Schilddrüsenknoten

A thyroid nodule is a lump within the thyroid gland at the front of the neck. Nodules are extremely common: ultrasound finds them in up to half of adults, more often in women and with increasing age. The great majority, around 90 to 95 in 100, are benign.

Most need no treatment, only a well-performed ultrasound and, where indicated, a needle biopsy to identify the few that are cancerous or the few that overproduce hormone. Thyroid cancers found this way are usually slow-growing and very treatable.

Symptome

• No symptoms at all, found by chance on a scan or examination
• A visible or palpable lump in the lower front of the neck that moves on swallowing
• A feeling of pressure or tightness in the neck
• Difficulty swallowing or breathing when lying flat, with large nodules
• Hoarseness, which needs prompt assessment
• Palpitations, weight loss, tremor and heat intolerance if the nodule is overactive

Ursachen und Risikofaktoren

Most nodules are benign overgrowths of thyroid tissue, fluid-filled cysts, or part of a multinodular goitre. Iodine deficiency, Hashimoto's thyroiditis, increasing age and female sex make them more likely. Risk factors for a nodule being malignant include radiation to the head, neck or chest in childhood, a family history of thyroid cancer or related syndromes, age under 20 or over 60, male sex, rapid growth, a hard fixed lump, enlarged neck glands and a change in the voice.

Wie es diagnostiziert wird

• TSH blood test: The first step. A low TSH suggests an overactive nodule, which is then checked with an isotope scan and is almost never cancer.
• Neck ultrasound: The key test. Size, composition, edges, shape and microcalcifications are scored with a system such as TI-RADS, which decides whether to biopsy, follow or discharge.
• Fine needle aspiration biopsy: A thin needle takes cells under ultrasound guidance in a few minutes without anaesthetic or with a little local. Results are reported in the six Bethesda categories.
• Molecular testing: Gene panels on indeterminate biopsy samples can help decide between surgery and observation where available.
• Thyroid scintigraphy: Shows whether a nodule is hot, meaning overactive, or cold.

Behandlungsmöglichkeiten

• Observation: Benign nodules are rechecked with ultrasound at 12 to 24 months, then less often if stable. No tablets are needed.
• Radiofrequency or ethanol ablation: Shrinks benign solid nodules or cysts that cause pressure or cosmetic concern, through a needle under local anaesthetic, without a scar.
• Radioactive iodine: For overactive nodules. A single capsule, with thyroid function monitored afterwards.
• Hemithyroidectomy: Removal of the affected half of the gland for indeterminate, suspicious or large nodules. About one in five to one in three people later need levothyroxine.
• Total thyroidectomy: For confirmed cancers above a certain size, nodules on both sides or large goitres. Lifelong levothyroxine follows. Risks include voice change and low calcium.

Wenn es dringend ist

Thyroid nodules are rarely urgent. Seek emergency care locally for difficulty breathing, noisy breathing, or sudden painful neck swelling, which can be bleeding into a cyst. After thyroid surgery, neck swelling with breathing difficulty, or tingling around the mouth and cramping hands from low calcium, need immediate attention.

Reisen nach Türkiye zur Behandlung

Assessment fits a short trip well: TSH, specialist ultrasound and needle biopsy can be done within 2 to 3 days, with cytology back in a few days. Thyroidectomy is a planned operation with one or two nights in hospital and about 7 to 10 days before flying, once calcium and voice have been checked. Follow-up ultrasound, levothyroxine adjustment and any radioiodine treatment should be arranged with a doctor at home before you travel.

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