Thyroid nodular goiter is a condition in which the thyroid gland is not only enlarged, but also has nodules. These nodules can produce a large amount of thyroid hormones (toxic nodular goitre), resulting in an excess of these in the body. However, in some people the nodules do not disturb the functioning of the thyroid gland (neutral, non-toxic nodular goitre). What are the causes and symptoms of nodular goiter? How is the treatment going?

Thyroid nodular (nodular) goiteris a condition in which one or more nodules can be sensed in the structure of the thyroid gland.

There are two types of nodular goiter:

  • toxic nodular goitre- local nodules secrete thyroid hormones, resulting in their excess in the body;
  • nodular goiter non-toxic (neutral)- nodules do not secrete thyroid hormones, therefore there is no increase in their level in the body (their concentration is normal);

In addition to the development of nodules, the thyroid gland is enlarged, although nontoxic nodular goitre is also diagnosed when the volume of the entire gland is not enlarged, but there is a palpable nodule (or nodules) in its structure.

Thyroid nodular (nodular) goitre - causes

The most common cause of both toxic and indifferent nodular goiter is iodine deficiency. In the case of the latter, genetic predispositions are also important, as well as the influence of goiter substances that interfere with the absorption of iodine (e.g. cruciferous vegetables, peanuts), smoking, ionizing radiation, thyroiditis, and autoimmune diseases.

Nodular (nodular) thyroid goitre - symptoms

In both cases, there are symptoms of an enlarged thyroid gland, such as a feeling of pressure in the neck, and sometimes difficulties in breathing and swallowing food, or shortness of breath due to pressure on the trachea. The symptom of "too tight shirt collar", which occurs in men with thyroid goitre, is also characteristic. A hoarseness may also appear, caused by the paralysis of the recurrent laryngeal nerve and the paresis of the vocal cord. However, such symptoms appear most frequently in the case of toxic nodular goiter. Non-toxic nodular goiter (indifferent) remains in many casesasymptomatic.

In addition, there are nodules within the enlarged thyroid gland, although in the toxic form, nodules in the thyroid gland may not be palpable.

In the case of toxic nodular goiter, in addition to the enlarged thyroid and palpable nodules, there are also symptoms of hyperthyroidism, e.g. hypersensitivity to heat and excessive sweating, irritability, nervousness, palpitations, weight loss. It is associated with the excessive secretion of thyroid hormones by the nodules.

Thyroid nodular (nodular) goitre - diagnosis

The diagnosis is made on the basis of the examination:

  • physical (palpating), i.e. touching the thyroid gland
  • thyroid ultrasound (and sometimes thyroid scintigraphy)
  • blood - thyroid profile is performed (among others, the level of TSH, fT3 and fT4 is measured)

In some cases, a thyroid biopsy may be necessary.

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Thyroid nodular (nodular) goitre - treatment

  • non-toxic nodular goitre

The patient can be observed, but surgery is usually performed, which is the basic and most effective method of treating neutral nodular goiter. Treatment with radioactive iodine (rarely used) is of little importance. Only a few patients are given drugs (mainly levothyroxine).

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  • toxic nodular goiter

The patient is given high-dose anti-thyroid medications to control the symptoms of an overactive thyroid gland. However, it is only symptomatic treatment, therefore a decision is made to either radioiodine treatment or surgery.

Radioiodine is mainly used in patients in whom surgery is impossible or when the goiter is small and the nodules are not malignant.

The operation is necessary when the thyroid nodules are malignant and when the goiter is large.

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