Overview
Most of them have no obvious symptoms, but those with obvious goiter may have symptoms such as neck enlargement, cough, hoarse voice, etc. It is mainly due to the lack of iodine in the body, which leads to the insufficiency of thyroid hormone. Asymptomatic people usually do not need treatment; symptomatic people can take medication, surgery, etc. Most of them have good prognosis, and the cancer rate is less than 1%.
What is a nodular goiter?
Definition
A nodular goiter is a multinodular nodule that develops in the advanced stages of endemic goiter and sporadic goiter.
Nodular goiter is a benign nodule with a cancer rate of less than 1%.
Classification
Classification according to the number of nodules
Single nodular goiter.
Multinodular goiter: can be further divided into 2 categories according to the presence or absence of hyperthyroidism.
Non-toxic multinodular goiter.
Toxic multinodular goiter.
Classification according to the benign or malignant nature of the nodules
Benign nodules and malignant nodules.
Morbidity
The incidence of nodular goiter in the population is 5-10%.
Where iodine is plentiful, the male-to-female ratio of nodular goiter is about 1:5.
Questions you may be concerned about
Can nodular goiter become cancerous?
Nodular goiter is usually not cancerous, but the possibility of cancer cannot be ruled out, but the probability is low.
Simple goiter has less than 1% probability of developing atypical hyperplasia or even cancer if the goiter grows and recurs repeatedly. Preliminary screening can be done by ultrasound to observe the size, shape, degree of adhesion with the surrounding tissues, and internal structure of the goiter, and if malignant changes are suspected, early pathological biopsy can be done to make a definitive diagnosis.
Will nodular goiter go away on its own?
Nodular goiter does not usually go away on its own.
Nodular goiter is the result of prolonged hyperplasia and uneven repair of the glandular tissues, resulting in the gradual formation of multiple nodules of different sizes and shapes, leading to diffuse asymmetric enlargement of the thyroid gland, which usually does not require treatment when asymptomatic.
Larger nodular goiter may compress the surrounding tissues, resulting in respiratory and swallowing difficulties, which require surgical treatment.
Is nodular goiter serious?
A nodular goiter is not a serious condition, but it should be taken seriously. If the goiter is small, does not adhere to the surrounding tissues, does not compress the blood vessels, and the thyroid function is normal, it usually does not require special treatment, and regular checkups are sufficient.
If the nodular goiter presses on blood vessels, esophagus, or trachea, it is more serious and should be treated by a doctor in time for further examination, and then appropriate treatment should be chosen.
Causes
Causes
Deficiency of iodine or insufficient production of thyroid hormones for various reasons leads to compensatory enlargement of the thyroid gland. With the progression of diffuse goiter, some of the thyroid follicles degenerate and some of them become enlarged and gelatinous, gradually forming nodules of varying sizes and textures and developing into nodular goiter.
Iodine deficiency is the main factor causing diffuse goiter.
饮食中碘摄入不足。
短时间内大量进食卷心菜、白菜、花椰菜、甘蓝等十字花科蔬菜，应用硫脲类、硫氰酸盐、高氯酸盐、锂盐等药物也可通过抑制碘吸收引起弥漫性甲状腺肿。
Inadequate production of thyroid hormones due to genetic defects or mutations.
Thyroid disorders, such as Hashimoto’s thyroiditis or Graves’ disease, can also be the cause of goiter with nodule formation.
Symptoms
Main Symptoms
Nodular goiter has a long course and symptoms are often not obvious, and are often found incidentally during a physical examination. Some people with obvious goiter may have the following symptoms.
Neck swelling
Manifested as a thick, palpable, soft-textured mass in the neck.
Compression symptoms
If it compresses the trachea, esophagus, nerves and other peripheral organs, compression symptoms such as coughing, dyspnea, difficulty in swallowing, hoarseness, etc. may occur.
If the jugular vein is compressed, it may cause impaired venous return in the head and neck, facial bruising, swelling and superficial cervico-thoracic vein varicose (bulging veins).
Complications
Hyperthyroidism
It may be characterized by hyper appetite, weight loss, palpitations, easy agitation, and protruding eyes.
Ruptured and bleeding nodular goiter
It manifests as a sudden enlargement of the thyroid nodule in a short period of time, and may present with symptoms such as pain, dyspnea, dysphagia, hoarseness, and so on.
Thyroid cancer
Very rarely, nodular goiter may turn into thyroid cancer.
The presentation is similar to that of nodular goiter, but the thyroid mass is hard and fixed, and may be accompanied by enlarged lymph nodes in the neck.
Consultation
Department of Medicine
General Surgery
If there is a nodule in the neck during physical examination, a thyroid nodule on ultrasound, or symptoms such as neck enlargement, cough, difficulty in swallowing, or hoarseness, it is recommended to consult a doctor promptly.
Emergency Department
If symptoms such as breathlessness, sudden enlargement of thyroid nodules with severe pain occur, it is recommended to go to the Emergency Department as soon as possible or call the 120 emergency number.
Preparation for medical treatment
Preparation for medical consultation: registration, preparation of documents, common problems
Tips for seeking medical treatment
Avoid self-medication before seeking medical treatment, as this may cover up your condition.
Record the changes in the size and texture of the neck lump to give the doctor more reference.
Preparation Checklist
Symptom list
Especially focus on the time of onset of symptoms, special manifestations, etc.
Where is the discomfort? How long have the symptoms lasted?
Has the neck swelling increased in size? Is it accompanied by pain?
Are there any symptoms such as breathlessness, difficulty swallowing, hoarseness, etc.?
List of medical history
Any other previous thyroid disease, such as diffuse goiter?
Where have you lived for a long time?
List of examinations
Test results from the last six months to bring to the doctor’s office
Laboratory tests: thyroid function test, serum thyroglobulin test, urine iodine test
Imaging tests: ultrasonography, thyroid nuclear scan, CT examination
Medication List
Medication used in the last 3 months, if available in boxes or packages, bring with you to the doctor’s office
Thyroid hormone: levothyroxine sodium
Diagnosis
Diagnosis based on
Medical history
History of diffuse goiter.
Chronic iodine deficiency, living in mountainous and highland areas.
Clinical symptoms
Most of them have no obvious symptoms, and those with obvious goiter may have symptoms such as thick neck, cough and hoarseness.
Single or multiple nodules of varying sizes can be detected on one or both sides of the neck, which are smooth and soft and move up and down with the larynx and trachea when swallowing.
Laboratory Tests
Thyroid function tests
The main tests include serum thyroid stimulating hormone (TSH), serum total thyroxine (TT4), serum total triiodothyronine (TT3), etc., which can be used to assess thyroid function.
Serum TSH generally behaves normally.
TT4 appears normal or mildly decreased, and TT3 can be slightly elevated.
Serum Thyroglobulin Measurement
Serum thyroglobulin (Tg) levels are normal or elevated, with the degree of elevation positively correlating with goiter volume.
Urine Iodine Measurement
Urinary iodine ion content can be measured, which helps to evaluate iodine nutritional level.
Urinary iodine less than 100 μg/L is considered iodine deficiency.
Imaging
Ultrasonography
With the advantages of being convenient, fast and non-invasive, it is a commonly used thyroid examination method.
The examination can show the size of the thyroid gland and the specific features of the nodules, including: size, number, border, shape, echogenicity, whether there is calcification, blood flow, and the cystic solidity of the nodules, and those with cysts are mostly benign nodules. Substantial nodules have a smooth surface, intact peritoneum, and are hypoechoic or isoechoic.
Thyroid Nuclear Scan
It shows the location, size, and shape of the thyroid gland and also provides information about the function and blood supply of the thyroid nodule.
The examination reveals an irregular pattern and increased size of the thyroid gland.
Note: Drink plenty of water after the examination to facilitate the elimination of contrast medium.
CT or MRI
It is mainly used to clarify the goiter and the relationship between the nodule and adjacent tissues, and the continuation of the retrosternal goiter.
Precautions: Metal objects on the body, such as necklaces and earrings, should be removed during the examination.
Barium esophagography
It can clarify the degree of esophageal compression.
Precautions: Fasting from food and water for 8 hours before the examination.
Other Tests
Pulmonary function test: It helps to clarify whether the trachea is compressed or not, usually the tracheal lumen is compressed and narrowed more than 70% to produce compression symptoms.
Fine needle aspiration cytology: helps to clarify the nature of goiter.
Differential diagnosis
Thyroid cyst
Similarities: Both may present with symptoms of compression such as dyspnea, dysphagia, and hoarseness.
Differences: Thyroid cysts are cystic masses that occur on the thyroid gland and contain liquid or semi-solid material. Thyroid cysts and nodular goiter have similar clinical symptoms and often rely on imaging to differentiate them. Ultrasound can reveal fluid dark areas within the mass, thin and smooth walls, and clear cystic fluid.
Thyroiditis
Similarities: Both may present with enlarged thyroid gland.
Differences: Thyroiditis is usually accompanied by pain, which is aggravated by swallowing, and may be accompanied by general malaise, muscle pain, fever, and fatigue.
Treatment
Asymptomatic patients usually do not need treatment, and regular checkups are sufficient.
For those with obvious enlargement of the thyroid gland, accompanied by pressure symptoms, drug and surgical treatment can be taken according to the specific situation.
Medications
Thyroid hormone
Thyroid hormone can be used for those with obvious goiter and normal thyroid function.
Commonly used drugs are levothyroxine sodium.
It is usually started at a low dose and the dosage should be adjusted under the supervision of a doctor, and thyroid function should be monitored during treatment.
Adverse effects such as arrhythmia, headache, muscle weakness, insomnia and excessive sweating may occur if the individual’s tolerated dose is exceeded or if an overdose is taken.
Surgery
Indications
Nodular goiter suspected to be malignant.
Those with large lumps that affect life, work and aesthetics.
Nodular goiter compressing the trachea and esophagus, etc., with localized compression symptoms.
Combined with hyperthyroidism.
Those with retrosternal nodular goiter.
Surgical approach
Depending on the location, size, number and degree of hyperplasia of the nodules, the appropriate surgical method is selected.
Commonly used surgical methods include thyroid nodule excision, major thyroidectomy, and total thyroidectomy.
Post-operative precautions
After surgery, pay attention to wound hygiene, avoid touching and sterilize regularly.
After surgery, you need to learn the correct way of coughing, coughing should be soothing, avoiding violent coughing.
Strenuous activities, especially neck activities, are not recommended after surgery; the neck can be moved gradually after the wound heals.
After surgery, it is advisable to eat a light diet and avoid stimulating foods to prevent coughing.
Prognosis
Cure
Most patients with nodular goiter do not need special treatment; those with obvious goiter or with pressure symptoms usually have a good prognosis after standardized treatment.
Most nodular goiter is benign, with a cancer rate of less than 1%. Even if cancer occurs, most of them have a good prognosis after treatment and can survive for a long time.
Hazards
If the goiter is obviously enlarged, it may cause symptoms such as neck enlargement, difficulty in swallowing and breathlessness, which may affect the appearance and life.
Although the probability of malignant transformation is low, nodular goiter may increase the psychological burden of patients and cause negative emotions such as anxiety and depression.
Daily
Daily Management
Dietary management
Iodine-deficient patients can supplement iodine-rich foods, such as kelp, seaweed and nori, and use iodized salt in cooking.
Avoid excessive consumption of foods that inhibit thyroid hormone synthesis such as cabbage, radish, spinach and peanuts for a short period of time.
Limit the consumption of high-fat foods, such as walnuts, sesame paste, ham, pancetta and cheese.
Avoid foods high in cholesterol, such as cream, animal brains and offal.
Life Management
Adopt good living habits, regular work and rest, and avoid exertion.
Exercise moderately to improve physical fitness.
Maintain a good state of mind and avoid bad emotions such as fear and anxiety.
Disease monitoring
Patients receiving medication
Regularly check thyroid hormone levels as prescribed by the doctor.
Pay attention to perceive whether there is pain in the thyroid area, whether there is difficulty in swallowing, breathlessness, hoarseness and other symptoms.
If symptoms occur, prompt medical attention is required.
Patients after surgery
Focus on monitoring the condition of the surgical wound at home.
Observe whether the wound is infected and whether there is any pus breakthrough, and seek medical attention promptly if any uncomfortable symptoms appear.
Prevention
Those who have iodine deficiency or live in iodine-deficient areas can take moderate iodine supplementation, such as choosing seafood such as kelp and nori.
If there are thyroid diseases such as diffuse goiter, they should be actively treated.
Regular medical checkups and pay attention to the results of thyroid-related tests.