Cold lump on the thyroid gland


Cold knots are inactive areas of nodular form in the thyroid.
From them goes no hormone production more and they point to a more or less pathological change of the fabric.

The causes for one cold knots in the thyroid gland can be versatile. Both benign appearances like Cysts, scar or Adenomas (benign tumor), as well as malignant diseases such as malignancies (malignant tumor) to be clarified.

A cold lump can be with a underactive thyroid be socialized.
This means that the thyroid gland does not produce adequate amounts of hormones, which has various effects on the whole organism.

In any case, a detailed examination is required if such an abnormal finding is detected.


Benign causes

A cold knot does not have to have a bad cause.
There are various benign manifestations that appear in the scintigraphic image as inactive area represent. Benign means that there are usually no devastating clinical pictures, but they still have to be examined and usually treated.
In contrast to confirmed diseases, however, the prognosis is usually better.

Belong to the group of benign causes of cold lumps in the thyroid gland Cysts.
Cysts are chambers that can form in a wide variety of tissues. You are with Deck cells (Epithelial cells) lined and contain a thin or thick Inflammatory secretions.

Through the Encapsulation to surrounding tissue, inflammation will not spread rapidly, but the size of the cyst can increase over time.
This allows a surgery may be necessary to remove the cyst.

At the point where the cyst exists are no normal thyroid cells more available. As a result, no radioactive contrast agent can be used there Scintigraphy stored, which results in a cold knot in the image.

Furthermore you can scar (also Fibrosis) as inactive thyroid areas. Scars or fibroses may result from Inflammation arise that have healed independently, but also through Operations. At a Scarring (Fibrosis) the substance accumulates fibrin into the tissue, which is part of the Coagulation system represents and hardens the corresponding area. Part of the thyroid gland is removed, if about one cyst or a tumor must be treated, then the tissue will usually scar on the areas where incisions have been made. There is scarred tissue harder than other tissue and loses its functions during this conversion. Cold lumps caused by scars are therefore completely harmless as long as the function of the thyroid gland is not too severely restricted. If the fibrous areas get out of hand, as can be the case after a very serious inflammation, there is a possibility of developing one Hypothyroidism.

Does it come with traumatic processes, like with one accident, damage to the neck region or the thyroid gland, this can lead to bleeding in the same. Pathological changes in the blood vessels that cause acute damage to the ducts can also be responsible for bleeding. Bleeding can damage the surrounding tissue and cause inactive areas in the thyroid gland. As usual, these appear as colorless in the scintigraphic image cold knotsn represent.

Thyroid adenomas are benign tumors. They evolve from the Follicular epithelial cells of the thyroid (Thyroid gland), the so-called Thyrocytes.
Follicular epithelial cells are cover cells that are arranged around the smallest of cavities in which, in the case of the thyroid gland, the thyroid hormones are formed and stored.
Mainly go Thyroid adenomas with a Hyperthyroidism hand in hand.

If this is not the case and the proliferating cell clusters are inactive cells, an adenoma can also be the cause of a cold lump. However, unfortunately most of them are cold knotswhich with Tumors are associated malicious Nature and are called Thyroid cancer designated.

Malignant causes / cancer

Cold knots are in scintigraphic Findings are not uncommon.
Often times are benign diseases the background of such eye-catching images. However, a malignant tumor disease be excluded.

Thyroid cancer characteristically, when the size is sufficient, as cold knot in the tissue.
Since the laboratory results are usually inconspicuous, the picture or a questionable palpable finding first evidence of a Thyroid cancer give.

A distinction is made between different types of Thyroid cancer. The forms are very different in their course and in the probable chances of recovery.

Have the best forecast papillary thyroid carcinoma, Which approx. 65% of all malignant tumors.
In terms of prognosis, they are closely followed by the similar one follicular thyroid cancerthat has a share of approximately 25 % matters.

It is less common medullary thyroid cancer, that results from the C cells of the thyroid forms.
These cells produce the hormone Calcitoninthat the Calcium balance regulates.

Because of this, it happens with medullary tumor to a separate symptomatology, with an increased hormone level of calcitonin and a subsequent hypocalcemia, a Calcium deficiency, goes hand in hand.

Very rare are anaplastic thyroid carcinomawhich at the same time have the lowest chances of recovery.
Because of the strong Dedifferentiation of the cells the tumor grows extremely quickly. De-differentiation means that the cells no longer have anything in common with the surrounding tissue - they do not resemble any cell found in the thyroid gland. Therefore, the malignant tumor can be influenced, let alone stopped, by very few therapeutic measures. Another way to pose for cold nodules is malicious Metastases The thyroid is, however extremely rare affected by metastasis.


Cold knots can go completely unnoticed clinically.
Depending on the cause and size, they may go unnoticed for a long time and rather than Incidental finding getting discovered.

If the knots are painful, it is more like one acute cause like bleeding or otherwise injury to think.

If the nodes can be palpated after a period of pain or shown with imaging methods, then a previous one is necessary Inflammation of the thyroid gland (Thyroiditis) probably.

As mentioned earlier, the blood values (Hormone levels) neoplastic (tumor-related) diseases are not necessarily changed.
However, if an increase or decrease is noticed, further diagnostics should be included closer examination of the thyroid gland consequences.

If there are oversized, cold lumps that actually affect the thyroid function, the clinical picture of a develops Hypothyroidism - of the Hypothyroidism.

underactive thyroid

The thyroid is for the Iodine balance of the body and for production important hormones responsible. With the help of the absorbed and stored iodine are in the organ T3 (triiodothyronine) and T4 (thyroxine) manufactured.
These hormones are important components of the Regulation of the energy metabolism, as well as the Growth control of all cells as well as the body itself. They are made in the thyroid cells, unlike that The hormone calcitonin. This is in so-called C cells produces and controls together with the Parathyroid hormone, which from the Parathyroid originates from Calcium balance of the body. Calcitonin is responsible for lowering the calcium level in the blood and parathyroid hormone is the corresponding counterpart.

A Subfunction usually develops slowly and is initially not noticed by many patients.

The Efficiency decreases due to the disturbed energy metabolism. Following Poor concentration and muscle weakness, but also a general inclination to fatigue.
The patients are often unpowered and freeze often because the body is not producing enough energy.

Also in the digestion The reduced energy supply is reflected in blockages.

It can be confused with a depressive phase, especially in older patients. Due to the lack of drive and depressive character of the Hypothyroidism the symptoms can be misinterpreted.
Also Memory problems or Loss of appetite can represent common clinical signs that can be differentiated by a blood test.

Also on the vital signs of the patient the Subfunction their influence: the The pulse and blood pressure drop permanently, unwanted things happen Weight loss, the skin is rough and overall the patient looks unhealthy. Gender-specific symptoms show up in men lack of sex drive and Erectile dysfunction, by women Disorders in the female cycle or lumpy changes in the chest. In children with hypothyroidism, it can Developmental disorders or delays in growth, which need not be the case.

As the most severe form of one Subfunction of the thyroid can become a so-called hypothyroid coma to adjust.
There the vital functions decrease further down. The heartbeat is difficult to perceive, the Pulse slows down again. Also the Blood pressure and body temperature are decreased and aggravate the patient's condition.
The patient continues to fail shallow breathing and weak to absent reflexes.

Characteristically, the patient shows a Myxedema.
This leads to the accumulation of components of the connective tissue (Glycosaminoglycans) into the subcutaneous tissue. Because these substances water-attracting act, following one general suspension the subcutaneous tissue, which makes the patient look puffy despite his often low weight.

This maximum increase in the clinical picture of hypothyroidism is rather rare, as the signs are usually interpreted at an early stage and with the help of Hormonal drugs the disease is counteracted.

Hair loss

An underactive thyroid, as it occurs in cold knot this affects some patients Hair growth.
This happens because the hormones perform essential functions regarding the thyroid gland Development of cells of all kinds of the human body. So they also work on him Hair structure.

The hypofunction partly causes the hair to have insufficient stability - it loses strength and has a smaller diameter than healthy hair. This is optically in one Loss of density to recognize. Patients report an increasing Weariness of her scalp hair and from increased fragility. All these aspects have a negative impact on the maintenance of the hair - they fall out more easily and bald spots form.

Treated tumors may also cause hair loss from previous cold lumps in the thyroid gland.

Treatment of first choice for tumors is removal of the thyroid and subsequent administration of Thyroid hormone preparationsto achieve hormonal balance.
As a result of the operation, radioiodine therapy can be added to eliminate the last remains of the thyroid gland.

For this purpose, the patient is injected with radioactive iodine, which destroys the remaining thyroid tissue. It can happen that a treatment-related hypothyroidism is triggered. This can also lead to hair loss in addition to other symptoms.


The concept of one cold knot in the thyroid is determined by a Scintigraphy derived. A scintigraphy is a method of nuclear medicine imaging.
The patient is injected with radioactive, but not harmful substances, which are deposited in certain tissues, for example in the thyroid.
With the help of a so-called Gamma camera the radiation emanating from the radioactive substance can then be displayed in an image.

If the thyroid is represented in this way and there is an otherwise colorful picture colorless area, this is called cold knots. Cold because colorlessness is one Inactivity of the relevant area means and knot, because the structures are mostly round.

The attending physician can also use the thyroid with the help of a Sonography (Ultrasonic) or with a palpable finding. Ultrasound is particularly good at doing this Cysts represent, since the sound the liquid in the cyst can not penetrate and thus a shadow is cast. When differentiating the origin of other abnormalities, the Options for a sonographic examination are limited. Can the knot already groped will or is he even from visible outside, so this points to one advanced findings down.

The laboratory parameters can also provide information on the cause of the existing lumps. Are the thyroid parameters T3 (triiodothyronine) and T4 (thyroxine) humiliated, that TSH (Thyroid stimulating hormone; Thyroidea = Thyroid) but normal or elevated, that's how it works Hypothyroidism from the organ itself and there is a large area Damage to thyroid tissue in front.

Are the Thyroid hormones inconspicuous, the restriction is limited - it can still Cysts, scarring, or tumors consist.


Cold Lump - What To Do?

Anyone who feels a lump in themselves should see a doctor as soon as possible.

Such an abnormality does not always have a bad cause, but it must be checked what kind of change is behind it.
A cold lump is often a chance find discovered during other investigations.

If the lump is shown by sonography or scintigraphy during further diagnostics, a malignant disease must be excluded in any case.

For this purpose, biopsies are often carried out, i.e. the smallest of tissue samples that are examined finely. For the thyroid, fine needle biopsy is usually used to take a tissue sample.

Read on under: Thyroid biopsy

In any case, you should keep calm and have the findings clarified by a doctor.

Medical therapy

Hormone therapy is absolutely indicated for young patients with hypothyroidism.

It comes to one Hypothyroidism, this should always be stopped with medication to avoid long-term problems.

The dose of prescription hormonal drugs must be individually adapted to each patient.
First, small doses are administered, which can be gradually increased up to the desired therapeutic value.
In this way, side effects can be avoided in the best possible way.

The subjective feeling of the patient plays an important role in setting the medication between 50 and 150 micrograms per day.
Likewise the TSH levels checked after one and a half to two months. This gives a long-term guideline value for correct drug administration.

Particular attention should be paid to very young patients. Depending on the age, the hormone levels can fluctuate. Deficiency symptoms like Growth retardation or Weight loss be kept in mind. A Control of blood values at shorter intervals is more important for people who are still growing than for adults. However, adults should also have their thyroid hormone levels checked regularly.

Does it come to the clinical picture of hypothyroid coma, it requires a more complex treatment. Since this is the Life is acutely threatened, the patient must immediately respond to a Intensive care unit be included. The vital functions must be continuously monitored and the body temperature normalized, as the patients usually suffer from hypothermia (Hypothermia) Suffer.

Drug treatment is carried out with the help of glucocorticoids (Cortisone) and glucose, as well as with an intravenous dose of L-thyroxine, a thyroid hormone.


Don't always have to cold knots in the thyroid Cause for a surgery be.

In many cases, a resulting ailment, for example a Hypothyroidism, by Medication get a grip.
Often it also happens that the node remains clinically completely silent and no symptoms arise, even if nothing is done in the long term.

However, if the cold lump is due to a malignant tumor diseaseso this lump or even the entire thyroid gland must be removed.
This can be done in a number of ways.

A removal of the individual parts as well as the entire organ is possible, but not always necessary. Especially at benign tumors One often resorts to only removing the knot with a certain safety margin.


Before starting the operation, a few questions should be answered that influence the procedure during the procedure from the start.

So it must be clear whether just the knot is to be removed, or larger parts of the tissue.
While with various other diseases of the thyroid gland no total Resection (Distance) is required, the total distance is at Thyroid cancer almost always indexed. The risk of preserving tissue is rarely taken. There is almost always the risk that the smallest tumor components will be overlooked due to their minimal size and later become one Relapse (Disease recurrence) lead.

The OP is in general anesthetic carried out. Of the Access to the operating area is from the front via a Cross section directly on the neck.
This is often done in a skin fold in order to be able to achieve a better optical result when it heals later.
The skin layers, the connective tissue and the neck muscles are severed in order to reach the thyroid gland.

If the thyroid is gradually removed from the surrounding tissue, hemostatic measures must be taken continuously, as the organ is well supplied with arteries and veins.

A Hemithyroidectomy, one half-sided removal the thyroid gland, can be detected in one early papillary thyroid carcinoma (so.) can be applied.

It can various complications in removing the thyroid occur. On the one hand, grossly negligent behavior of the Larynx or the windpipe Take damage, which should not happen to experienced surgeons.

Located on the back of the thyroid are four so-called epithelial bodies, the so-called Parathyroid glands, in the must be preserved in each case.
Because in them it will Parathyroid hormone which plays an important role in the body's calcium balance.
Due to the small size of the parathyroid glands, it is necessary to proceed very carefully.

If enough of the surrounding tissue cannot be preserved in place, the epithelial cells can be transplanted into the arm. There they are connected to the blood supply and can continue to perform their tasks.

It should also be extremely careful with that Recurrent laryngeal nerve be proceeded. This runs a lot on the way to the larynx close to the windpipe and thus also passes through the thyroid area.
In the larynx, it controls almost all the muscles present.

In the event of damage, there are various restrictions such as persistent hoarseness or shortness of breath.


If the present cold nodules in the thyroid gland have no devastating cause or if there is no serious hypothyroidism, alternative remedies can also be used.

Homeopathy is also understood as a supportive form of treatment that can be used in addition to conventional medical measures in order to achieve the greatest possible success.

For example, a slight hypothyroidism that has arisen due to cold lumps can be brought under control with homeopathic remedies.
Graphites and Pulsatille have a metabolic slowing effect, which also stimulate digestion, clean up skin changes or help women regulate the cycle.

Barium carbonicum and alumina can be administered for nervousness and reduced mental performance, whereas Kalium carbonicum and Silicea have a positive effect on people who are prone to increased fatigue or edema.

Some alternative practitioners are of the opinion that nodes in the thyroid are an expression of emotional conflicts and indicate special character traits. They are seen as a phenomenon of psychosomatics and as a result of undesirable stimuli. In the knot, the patient's soul is relieved. If the knot is safe, this concept advises against an operation, because it deprives the patient of a means of self-regulation.