The concept of euthyroid nodular goiter
The nodal euthyroid goiter - a collective,used to clinical diagnosis concept that unites these thyroid diseases, such as colloidal goiter, follicular adenoma, nodular variant of hypertrophic form of autoimmune thyroiditis, thyroid cyst.
Isolation of the concept of "nodular euthyroid goiter"due to the fact that the clinical diseases listed from each other is no different, and in most cases, the final differential diagnosis between them is possible only on the basis of fine-needle aspiration biopsy of the thyroid. When screening a healthy population using palpation of thyroid nodules are found in 3-5%, and at autopsy thyroid tissue every 2 mm, they are found in 50% of patients; less than 5% of clinically manifested themselves nodes are malignant. Colloidal goitre, the mechanism associated with the development of chronic nutritional deficiency of iodine, is formed mainly due to excessive accumulation of colloid in the follicular cavity and more often focal than diffuse. Follicular adenoma - a benign tumor of the thyroid follicular epithelium. In hypertrophic form of autoimmune thyroiditis as a result of local hyperplasia of the thyroid gland often formed pseudoknots.
Thyroid cyst - cavernous, filledcystic fluid formation in the thyroid tissue. True cyst of the thyroid gland is characterized by the presence of the false lining of the follicular epithelium. Thyroid cyst must be differentiated from cystadenoma. In the latter case we are talking about the formation of the cavity decay in thyroid tumors. Thyroid Cysts constitute 3-5% of thyroid nodules. As a result of minor hemorrhages, degeneration of colloid nodes, hyperplasia of individual follicles.
The clinical picture of the disease
The presence of nodule in the thyroid gland,determined by palpation. When hormonal study revealed euthyroidism. It should be noted that thyroid disease can develop viewed against a background like hypothyroidism and hyperthyroidism. US confirms and accurately describes the size of nodule.
Diagnosis of the disease
Diagnostic ultrasound search, above all, aimed at elimination of thyroid cancer.
Differential diagnosis of goiter uetireoidnogoand thus to establish a clinical diagnosis based on ultrasound inappropriate. Palpable nodules and nodular goiter, exceeding by ultrasound 1 cm in diameter, shall be subject to fine-needle aspiration biopsy, if necessary, under ultrasound guidance. When scintigraphy thyroid nodules can be characterized as cold, warm and hot. Cyst of thyroid ultrasound is defined as a unit with a hyperechoic rim and almost anechoic internal structure. When fine-needle aspiration biopsy is obtained liquid.
Nodules less than 1 cm in diameter(Random finding in US) have no clinical significance. Requires dynamic control with the help of ultrasound (1 every 6 months). In iodine-deficient regions shows the assignment of preventive doses of potassium iodide.
In most clearly encountered colloid goiter,not exceeding 3 cm in diameter, shows the therapy with L-thyroxine and potassium iodide. potassium iodide administered in prophylactic dose (200 mg / day for adults). The purpose of the appointment of L-thyroxine is the suppression of thyroid-stimulating hormone level to the lower limit of normal, which reduces its impact on the trophic thyrocites. Typically, this suppression thyrotropin level manages to reach the destination of 75-100 mg of the drug.
In the absence of effect of conservative therapy,t. e. with increasing unit size at ultrasound control after 6 months, operative treatment, which consists in the removal of the affected lobe. It is also indicated for follicular adenoma, which cytologically, t. E. The study of the material obtained by fine-needle aspiration biopsy, it is difficult to distinguish from well-differentiated thyroid cancer. When the thyroid gland cyst is a fine-needle aspiration biopsy followed by sclerotherapy with ethanol cyst cavity. With repeated relapses, brush size greater than 3 cm, presence of dense fibrous capsule shows resection of thyroid lobe.