The primary diagnosis of nodular goiter is carried out by an endocrinologist by palpation of the thyroid gland. To confirm and clarify the nature of nodal education, the next stage is usually the ultrasound of the thyroid gland. The presence of palpable nodular goiter, whose size, according to ultrasound, exceeds 1 cm, serves as an indication for a fine needle aspiration biopsy. Puncture biopsy of the nodes makes it possible to verify the morphological (cytologic) diagnosis, to distinguish benign nodal formations from thyroid cancer.
In order to assess the functional activity of nodular goiter, the level of thyroid hormones (TSH, T4, T3, etc.) is determined. The study of the level of thyroglobulin and antibodies to the thyroid gland in nodular goiter is inexpedient. To identify functional autonomy of the thyroid gland, radioisotope scanning (scintigraphy) of the thyroid gland with 99mTc is performed.
Radiography of the chest and radiography of the esophagus with barium can reveal compression of the trachea and esophagus in patients with nodular goiter. Tomography is used to determine the size of the thyroid gland, its contours, structure, enlarged lymph nodes.
Treatment of nodular goiter
The treatment of nodular goiter is differentiated. It is believed that special treatment of nodular colloid proliferative goiter is not required. If the nodular goiter does not disrupt the function of the thyroid gland, has small dimensions, does not represent a threat of compression or a cosmetic problem, then in this form the patient is followed by a dynamic observation of the endocrinologist. A more active tactic is indicated if the nodular goiter shows a tendency to rapid progression.
In nodular goiter, medicamentous (suppressive) therapy with thyroid hormones, radioactive iodine therapy, and surgical treatment can be used. Carrying out suppressive therapy with thyroid hormone (L-T4) drugs is aimed at suppressing secretion of TSH, which can lead to a decrease in the size of the nodular formations and the volume of the thyroid gland in diffuse goiter.
Surgical treatment of nodular goiter is required in case of development of compression syndrome, visible cosmetic defect, detection of toxic goiter or neoplasia. The volume of resection in nodular goiter can vary from enucleation of the thyroid gland to hemithyroidectomy, subtotal resection of the thyroid gland and thyroidectomy.
Therapy with radioactive iodine (131I) is considered as an alternative to surgical treatment and is carried out for the same indications. Adequate dose selection allows to achieve reduction of nodular goiter by 30-80% of its volume. Methods of minimally invasive destruction of thyroid nodules (ethanol ablation, etc.) are less often used and require further study.
Prognosis and prevention of nodular goiter
With nodular colloid euthyroid goiter, the prognosis is favorable: the risk of developing compression syndrome and malignant transformation is very low. With functional autonomy of the thyroid gland, the prognosis is determined by the adequacy of correction of hyperthyroidism. Malignant thyroid tumors have the worst prognostic prospects.
In order to prevent the development of endemic nodular goiter, mass iodine prophylaxis (the use of iodized salt) and individual iodine prophylaxis of people at risk (children, adolescents, pregnant and lactating women) is shown, consisting in the intake of potassium iodide in accordance with age-related dosages.