Given the nature and origin of the following types of nodular goiter: euthyroid colloid proliferating, diffusive-nodal (mixed) goiter, benign and malignant tumor nodes (follicular thyroid adenoma, thyroid cancer). About 85-90% of the thyroid gland is represented by nodular colloid proliferating goiter; 5-8% – with benign adenomas; 2-5% – with thyroid cancer. Among malignant tumors of the thyroid gland is found follicular, papillary, medullary cancer and undifferentiated forms (anaplastic thyroid cancer).
In addition, the formation of pseudo nodes (inflammatory infiltrates and other nodal-like changes) in the thyroid gland is possible with subacute thyroiditis and chronic autoimmune thyroiditis, as well as a number of other diseases of the gland. Often, along with nodes, cysts of the thyroid gland are identified.
Depending on the number of nodal formations, a solitary (single) node of the thyroid gland, a multinodal goiter and a congolateral nodular goiter are distinguished, which is a three-dimensional formation consisting of several knots welded together.
At present, the clinical practice uses the classification of nodular goiter, proposed by O.V. Nikolaev, as well as the classification adopted by WHO. According to O.V. The following degrees of nodular goiter are distinguished for Nikolayev:
- the thyroid gland is not determined visually and palpatory
- the thyroid gland is not visible, however it is determined by palpation
- the thyroid gland is visually determined by swallowing
- due to visible goiter increases the contour of the neck
- visible goiter distorts the configuration of the neck
- enlarged thyroid gland causes compression of adjacent organs.
According to the WHO classification, the degrees of nodular goiter are different:
- no data for goitre
- the dimensions of one or both of the thyroid glands exceed the distal phalanx of the thumb of the patient. The goiter is determined by palpation, but is not visible.
- goiter is palpable and visible to the eye.
Symptoms of nodular goiter
In most cases, nodular goiter does not have clinical manifestations. Large nodal formations present themselves as a visible cosmetic defect in the neck region – a noticeable thickening of its anterior surface. In nodular goitre, the enlargement of the thyroid gland occurs predominantly asymmetrically.
As the nodes grow, they begin to squeeze the neighboring organs (esophagus, trachea, nerves and blood vessels), which is accompanied by the development of mechanical symptoms of nodular goiter. The compression of the larynx and trachea is manifested by a sensation of a “lump” in the throat, a constant hoarse voice, a growing difficulty in breathing, a prolonged dry cough, and suffocation. Compression of the esophagus leads to difficulty swallowing. Signs of compression of the vessels may be dizziness, noise in the head, development of the syndrome of the superior vena cava. Soreness in the site of the node can be associated with a rapid increase in its size, inflammatory processes or hemorrhage.
Usually, in nodular goiter, the thyroid function is not impaired, but there may be deviations in the direction of hyperthyroidism or hypothyroidism. With hypofunction of the thyroid gland, there is a tendency to bronchitis, pneumonia, SARS; pain in the heart, hypotension; drowsiness, depression; gastrointestinal disorders (nausea, decreased appetite, flatulence). Characteristic of dry skin, hair loss, lower body temperature. Against the background of hypothyroidism, children may experience a delay in growth and mental development; in women – menstrual disorders, spontaneous abortions, infertility; in men – decreased libido and potency.
Symptoms of thyrotoxicosis in nodular goiter are long subfebrile condition, trembling in the hands, insomnia, irritability, constantly experienced hunger, weight loss, tachycardia, exophthalmos, etc.