biopsy should be done before surgery.

During surgery Frozen test is beneficial for the amount of diapers to be removed during surgery The frozen procedure is that the nodule taken during the operation is examined by the pathologist who is close to it, and the surgeon reports whether it is benign or cancer during the operation.

If the nodule is found to be benign on frozen examination and if it is a single nodule, the thyroid lobe with the nodule and a small part of the opposite lobe are removed. In other words, normal thyroid tissue is left behind. If it is reported that the nodule is cancer on frozen examination, it is necessary to remove all of the thyroid gland. For this reason, it is more advantageous to be operated in a hospital where frozen examination is performed.

If the nodule is found to be cancer in the thyroid biopsy performed before the surgery, the entire thyroid gland is removed. Leaving a part of the thyroid gland in a patient with thyroid cancer is a wrong type of surgery.

Thyroid Nodules and Nutrition

Points to be Considered in the Nutrition of a Patient with a Nodule:

People with Thyroid Nodules should eat non-iodized salt. Non-iodized salt is produced by some companies. If non-iodized salt cannot be found, rock salt should be eaten. In addition, cough syrups containing iodine should not be drunk, and if possible, those with iodine should not be used among the drugs used in x-rays. Excess iodine taken can cause the nodule to overwork and produce excess thyroid hormone. There is no food, vegetable or fruit that should not be eaten from other foods.

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