Hyperthyroidism (Toxic Goiter) Causes and Treatment
The condition that occurs as a result of excessive...
Solitary thyroid nodules are the most common thyroid disease. Thyroid nodule is encountered in 4-7% of the population between the ages of 30-50.
The presence of a single nodule in the thyroid is called solitary thyroid nodule.
The cancer rate in thyroid nodules varies by country and age. This rate is between 11-30%.
The majority of solitary thyroid nodules are asymptomatic. The cancer rate in solitary nodules in children is very high. Although it is more common in women, the cancer rate in solitary nodules is higher in men.
The cancer rate in solitary nodules is higher in children who received radiotherapy, especially for neck lymphoma.
In endemia regions, the rate of papillary cancer is more common in iodine-rich areas, and follicular cancer is more common in iodine-poor areas.
In the anamnesis, rapid growth of a previously existing nodule, detection of lymphadenopathy with a hard, fixed nodule in the neck, and hoarseness suggest cancer.
In benign thyroid nodules, the patient is followed up and the decision for surgery is made based on the changes during follow-up.
In surgical treatment, surgical techniques such as total thyroidectomy, near-total thyroidectomy, total lobectomy or subtotal thyroidectomy are applied depending on whether the nodule is benign or cancerous.
The thyroid gland synthesizes and secretes thyroid hormones. The most secreted of these hormones, which are formed by binding iodine to tyrosine amino acids, is T4. T3 is secreted less. The other hormone of the thyroid gland is calcitonin and is secreted from parafollicular C cells.
The most commonly used laboratory tests in the diagnosis of thyroid diseases are the levels of thyroid hormones in the blood. Total T4-T3, TSH and free T4-T3 levels are functionally helpful for easier measurement. In advanced cases, Thyroid antibody (Antithyroid peroxidase antibody-TPO Ab), Anti TSH receptor antibody, and antithyroglobulin antibody (TgAb) are determined. Thyroglobulin (Tg) and calcitonin are determined in tumor cases.
In addition to laboratory tests, examinations performed by radiology and nuclear medicine departments are used in the diagnosis of the disease.
The easiest and cheapest method used recently in radiology is ultrasound.
The most commonly used method in the nuclear medicine department is scintigraphy. It provides information about both the growth of the thyroid and the function of the lesion.
Fine needle aspiration biopsy has the most important place among the tests used recently in the diagnosis of thyroid diseases.
Enlargement of the thyroid gland for any reason is called goiter.
It is the unilateral or bilateral enlargement of the thyroid gland in certain geographical regions. It mostly occurs as a result of iodine deficiency or eating foods low in iodine.
In addition to goiter caused by iodine deficiency, some foods found in nature contain substances that cause goiter. These are called goitrogens. Turnip and its seeds, cabbage, and antithyroid drugs can also cause goiter.
In studies conducted in Turkey, Isparta, Burdur, Western and Eastern Black Sea regions were accepted as endemic regions.
Thyroid gland enlargement that develops outside endemic regions and whose cause is unknown is called sporadic goiter. It is also defined as simple goiter, they are mostly euthyroid.
Since there is no dysfunction in this type of goitre, patients mostly present with aesthetic appearance and pressure complaints.
Treatment of simple and endemic goiters is primarily through prophylaxis. In endemic areas, attention should be paid to goitrogenic substances and iodine prophylaxis is performed.
Surgery should be performed in cases that grow despite medical treatment, cause retrosternal compression symptoms, impair aesthetics, and are suspected of cancer. After surgery, these patients should be treated with L-Thyroxine.
The most important factor in the etiology of multinodular goiter is endemic goiter.
One of the most important problems in multinodular goiters is the risk of cancer.
In asymptomatic cases, L-Thyroxine can be given according to the patient's TSH level. Cancer risk, retrosternal growth, compression symptoms and cosmesis require thyroidectomy.
The treatment of patients is decided based on thyroidectomy, radioiodine therapy and T4 application, the patient's condition, age and stage of the disease.
Thyroidectomy is the standard treatment for young, healthy patients, especially those with pressure symptoms.
T4 treatment is the preferred treatment for the middle-aged group whose risk is low and whose TSH level is at the upper limit. Radioiodine treatment may be chosen in elderly patients with mild hyperthyroidism.