Dr Sylvie ROUX-GUINOT

Endocrinologie
Conventionnement : Secteur 2
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Thyroid : goitre, nodules and cancer (in English) - Dr Sylvie ROUX-GUINOT - Docvadis

Thyroid : goitre, nodules and cancer (in English)

The thyroid nodules are extremely common particularly in women. About 5% of the nodules are cancererous. Every nodule, except if it is very small (a few millimetres) needs a fine-needle aspiration biopsy.

Goitre

Causes

Lack of iodine in your diet can cause an enlarged thyroid. The thyroid gland is not able to make enough thyroid hormone to meet the body's needs. To make up for the shortage of thyroid hormone, the thyroid gland grows larger. A simple goitre is always benign.

Treatment

A treatment by a pill of synthetic levothyroxine hormone (T4), which is the copy of T4 produced by the thyroid, will allow the reduction of the goitre.

Thyroid nodules

What’s a nodule?

Thyroid nodules are extremely common. You often won't know you have a thyroid nodule. In fact, most of the time, a thyroid nodule lesser than 1 cm in diameter is usually unpalpable. The nodules larger than a centimetre, relate to approximately 5% of the population. n 95% of the cases they are benign.

The size of one or more nodules is not proportional to its gravity. Most thyroid nodules don't cause signs or symptoms. Occasionally, however, some nodules become so large that they can:

  • Be felt

  • Be seen, often as a swelling at the base of your neck

  • Press on your windpipe or esophagus, causing shortness of breath or difficulty swallowing.

About 5% of the thyroid nodules are cancerous (malignant), but it's difficult to tell which nodules are malignant by symptoms alone. So, it’s important to see an endocrinologist

 


Thyroid nodule

Risk factors:
  • Women are more likely than men to develop thyroid disorders. (up to 80% of patients with thyroid problems are women).

  • If a parent had thyroid nodules, or a goitre, or a a thyroid cancer, children have a higher risk of developing thyroid nodules.

  • Thyroid nodules are present in 50% of pre-menopausal women (i.e. after 50 years ).

Associated signs

The size of one or more nodules is not proportional to its gravity. Most thyroid nodules don't cause any signs or symptoms. Occasionally, however, some nodules become so large that they can:

  • Be felt

  • Be seen, often as a swelling at the base of your neck

  • Press on your windpipe or esophagus, causing shortness of breath or difficulty swallowing, broken voice…

Tests and diagnosis

A nodule is a lump, a “ball” developed in the thyroid gland

   Thyroid nodule

Do your nodules present risks?

The most important question to ask when a thyroid nodule is discovered is : is this a cancer.

Fortunately, most thyroid nodules are benign (i.e. not cancer) and non-functional (i.e. not causing hyperthyroidism). Only 5 to 10% of thyroid nodules will end up being cancer.

Most thyroid nodules do not cause any symptoms (i.e. they are asymptomatic). In fact, many patients will not know that they are there. If a nodule is hyperactive, patients may experience the signs and symptoms of hyperthyroidism. See Hyperthyroidism .

Thyroid stimulating hormone  measurement

Thyroid stimulating hormone (TSH) can be measured with a blood test . TSH is released by your pituitary gland, and can indicate whether your thyroid is producing too much thyroxine (hyperthyroidism) or too little (hypothyroidism). A lower than normal TSH may mean that the patient is hyperthyroid.

However, most thyroid nodules, including those that cancerous, are actually non-functioning

Thyroid ultrasonography

It must be practiced by an experienced ultrasound doctor.

This very accurate test can easily determine if a nodule is solid or fluid filled (cystic), and it can determine the precise size of the nodule(s). Ultrasound can help identify suspicious nodules since some ultrasound characteristics of thyroid nodules are more frequent in thyroid cancer than in noncancerous nodules.

Thyroid ultrasound can identify nodules that are too small to feel during a physical examination. It also ev aluates the size of thyroid (increased or not), and specifies, in the event of a large nodule, if the windpipe (trachea) is pressed.

Fine-needle aspiration

FNA is accurate in identifying cancer in thyroid nodule.

FNA uses a thin needle to remove small tissue samples from the thyroid nodule. The tissue is examined under a microscope by a pathologist.

If the nodule is small, benign and asymptomaic, it is useless to follow any treatment. Follow up ultrasound exams are important, once a year. Occasionally, another biopsy may be required in the future, especially if the nodule grows over time.

On the other hand, if the nodule is bulky (lesser than 2 cms) or if they are several nodules, your endocrinologist will be able to give you a thyroid hormone suppression therapy in order to slow down growth of thyroid nodules.

 

The idea is that supplying additional thyroid hormone will signal the pituitary to produce less TSH, the hormone that stimulates the growth of thyroid tissue, particularly thyroid nodules

Diagnosis

The report of thyroid fine-needlebiopsy indicate the nodule is malignant (cancerous) or suspicious for malignancy. Malignant result is obtained in about 5% of biopsies and is most often due to papillary cancer, which is the most common type of thyroid cancer.

These cancers are not rare and occur at every age .It is necessary to detect them, because, taken in time, thyroid cancers are curable and rarely cause lifethreatening problems. 

Treatment

The treatment of a thyroid cancer is very different from those of other cancers,. There is neither chemotherapy, nor radiotherapy. In most cases, when cancer is detected in time and well treated the ri sks of relapse are very weak, even non-existent. All thyroid nodules that are found to contain a thyroid cancer, or that are highly suspicious of containing a cancer, should be removed surgically by an experienced thyroid surgeon.

  • If no ganglion is involded, a simple monitoring is necessary with regular assessments, but for life.

  • Patients with one or more ganglia involded and/or with bilateral micro-cancer need radioactive iodine (I-131) remnant ablation and therapy. Radioiodine therapy refers to administration of 131 Iodin with the intention to destroy residualn recurrent or metastatic disease.

This radioiodine therapy is not dangerous

- The thyroid gland: its role and its problems.

- Hypothyroidism

- Hyperthyroidism

 

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