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      Nodules and multi-nodular goiters are very common

Nodules are "balls" present in the thyroid gland (a bit like an apricot pit in the fruit) and are made up of abnormal glandular tissue.

Most nodules do not cause problems and are discovered either by examination of the neck by the doctor, or by an ultrasound examination or by a Doppler ultrasound to analyze the carotid arteries; the risk of having nodules increases with age; Nearly one in two women have a thyroid nodule after the age of 50 and the majority of these nodules do not cause disease.
The discovery of a nodule or several nodules (we then speak of multinodular goiter) raises several medical questions:
- Can the nodule be cancerous or become cancerous?
- How to assess the nodule to know its nature and risks?
- Is there a need for treatment if the nodule does not cause me any discomfort?
- Should I have him monitored and if so, how?
-Are there known causes and particular risks (especially for my children)?
- What are the risks for structures in contact, compression of the trachea or esophagus?


goiter drawing.jpg

Your medical care in 4 steps:

1 - Diagnosis thyroid nodule is done by clinical examination and ultrasound.

Any palpable or bothersome nodule or even any recently discovered nodule must benefit from an assessment combining a TSH dosage to analyze the functioning of the gland and an ultrasound of the neck to assess its physical characteristics (cyst or solid nodule; simple or nodule nodule suspected of cancer).

2 - The biological assessment (blood test) most often shows good functioning of the gland; in some cases the TSH is lowered, indicating a functional nodule, secreting hormones autonomously and which may be responsible for hyperthyroidism.

- Ultrasound is the essential examination to have a complete vision of the anatomy of the diseased gland and to assess the risk of cancer of a nodule.

The doctor who performs the ultrasound classifies the nodule in the TIRADS or EU-TIRADS system and thus carries out an assessment of the risk of cancer: nodules in categories 2 and 3 are benign or have a very low risk of being cancerous; category 4 nodules are doubtful and a fine puncture must be carried out

category 5 nodules are very suspicious

Category 6 nodules are cancers.

3 - The Cytopuncture (fine needle aspiration) of the nodule guided by ultrasound will make it possible to establish the risk of cancer more precisely. The nodule will be classified in the Bethesda system:

-   category I sample unsatisfactory for diagnosis

- category II if benign nodule, to be monitored by ultrasound

- categories III, IV and V if doubtful nodule or suspected cancer for which ablation is most often recommended

- category VI if confirmed cancer;

4 -The 2 support options which are discussed in the presence of a nodule are:

- The surveillance by clinical examination, ultrasound, thyroid biology.

This monitoring is carried out annually for simple nodules, considered to have no significant risk of cancer after assessment (ultrasound possibly supplemented by cytopuncture).

- Surgery which allows the removal of the nodule(s) and their analysis; it is recommended for all nodules suspected of cancer, for “hot” or functional nodules; which cause hyperthyroidism (hot nodules) and for nodules which cause local discomfort.

Removal of the thyroid is recommended in  case of goiter compressing the trachea (risk of respiratory discomfort). Compression of the trachea is assessed on a CT scan of the neck and thorax.

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