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 DEFINITION
A thyroid nodule is an abnormal accumulation of thyroid cells forming a tumor inside the thyroid gland. Mostly they are benign and they do not produce any problem, other times can produce hormones generating general alterations for it and in a small proportion they can be malignant or cancerous.
In most cases they can be observed in the neck to simple seen by the proper patient and in other cases in a physical examination of the neck on the part of the doctor in a routine examination.
Sometimes they can produce inconveniences or pain for his size in the neck, even at level of the jaw or of the ear. In case of major size it can go so far as to produce a local pressure with hoarseness, difficulty to breathe or to swallow the solid food. If the nodule contains many thyroid active cells it can produce thyroid hormone in high proportions, producing a hipertiroidismo.
In some cases these nodules can be cancerous.
The thyroid nodules are very frequent, almost 10 % of the persons can have them, but in only 1 of every 10 of these nodules they are malignant, then most they are of benign character with or without hormonal influence.
When a nodule is functional and produces thyroid hormone it is called a nodule or autonomous nodule, when it does not produce it and contains liquid or blood one usually says that it is a thyroid cyst.
Also secondary thyroid nodules usually take place to autoimmune illnesses as in the Hasimoto tiroiditis. In diet low in iodine in the diet thyroid nodules can take place.
DIAGNOSIS OF THE THYROID NODULES
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Physical examination
In a palpación of the neck one or several they can appreciate nodules in the thyroid gland. Then in a general exploration one will see if it has hiccup symptoms or hipertiroidismo.
Analytical
In the blood one will determine the levels of TSH (stimulant hormone of the thyroid gland), of thyroid hormone T4, with this it is possible to see the functionality of the nodule, but we will be necessary other tests to see if it is benign or malignant. Most of the nodules usually has this one analytical normal.
Thyroid Gammagrafia
For it radioactive iodine is injected to the patient to small doses, and the thyroid gland absorbs it depending the functionality and activity of his cells. This then gathers in a badge sensitive to the beams gamma and a X-ray image is obtained.
If the nodule turns out to be cold, that is to say it does not receive radioactive iodine, it is necessary to think a puncture aspiration to analyze the sample gathered to the microscope.
If the nodule funcionante that gathers Iodine normally, there is no hurry to do the puncture since it is a thyroid normal textile.
If the nodule gathers exaggeratedly the iodine or is warm, the biopsy is not usually necessary, since mostly there are benign nodules.
The nodule is warm. The caught radioactive iodine is major than that of the normal cells. The cancer probability is extremely low and the biopsy generally is not necessary.
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Puncture / aspiration of the thyroid nodule with thin needle
It is not very aggressive exploration since with local anesthesia and the needle that is thin it is not an exploration painful at all. It is realized ambulatoriamente without special previous preparation, and it is possible to go to house after realizing it without problems.
The puncture is realized in the different nodules and in different places of every nodule to obtain a major sample and that is significant. The sample is sent to pathological anatomy for his study to the microscope.
In this study it can appear:
A sample with colloidal textile, is usually in more than half of the cases and shows that the nodule is benign. In very few cases there could be a thyroid cancer. If the nodule increases of size it indicates itself another puncture but in general it is not necessary to do it more. A doubtful sample, in this case spelling owes to complete the decision with the gamma Appearance of malignant cells papilares or foliculares, which suggests a cancerous nodule that must be extirpated as soon as possible by surgery. There can be not useful result for bad collection of the sample or for being a cyst with scarce celularidad; there are cysts with few cells and in this case another puncture usually necessary or be taken control be depending on the rest of explorations but the result must not remain here. As a whole with the gammagrafía if the nodule is cold and the positive biopsy was directing it it is necessary, if the biopsy is doubtful and the cold nodule almost always is necessary. Then there must be quite in favor not to have to come to the surgery.
Thyroid gland ultrasound scan
For it there is used an ecógrafo that produces waves of high frequency and in his rebound, depending on consistency of textile an image of the area is obtained.
It is possible to see and to differentiate very well a solid nodule of another quístico, and especially the size and quantity of the nodules as well as his place. Then it serves to face for his characteristics on the possibility of being malignant and then in the periodic control panel his evolution as for size especially.
A diagnostic exploration is not a peerse, then it is a support especially to realize the biopsy in the suitable nodules and to be able where it is necessary to do.
TREATMENT
The studied thyroid nodules and that give a benign result must be controlled by ultrasound scan, at least, every 6 ó 12 months.
Sometimes thyroid hormones are used to try to diminish his size, then it would pass to a situation of induced hipertiroidismo. It is called a treatment supresivo (of the nodule).
If in spite of this treatment the nodule grows, with benign biopsy the surgery is even recommended to extract the same one.
On the other hand the nodules with clear malice must be taken control by surgery, since the prognosis of cancer of thyroid gland is very good if it is operated well from the beginning.
WHAT DOCTOR CAN TREAT ME?
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DEFINITION 
