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What is a nodule?

A thyroid nodule is the equivalent of a pit in a fruit. It is a tumor created by the abnormal multiplication of cells. Most nodules are benign (adenomas) cause little discomfort and do not produce hormones. A minority of nodules correspond to cancer or adenocarcinoma.

The assessment of a thyroid nodule is based on: clinical examination, ultrasound, blood test. The clinical examination consists of palpating the lower part of the neck to assess the size of the nodule and its indurated appearance or not.; ultrasound allows you to see the nodule perfectly and even analyze its contents; Ultrasound allows nodules to be classified according to their cancer risk (TIRADS classification); The blood test is done to measure thyroid hormones and therefore allows us to know the quality of functioning of the gland. Most often, hormone levels are normal (euthyroidism) despite the presence of nodules.

If a thyroid nodule is discovered, what assessment should be carried out?

When should the nodule be punctured?

The puncture of a nodule is carried out under ultrasound and with a fine needle. The objective of the puncture is to better clarify the risk of cancer. A puncture must therefore be carried out when a nodule is doubtful on ultrasound, when it is large or when it significantly increases in size. The results of the puncture must be analyzed by a thyroid specialist who will determine the benefit of an operation.

What do the stages of the BETHESDA classification correspond to on my puncture result?

The BETHESDA classification ranges from 0 to 6 depending on the risk of cancer.

stage 0: not enough cells, puncture to be redone;

stage 1: normal cells;

stage 2: benign nodule;

stage 3: lesion at low risk of cancer requiring monitoring or operation (if troublesome nodule);

stage 4: gallbladder neoplasm type lesion (oncocytic nodule is a synonym) with a cancer risk of 20% or more requiring removal of the nodule by surgery;

stage 5: lesion very suspicious of cancer always requiring surgery with an intervention which will often involve treatment of the lymph nodes;

stage 6: cancer; programming a surgical treatment adapted to the size, location and ultrasound data.

Most nodules do not produce hormones, we say that they are cold. Certain nodules produce hormones in excess (“hot” nodule) and these hormones will be responsible for a hyperthyroidism syndrome (palpitation, sweating, hyperemotovity, tremors, etc.).

The diagnosis of a hot nodule is made on the blood test which will show a collapsed TSH (see functioning of the thyroid gland) and on the thyroid scintigraphy which will show an accumulation of the tracer at the level of the nodule.  

Hot nodules are treated either by surgery or by radioactive iodine depending on their characteristics and the terrain.  

What is a hot nodule?
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