Internal Medicine

Hot knot thyroid

introduction

Hot knotsn in the thyroid are areas that make you special active metabolism exhibit and many Hormones to produce. The causes of a hot lump are relatively one-sided, but must be differentiated from other clinical pictures.

Usually such a knot can be treated well. If the disease continues for a long time without a successful therapy, it can lead to a Hyperthyroidism that has various effects on the human body. Even if a hot lump in itself does not pose a threat to the patient, severe hyperfunction can still be life threatening or even fatal. However, cold lumps are many times more common.

Symptoms

Hot knots can be at the beginning of the formation without any symptoms exist. In the further course of the process, there are also patients who never find any effects on the body disturbing and therefore the formation of knots undetected remains. In blood are the values of Thyroid hormones increased to a greater or lesser extent, which indicates an overactive organ.

Even with hot nodes, the clinical picture gradually builds up, but follows the symptoms of one Hyperthyroidism. So stand in principle Restlessness, sleep problems, unwanted weight loss, strong sweat, one accelerated digestion With Diarrhea, Hair loss and Muscle spasms mostly in the foreground. Not always all signs have to be one Hyperthyroidism appear, as individual fluctuations are also possible here.

causes

Benign Tumors are in most cases the Cause of a hot lump. Such a tumor is also called Adenoma. Adenomas can in the thyroidwhich for the Iodine balance is responsible, due to a lack of precisely this substance. If a person takes in too little iodine through their food, it can Thyroid doesn't produce enough hormonesbecause they contain iodine. In order to maintain the hormone level, the body tries to compensate for the underproduction by the Thyroid gland grows. To do this, growth hormones are released, which can now lead to local cell growth - a knot arises. In some cases, the tissue that was stimulated to grow becomes independent autonomous (self-contained) adenoma is called. These cells are beyond the control of the brain and are now producing excess hormones.

One or more nodes can arise in this way. If the nodes in the thyroid get out of hand, it is called a disseminated (widespread) adenoma. The differentiation between hot nodes and Graves disease occur. Graves' disease is one Autoimmune diseasewhere the controlled control of the entire thyroid is lost. A general overfunction occurs, which no longer occurs focal (focal point) is limited. In very rare cases, both clinical pictures appear at the same time - it does exist Marine-Lenhart Syndrome. This makes the diagnosis very difficult.

cancer

Thyroid cancer is usually with cold knots associated. Will be a Scintigraphy carried out and an area arises without metabolic activity there must be a malignant tumor disease always be excluded first. At hot lump is a benign tumor underlying. It is extremely unlikely to result from an existing hot lump in the thyroid gland Thyroid cancer, that is, forms a malignant tumor. This is one reason why hot knots tend to be relatively safe for the patient are. However, a patient whose thyroid shows hot lumps can also take a bad course of the disease - namely through a Hyperthyroidism.

Hyperthyroidism

The thyroid occupies an important position in the Control of the energy balance and the Growth control a. It affects the cells of the body with the help of the hormones they produce - T3 (Triiodothyronine) and T4 (Thyroxine).

At a Hyperthyroidism (Hyperthyroidism) become too many Hormones educated. The metabolism is boosted and one is created Excess of energy for the body. Every patient reacts individually to an overactive thyroid. Often it goes unnoticed at first, but later on it can not only become a burden, but also cause danger become. The whole body responds to the excess energy. The patients are in one Permanent state of restlessness and excitement, can only poorly relaxing or sleeping, and tend to sweat more. Of the Blood pressure rises and the Heart beats faster, taking it to Cardiac arrhythmias and Atrial fibrillation can come. The restlessness shows itself not only mentally, but also in motor skills tremor (Tremble) and Muscle weakness. Through the extreme metabolism take the patient despite constant feeling of hunger and complain about increased bowel movements, up to Diarrhea. More distressing symptoms are Hair loss and menstrual disorders.

Diagnosis

When diagnosing hot lumps, there are various ways of discovering them and then classifying them according to their level of activity. In many cases, hot lumps can be associated with symptoms of an overactive thyroid. Through a palpation examination (Palpation) the patient or a doctor can become aware of a lump for the first time. When talking to the patient, the symptoms of an overactive thyroid must be inquired about. About the typical clinical picture of Graves' disease, which also has protruding eyes (Exophthalmos) and a goiter (goiter) can be excluded, these abnormalities should be checked.

Patients who suffer from an overactive thyroid usually have an accelerated heartbeat at rest, which should be noticed when measuring their pulse. In the patient's blood count, increased thyroid levels (TSH, T3, T4) are evident. The examiner has various options for imaging. As a harmless procedure, an ultrasound is always carried out first, with which existing nodes can be shown very well. If the knot is larger than 1 cm, scintigraphy is used. The patient is given radioactive contrast medium (Technetium) administered. This is not harmful and is stored especially where the metabolism is high - in the hot knots. An image is generated with the help of a so-called gamma camera, which can display the radiation emanating from the contrast agent. The particularly colored areas are congruent with the metabolically active nodes.

Hot lumps are shown on a scintigraphy

Scintigraphy Thyroid gland of a female patient 46 years with autonomic adenoma.

right lobe of thyroid
“hot ”knot = highly iodine-absorbing area
left thyroid lobe (normal iodine uptake)

Ultrasonic

Often lumps that were initially felt are shown by ultrasound in the course of further diagnostics. In principle, the final decision as to whether the lump is cold, hot or metabolically normal can only be made with the help of a scintigram. However, on ultrasound, the lump may have certain characteristics that make a hot lump more likely.

If the structure is hypoechoic, i.e. if the sound is not reflected back well, there could be a hot lump. In the picture, this is shown as a dark area, since echo-rich areas are shown as bright. Often there is fluid in the middle of hot nodes, which can also be referred to as a cystic area. This liquid is usually inflammatory in nature. Liquids also appear dark in the ultrasound.

The examining doctor can display the blood flow in the tissue marked in color in the image. With the help of this function, a clearly perfused border area should become visible in the case of a hot lump. This is due to the high metabolic activity of the node.

If necessary, a tissue sample of the suspicious area can be taken under ultrasound control and examined microscopically. This procedure is called a biopsy. The so-called fine needle biopsy is usually sufficient for the thyroid gland.

Find out more at: Thyroid biopsy

therapy

Medical therapy

Patients who called thyroid nodules suffer do not necessarily have to be in need of therapy. However, one occurs in the context of an autonomic thyroid adenoma Hyperthyroidism one, it should definitely be treated. The stress felt by the patient can vary individually. The same treatment does not have to follow if the hormone level is the same.

While there are several options for therapy, this is medication usually first choice. The thyroid cells are through Medication thwarted. This is done via a Inhibition of iodine processing, after this has been absorbed from the blood. As a result, will produces less thyroid hormones and the metabolism can normalize. Medicines with a corresponding effect are for example Thiamazole or Propylthiouracil. There dose-dependent side effect exist, you should always stick to the specified quantities.

Radioiodine therapy

The Radioiodine therapy is a variant of the treatment of the most diverse Thyroid disease. Also at hot knotthat with a Hyperthyroidism connected, this therapy can be the Nuclear medicine can be used. The patient is doing this radioactive iodine administered. By taking in that Iodine in the thyroid gland can a locally limited effect be achieved. Since the substance also Radiation damage causes the metabolism to slow down and the cells to lose their function, then to inhibition of reproduction and ultimately to Cell death.

Due to the short range of the therapeutic beta radiation (approx. 0.5 millimeters in the tissue), which from radioactive iodine goes out, the neighboring organs are protected as best as possible. In long-term studies no increase in cancer cases after radioiodine therapy to be established. Treatment must be inpatient, even if the Radiation exposure is only about as high as an X-ray. The reason for this lies in the Excretion of radioactive particles by the patient.

Removal of the knot

If the consequences of one or more hot lumps could not be remedied by previous therapy, one can also refer to a Removal of the knots can be used. Another occasion is a very large goiter (Goiter), which brings about mechanical restrictions for the patient or a more extensive one Infested with cold lumps. When removing the lump, there are several ways to preserve thyroid tissue. On the one hand there is the possibility of using the round stove with a certain Safety distance to remove and the Leave most of the supposedly healthy tissue. On the other hand can be a whole Thyroid lobe (Hemithyroidectomy) or even the whole thyroid (Thyroidectomy) must be removed.

surgery

In the Thyroid surgery the patient will always be in, regardless of whether only the node or entire parts are removed general anesthetic offset. Precise work is also of the utmost importance here. To get to the operating area, the Cut across the neck at half length carried out. For later cosmetic reasons, an incision in a skin fold is often used. Due to this localization, the scar is often barely noticeable after complete healing. After the topmost layer of skin, the lower layers, the connective tissue and the neck muscles follow. The thyroid gland lies on top of that Larynx up and must now carefully removed become. Through the good vascular supply, with which the organ is equipped, the surgeon should at all times Bleeding count and be prepared for it through hemostatic measures.

Also read: Thyroid Removal.

At Operations on the thyroid gland special complications can arise. As a rule, the larynx or the windpipe is not injured, as this would have to be handled very roughly. Particular attention must be paid to the Parathyroid glands, also Epithelial bodies, be taken. These are arranged in pairs on top of each other, behind each thyroid lobe, and are important for the Calcium metabolism. they produce Parathyroid hormone, which one Increase calcium levels in the blood can. Since the Epithelial bodies are very small, there is a risk that they will be removed with.

If not enough tissue can be left in the operating area, there is another variant of preservation. The Parathyroid glands relocated to the arm and connected to the vascular system so that the calcium balance can still be regulated.

Besides these smallest organs, is on the Recurrent laryngeal nerve to pay attention.In its course it passes the thyroid region and finally arrives at the side of the windpipe located until Larynx. There he is for them nerve supply of almost all larynx muscles responsible, which shows its immense importance. By damaging the Recurrent laryngeal nerve permanent damage can occur. These show up in the form of persistent hoarseness or shortness of breath. Damage to both sides is problematic. Since the muscles of the larynx and the vocal cords can no longer be moved, it is impossible to open the glottis - the patient threatens to suffocate.

Further information

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