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Definition of Thyroid Nodule The thyroid gland is located in the lower front of the neck, below the voice box (larynx) and above the collarbones. A thyroid nodule is a lump in or on the thyroid gland. Thyroid nodules are detected in about 6 percent of women and 1-2 percent of men; they occur 10 times as often in older individuals but are usually not diagnosed. Any time a lump is discovered in thyroid tissue, the possibility of malignancy (cancer) must be considered. More than 95 percent of thyroid nodules are benign (noncancerous), but tests are needed to determine if a nodule is cancerous. Benign nodules include: Multinodular goiter, also called a nontoxic goiter. The word goiter means the thyroid gland has grown too large. This usually happens when the pituitary gland in the brain creates too much thyroid stimulating hormone. If the goiter is small, the problem may be treated with thyroid hormone pills. Surgery is needed if the goiter is large or does not stop growing after taking thyroid hormones. A large thyroid gland can press against the trachea (windpipe) or esophagus (food tube) and cause difficulty breathing or eating. Benign follicular adenomas, the word follicular means the cells look like a group of small circles under a microscope. If the follicular cells are contained within the nodule, the condition is called benign. If the cells have invaded the surrounding tissue, the diagnosis is cancer. Thyroid cysts are nodules filled with fluid. If a nodule has both fluid and solid parts, it is called a complex nodule. They need to be surgically removed if they cause neck pain or difficulty swallowing. Epidemiology of thyroid nodule Thyroid nodules can be palpated in 4% to 7% of adults. However, they are found incidentally in up to 40% of patients who undergo ultrasonography of the neck, and in 36% to 50% of persons at autopsy. Some studies estimate that 20% to 76% of the population has at least one thyroid nodule. Types of Thyroid Nodule There are different types of thyroid nodules: Colloid nodules: These are one or more overgrowths of normal thyroid tissue. These growths are benign (not cancer). They may grow large, but they do not spread beyond the thyroid gland. Thyroid cysts: These are growths that are filled with fluid or partly solid and partly filled with fluid. Inflammatory nodules: These nodules develop as a result of chronic (long-term) inflammation (swelling) of the thyroid gland. These growths may or may not cause pain. Multinodular goiter: Sometimes an enlarged thyroid (goiter) is made up of many nodules (which are usually benign). Hyperfunctioning thyroid nodules: These nodules autonomously produce thyroid hormone without regard for normal feedback control mechanisms, which may lead to the development of hyperthyroidism. Hyperthyroidism can affect the heart and cause such problems as sudden cardiac arrest, high blood pressure, arrhythmias (abnormal heart rhythm), osteoporosis and other health problems. Thyroid cancer: Less than 5 percent of thyroid nodules are cancerous. Causes and Risk factors While we don’t fully understand why children and adolescents develop thyroid nodules, there are several factors that increase the risk of being diagnosed with a thyroid nodule. These include: Age: The risk of developing a thyroid nodule increases with age Gender: Females are at increased risk of developing thyroid nodules compared to males Family history of thyroid disease (thyroid nodules or thyroid cancer) Personal history of thyroid disease Radiation exposure: Both environmental (rare) and medical exposure to radiation, for evaluation and treatment (for example, a previous history of cancer that was treated with ionizing radiation) Iodine insufficiency (iodine is needed for the production of thyroid hormone) Thyroid Nodule symptoms Thyroid nodule patients usually have no symptoms, but when they do have symptoms they are most commonly: - A lump in the neck (thyroid) - Uncomfortable pressure sensation on the breathing tube (trachea) - A sense of feeling like they need to swallow something or difficulty swallowing - Discomfort in the neck Thyroid nodules may also rarely produce the thyroid hormone, thyroxine, in excess. This is uncommon but the reason why all patients with thyroid nodules should have a blood test for thyroid stimulating hormone (TSH). Thyroid nodules that produce extra thyroid hormone can cause symptoms of hyperthyroidism which include: - Unexplained weight loss - Heat intolerance - Tremor - Nervousness - Rapid or irregular heart rate Complications of Thyroid Nodule Complications associated with thyroid nodules include: Problems swallowing or breathing: Large nodules or a multinodular goiter- an enlargement of the thyroid gland containing several distinct nodules can interfere with swallowing or breathing. Hyperthyroidism: Problems can occur when a nodule or goiter produces thyroid hormone, leading to hyperthyroidism. Hyperthyroidism can result in weight loss, muscle weakness, heat intolerance, and anxiousness or irritability. Potential complications of hyperthyroidism include an irregular heartbeat (atrial fibrillation); weak bones (osteoporosis); and thyrotoxic crisis, a sudden and potentially life-threatening intensification of signs and symptoms that requires immediate medical care. Problems associated with thyroid cancer: If a thyroid nodule is cancerous, surgery is usually required. Generally, most or all of your thyroid gland is removed, after which you’ll need to take thyroid hormone replacement therapy for the rest of your life. Diagnosis and test Most people don’t find thyroid nodules on their own, because the nodules aren’t easy to feel and don’t usually cause symptoms. Your doctor may have found a nodule on your thyroid when you were having a CT scan or ultrasound for another reason. Your doctor will do a physical examination and will ask you if you have symptoms or any changes in how you’ve been feeling. You may have tests to see how well your thyroid is working and to make sure the nodule is not cancer. Possible tests include: - A blood test to check the level of thyroid hormone in your body. - A thyroid scan, which uses radioactive material and a camera to get information about your thyroid gland and nodules. This is done if the level of thyroid hormone is high. Another test called an uptake scan can be done at the same time to see how well your thyroid gland is working. - Fine-needle aspiration, which removes a small amount of material from the nodule. The material is checked for cancer cells. - Thyroid ultrasound, to see the number and size of nodules or to locate the nodule for fine-needle aspiration. Treatment and medications The appropriate thyroid nodule treatment depends upon the type of thyroid nodule that is found. Benign thyroid nodules Benign thyroid nodules usually develop as a result of an overgrowth of normal thyroid tissue. Surgery is not usually recommended, and the thyroid nodule can be monitored over time. If the thyroid nodule grows, a repeat biopsy or surgery may be recommended. Some surgeons recommend excision of nodules over 4 cm. Suppressive (thyroid hormone) treatment If a thyroid nodule is not cancerous, but the nodule is large, some clinicians will suggest a trial of thyroid hormone (thyroxine [T4]) to shrink the nodule; this is called suppressive treatment. The American Thyroid Association guidelines do not recommend this treatment, because only a small percentage of nodules shrink and suppressive therapy may have side effects (eg, abnormal heart rhythm or loss of calcium from bone). Thyroid hormone levels should be monitored carefully during suppressive treatment. Malignant thyroid nodules (thyroid cancer) Only approximately 5 percent of all thyroid nodules are malignant. Most patients with thyroid cancer have an excellent chance for cure or long-term survival. The treatment of thyroid cancer will depend on the type of cancer. Thyroid cancers require surgical removal of the thyroid gland and sometimes one or more treatments with radioiodine, followed by thyroid hormone (T4) suppressive therapy. Suspicious for malignancy Nodules in this category have a 50 to 75 percent risk of malignancy. Patients with nodules that are suspicious for malignancy frequently have a lobectomy or a total thyroidectomy because the chance that the nodule is a cancer is higher than the chance it is benign. Follicular neoplasm The scan report of patients with biopsies shows follicular neoplasm, especially when the thyroid-stimulating hormone (TSH) is in the lower portion of the normal range. From 15 to 20 percent of follicular neoplasms prove to be cancer. Thus, if the scan shows a cold nodule or the TSH is not low, further evaluation with molecular markers, where available, is recommended. Molecular markers (assessed on the fine-needle aspirate) are used to select low-risk nodules for observation rather than surgery. These tests, if negative, are still associated with a 3 to 5 percent risk of cancer, while, if positive, the risk of cancer exceeds 45 percent, depending on the test used. If surgery is necessary, a hemithyroidectomy or a total thyroidectomy may be appropriate depending on the results of the molecular testing, the size of the nodule, and patient preference. Thyroid nodules that absorb the radioiodine (autonomous or “hot” nodule) are usually not cancerous, and treatment depends upon thyroid function tests and other factors. Fine-Needle Aspiration (FNA) Most patients who have nodules with atypical cells require repeat fine-needle aspiration (FNA). The optimal treatment depends upon patient factors, such as the risk for thyroid cancer, and the FNA (including molecular testing) and ultrasound features of the nodule. Molecular markers are frequently used to select low-risk nodules for observation rather than surgery. Most of these tests, if negative, are still associated with a 3 to 5 percent risk of malignancy, while, if positive, the risk of cancer exceeds 45 percent, depending on the test used. Non-diagnostic A nondiagnostic biopsy does not have enough cells for interpretation. It should not be considered a negative biopsy. For patients with non-diagnostic FNA biopsies, the FNA should be repeated using ultrasound guidance. Autonomous thyroid nodules Some thyroid nodules produce thyroid hormone, similar to the thyroid gland, but do not respond to the body’s hormonal controls. These nodules are called autonomous thyroid nodules. They are almost always benign, but they can overproduce thyroid hormone, leading to hyperthyroidism. If you have an autonomous nodule and high levels of thyroid hormone, you will usually be advised to undergo surgery to remove the thyroid nodule, or to undergo radioactive iodine treatment to destroy the nodule. Long-term treatment with the antithyroid drug methimazole is also an option, although methimazole cannot be taken during pregnancy. - If you have an autonomous nodule and normal thyroid function or minimal hyperthyroidism, the appropriate treatment will depend on your age and other health factors. - In young adults, autonomous nodules may be monitored over time. In older adults, radioactive iodine treatment or surgery may be recommended because high thyroid hormone levels pose a risk of abnormal heart rhythm (atrial fibrillation) and bone loss (osteoporosis). Cystic thyroid nodules Cystic thyroid nodules are usually benign nodules that have filled with fluid. These nodules may simply collapse when the fluid is removed. Cystic nodules are usually monitored for changes. If the cyst reforms or bleeds more than once, surgery can be performed to remove the thyroid nodule. (See “Cystic thyroid nodules”.) Thyroid Nodule prevention There’s no way to prevent the development of a thyroid nodule. If you’re diagnosed with a thyroid nodule, your endocrinologist will take steps to remove or destroy it or simply monitor it on an ongoing basis. The majority of noncancerous nodules aren’t harmful, and many people don’t need treatment.
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हिजोआज थाइराइडको समस्या लिएर स्वास्थ्यकर्मीकहाँ धाउनेहरुको संख्या बढिरहेको छ । आफँलाई थाइराइड भएको थाहा पाएपछि कतिपय बिरामी निकै आत्तिने गरेको पनि पाइन्छ । तर थाइराइडको समस्या देखिनासाथ आत्तिनु नपर्ने विशेषज्ञहरु बताउँछन् । थाइराइड भइहाल्यो भने पनि यसलाई सामान्यरुपमा लिएर विशेषज्ञको सम्पर्कमा जानुपर्ने चिकित्सकको सल्लाह छ । काठमाडौं मोडेल कलेज, सिनामंगलका उपप्राध्यापक तथा नाक, कान, घाँटी रोग विशेषज्ञ डा. दीपक रेग्मी थाइराइडको विषयमा के भन्नुहुन्छ त ? थाइराइड हुनुको कारण र नेपालमा यसको उपचार पद्धतिलगायतका विषयमा डा. रेग्मीसँग साधनाका प्रतिनिधि प्रशान्त वलीले गरेको कुराकानीका प्रमुख अंशहरु : कम काम गर्यो भने शारीरिक तौल बढ्ने, खान मन नलाग्ने, महिनावारी समयमा नहुने, आलस्य हुने, खुट्टाहरु सुन्निने, कपाल झर्ने हुन्छ । यसको सट्टा हर्मोनको लेभल धेरै भयो भने खान मन धेरै गर्ने तर तौल घट्ने हुन्छ । त्यसै गरी मुटको गति बढ्ने, डर लागेजस्तो हुने, आँखा ठँलो–ठँलो हुने हुन्छ । उप प्रा.डा. दीपक रेग्मी थाइराइड भन्नेबित्तिकै यो कस्तो समस्या होला भनेर यसका बिरामीहरु अलमलिने गर्छन् । आखिर के हो त थाइराइड ? थाइराइड शरीरमा हुने एक ग्रन्थि हो, जुन घाँटीमा हुन्छ । यसले हर्मोनहरु निकाल्छ । हाम्रो शरीर करोडौं कोष मिलेर बनेको हुन्छ । ती कोषको विकासमा थाइराइड ग्रन्थिबाट निस्कने हर्मोन अत्यावश्यक हुन्छ । थाइराइड हर्मोनविना बाँच्न नै असम्भव हुन्छ । शरीरका कोष तथा तन्तुलाई विकास र परिपक्व बनाउने थाइराइड सबै मानिसमा हुन्छ । यसकारण थाइराइड हुनु समस्या होइन तर थाइराइडमा आउने उतारचढावचाहिँ समस्या हुन सक्छ । शरीरलाई आवश्यकताभन्दा बढी (हाइपर) वा कम (हाइपो) थाइराइड हर्मोन उत्पादन हुनु वा थाइराइड हर्मोनको असामान्यरुपमा उत्पादन हुनु समस्या हो । मानिसको शरीरका लागि अत्यावश्यक थाइराइड हर्माेनको उत्पादन थाइराइड ग्रन्थिले नै गर्छ र यो ग्रन्थि घाँटीमा हुन्छ । यो ग्रन्थिले उत्पादन गर्ने हर्मोनको लेभल तल–माथि भयो भने समस्या पैदा हुन सक्छ । मुख्यतया २० देखि ५० वर्ष उमेर समँहका व्यक्तिमा यो समस्या देखा पर्ने गरेको छ । पछिल्लो समय थाइराइडका बारेमा चेतना वृद्धि भइरहेको छ । रोग पत्ता लगाउने प्रविधि पनि नेपालमा प्रशस्त छ । तर पनि थाइराइडका बिरामी धेरै भेटिने गरेका छन् । यद्यपि, थाइराइड भइसकेपछि कुनै पनि बिरामी आत्तिनुपर्दैन । थाइराइडका बिरामी दिन–प्रतिदिन किन बढ्दै छन् त ? थाइराइड ग्रन्थिले कि बढी काम गर्नुपर्यो, कि थाइराइडमा स्पेसिफिक रोग हुनुपर्यो । थाइराइडका बिरामी बढ्नुका मुख्य कारण यिनै हुन् । थाइराइडको समस्या महिलामा बढी हुने गरेको देखिन्छ । पुरुषमा थाइराइडको समस्या देखियो भने थाइराइडको क्यान्सर हुने समस्या बढी हुन्छ । यसको प्रारम्भिक लक्षणका बारेमा बताइदिनुस् न ? थाइराइड हर्मोनले कम काम ग¥यो भने शारीरिक तौल बढ्ने, खान मन नलाग्ने, महिनावारी समयमा नहुने, आलस्य हुने, खुट्टाहरु सुन्निने, कपाल झर्ने हुन्छ । यसको सट्टा हर्मोनको लेभल धेरै भयो भने खान मन धेरै गर्ने तर तौल घट्ने हुन्छ । त्यसै गरी मुटको गति बढ्ने, डर लागेजस्तो हुने, आँखा ठँलो–ठँलो हुने हुन्छ । यसबाहेक कुनै लक्षण नदेखिएर थाइराइडको क्यान्सर हुने सम्भावनासमेत रहन्छ । पुरुषको हकमा घाँटीको रुद्रघण्टीभन्दा हल्का तल्लो भागमा थाइराइड ग्रन्थि हुन्छ । सो ठाउँमा डल्लाडल्ली आयो भने ट्युमर पनि हुन सक्छ । त्यसैले तुरुन्तै उपचारमा लाग्नुपर्ने हुन्छ । थाइराइड पहिचानका लागि कहाँ सम्पर्क राख्ने ? अधिकांश ग्रामीण तहमा ल्याब टेस्टको समस्या छ । थाइराइड टेस्टका लागि थाइराइड फङ्कसन टेस्ट अपरिहार्य छ । यो जिल्ला तहका अस्पतालमा समेत छैन । अल्ट्रा साउन्डबाट पनि थाइराइड भए/नभएको थाहा पाउन सकिन्छ । त्यो पनि पर्याप्त छैन ग्रामीण तहमा । यस्तै एफएनएसी टेस्टबाट समेत थाइराइड भएको पत्ता लगाउन सकिन्छ । यो हर्मोनका लागि बेसिक स्क्रिनिङ टेस्ट हो । त्यो समेत पर्याप्त छैन । त्यसैले यो समस्या पहिचान गर्न सुविधा सम्पन्न स्वास्थ्य संस्था वा नजिकको ल्याब केन्द्रमा नै पुग्नुपर्ने हुन्छ । यसको प्रारम्भिक उपचार विधि के हुन सक्छ ? प्रारम्भिक उपचारभन्दा पनि यसको डाइग्नोसिस हुनु महत्वपँर्ण कुरा हो । त्यसैले घाँटीमा डल्लाडल्ली आयो, अगाडि नै बताइएअनुसार हाइपो अथवा हाइपर थाइराइडको लक्षण देखियो भने स्क्रिनिङ स्ट्याटेजी अपनाउनुपर्छ । त्यसैले यसका लागि सुविधा सम्पन्न अस्पताल वा ल्यब टेस्ट केन्द्रमा आएर थाइराइड फङ्क्सन टेस्ट गर्नै पर्छ । थाइराइडको समस्या भएको एकिन भएपछि मात्र उपचारका कुरा आउँछन् । यसको प्रारम्भिक उपचार भनेको नै हाइपो र हाइपर थाइराइडिज्म कुन हो एकिन भएपछि विशेषज्ञको सल्लाहअनुसार औषधि उपचार शुरु गर्नु हो । के यो समस्या नियन्त्रण गर्न सकिन्छ ? थाइराइडको समस्यामा सबैभन्दा बढी देखिने समस्या हाइपो थाइराइडिज्म हो । यो भनेको हर्मोनको उत्पादन कम भएर हुने समस्या हो । हाइपो थाइराइड भएका बिरामीमा मोटोपनको समस्या बढी हुने भएकाले मोटोपन घटाउन ध्यान दिनुपर्ने देखिन्छ । पुरुषको तुलनामा यो समस्या महिलामा बढी देखिन्छ । हाइपर थाइराइड हाइपोजस्तो धेरैलाई हुँदैन । हाइपर थाइराइडिज्म हाइपोको तुलनामा केही जटिल मानिन्छ । उपयुक्त तवरबाट उपचार नभएमा यसले ज्यान नै जोखिममा पार्न सक्छ । लक्षण देखा पर्नासाथ समयमै नजिकको सुविधा सम्पन्न स्वास्थ्य संस्थामा जानुपर्छ । औषधिको सेवनबाट नै यो समस्या नियन्त्रण हुन्छ । थाइराइडको क्यान्सर पनि हुन्छ भन्ने सुनिन्छ, वास्तविकता के हो ? थाइराइडको क्यान्सर हुन्छ तर यसको क्यान्सर भयो भन्दैमा मर्नुपर्दैन । सकभर क्यान्सर नहोस्, भए पनि थाइराइडको क्यान्सर होस् भन्ने गरिन्छ । मज्जाले हाम्रो सर्जन टिमले थाइराइड क्यान्सरको उपचार गरिरहेको छ । थाइराइडको समस्या कुन उमेर समँहलाई हुने सम्भावना हुन्छ ? थाइराइड जुनसुकै उमेर समुहमा हुन्छ । आमाको गर्भमा रहेको बच्चालाई पनि थाइराइडको समस्या देखिने गर्छ । यदि त्यस्तो वच्चा जन्मियो भने सुस्त मनिस्थितिको जन्मिन सक्छ । जन्मिएको बच्चामा पनि थाइराइडको क्यान्सर हुन सक्छ । पाँच वर्षको बच्चामा थाइराइडको क्यान्सर देखिएकाले हाम्रो टिमले अप्रेसन गरी निको बनाएको छ । बच्चामा मात्र नभएर वृद्धवृद्धामा पनि यसको लक्षण देखा पर्न सक्छ । त्यसै गरी २० देखि ५० वर्ष उमेर समँहका प्रजनन उमेरका महिलालाई पनि यसले सताउन सक्छ । उपचारका लागि नेपालमा पर्याप्त पूर्वाधार छ त ? नेपालमा थाइराइड उपचार पद्धतिका लागि वल्र्ड क्लास टेक्नोलोजी उपलब्ध छ । थाइराइडको अप्रेसनका लागि आवश्यक पर्ने सबै पँर्वाधार हामीसँग छ । हामीकहाँ पुरानो टेक्नोलोजी पनि छ । हर्मोनको लेभल टेस्टका लागि विदेश जानै पर्ने बाध्यात्मक अवस्था छैन । अझ भन्नुपर्दा अप्रेसन गर्नुपर्ने कुनै पनि केस अप्रेसन गर्न नसकेर विदेश जानुपर्दैन । कत्तिको खर्चिलो र जटिलता छ ? खर्चिलोको कुरा गर्दा रकममा ठ्याक्कै यत्ति नभनौं । सामान्य समस्या भएकाहरुलाई औषधि प्रेस्क्राइब गरिन्छ । त्यसैले यसलाई खर्चिलो भन्न मिल्दैन । यदि थाइराइडको क्यान्सर भएको छ भने अन्य क्यान्सरको उपचारभन्दा सस्तो छ । कम्तीमा तीन दिन जनरल्ली राख्छौं । जटिल प्रकृतिको अप्रेसन गर्नुपर्ने भए १० दिनमा अप्रेसन गरेर घर पठाउन सक्छौं ।