Knots and cysts of a thyroid gland
Knots of a thyroid gland - the focal formations of a thyroid gland of any sizes having the capsule, defined palpatorno or by means of the visualizing researches. Cysts of a thyroid gland – nodal formations of a thyroid gland with the cavity filled with liquid contents. Knots and cysts of a thyroid gland it is long can proceed without any symptoms, then there are various discomfortable phenomena in a throat and the knot to become noticeable at a view of a neck. Gormonalnoaktivny knots of a thyroid gland involve development of a gipertireoz. The diagnostic algorithm at suspicion on knot or a cyst includes ultrasonography of a thyroid gland, a punktsionny biopsy of education and hormonal researches.
Knots and cysts of a thyroid gland
Knots of a thyroid gland - the focal formations of a thyroid gland of any sizes having the capsule, defined palpatorno or by means of the visualizing researches. Cysts of a thyroid gland – nodal formations of a thyroid gland with the cavity filled with liquid contents. Knots and cysts of a thyroid gland long time can have asymptomatic character, at increase in sizes cause "a sdavleniye syndrome" of nearby structures of a neck: violations in work of a thyroid gland, suffocation, a voice osiplost, violation of the act of swallowing, irritation in a throat, painful feelings. The most dangerous complications of cysts – an inflammation and suppuration, knots – malignant regeneration.
10% of the population in the world have various focal educations of a thyroid gland. In a thyroid gland nodal educations, various in morphological forms, can develop, at the same time the most part from them has good-quality character (a nodal colloidal craw, adenoma of a thyroid gland, a cyst of a thyroid gland).
Knots are the most widespread pathology of a thyroid gland, by 4-8 times more often meeting at women. Frequency and the quantity of the knots which are formed in a thyroid gland increases with age. As the reasons of formation of knots in a thyroid gland serve hereditary predisposition to their development, iodic deficiency in food and water, toxic impact on gland of varnishes and paints, solvents, gasoline, phenols, lead, radiation and radiation therapy.
Knots in a thyroid gland can be single (solitary) and multiple; autonomous toxic (t. it is superfluous producing hormones) or quiet, not toxic. Both good-quality, and malignant knots of a thyroid gland meet. Cysts make from 3 to 5% of all formations of a thyroid gland.
Macroscopically thyroid gland consists of the pseudo-segments formed by follicles (vesicles, atsinusa) and surrounded with capillary network. Inside follicles are covered by tireoidny cages and filled with albumen – the colloid containing protohormones of a thyroid gland. Violation of outflow of contents of a follicle leads to accumulation of excessive liquid and increase in its sizes, i.e. formation of a cyst of a thyroid gland.
Cysts of a thyroid gland can be formed as a result of microhemorrhages, dystrophy or a giperplaziya of follicles of gland. Usually cysts of a thyroid gland do not influence its function; malfunction happens at development of a cyst against the background of other diseases of a thyroid gland. The course of a cyst generally good-quality, extremely seldom meets the malignant cyst of a thyroid gland which is usually reaching the big sizes. Clinically cysts of a thyroid gland behave variously: are sometimes observed for years without negative dynamics, sometimes quickly increase in sizes or spontaneously disappear.
Stages of development of nodal formations of a thyroid gland
Developments of knots of a thyroid gland differ in the consecutive staging determined by degree of their ekhogennost at ultrasonography:
- izoekhogenny uniform knot. Density of internal contents of knot corresponds to surrounding tissues of a thyroid gland. At a stage of an inekhogennost strengthening of blood circulation and expansion of network of the vessels surrounding knot is noted.
- izoekhogenny non-uniform knot:
- with minor changes of fabric
- with the expressed fabric changes
- with gipoekhogenny inclusions (sites of a cystous degeneration)
Izoekhogenny non-uniform knots are formed in process of exhaustion and death of tireoidny cages and follicles.
- hypo - or anekhogenny knot. It is characterized by final fracture of fabric of knot, filling of a cavity with liquid and the destroyed cages that leads to formation of a cyst of a thyroid gland.
- stage of a rassasyvaniye of contents of a cyst of a thyroid gland;
- stage of scarring of a cyst of a thyroid gland.
Process of phasic transformation of knots of a thyroid gland is long; its speed depends on the sizes of knot, work of immune system, a condition of compensatory and adaptive mechanisms thyroid and gland and an organism in general. For acceleration of processes of scarring of a cyst of a thyroid gland sometimes resort to its sklerotization.
Symptoms of knots of a thyroid gland
Knots and cysts of a thyroid gland long time develop asymptomatically, without causing any subjective feelings at patients. They are usually painless and small, do not cause pressure or discomfort in a neck. Small knots and cysts of a thyroid gland often come to light during planned survey or inspection concerning other diseases. They are defined by Palpatorno as the smooth, plotnoelastichesky nodal educations which are easily probed under skin. In comparison with knots other tissue of a thyroid gland has a usual consistence.
Usually the moment when the knot becomes noticeable approximately is the cause for the independent address of the patient to the endocrinologist and deforms a neck. By this time the sizes of knot or a cyst of a thyroid gland already exceed 3 cm in the diameter and cannot conservatively be treated. In process of increase in the amount of nodal education and squeezing anatomic of close structures of a neck characteristic complaints appear: feeling of "lump" and irritation in a throat, disorder of functions of swallowing and breath, an osiplost or loss of a voice, neck pain. Cysts of a thyroid gland of the big sizes can squeeze blood vessels. At malignant nodal educations cervical lymph nodes increase.
Autonomous toxic knots as a result of the hyperactivity lead to development of a gipertireoz and its symptoms: tachycardias, feelings of heartbeat, inflows of heat in a body, excitement, emotional lability, an ekzoftalm. The single (solitary) knot located among normal tireoidny fabric is most suspicious concerning a malignant tumor, than one of multiple knots, is more often than employees display of a diffusion nodal craw. Malignant knots differ in rapid growth, have a firm consistence, often are followed by increase in cervical lymph nodes. However at early stages it is very difficult to distinguish high quality of knot on external signs.
Complications of cysts and knots of a thyroid gland
Cysts of a thyroid gland can be exposed to an inflammation and suppuration. At the same time there is sharp pain in a neck, high temperature, intoxication symptoms, increase and an inflammation of regionarny lymph nodes. Knots and cysts of a thyroid gland of the big sizes can put pressure upon nearby bodies and vessels of a neck. Nodal formations of a thyroid gland can regenerate in malignant tumors.
Diagnostics of knots of a thyroid gland
At palpatorny definition of nodal formation of a thyroid gland it differential diagnostics is carried out further. When performing ultrasonography of a thyroid gland education existence is confirmed, its sizes and structure (a craw, adenoma, a cyst of a thyroid gland etc.) are defined. For definition of cyto-morphological structure of knot (good-quality or malignant) the tonkoigolny punktsionny biopsy is carried out. During the research the cellular structure from knot is taken away by means of a needle and the syringe and sent to a cyto-histologic research.
By means of a punktsionny method it is possible to receive contents of a cyst of a thyroid gland also. Usually cyst contents (at a good-quality or malignant current) hemorrhagic, henna-red color also contain old blood and the destroyed cellular elements of a thyroid gland. Congenital cysts of a thyroid gland contain transparent slightly yellowish liquid. When developing abscess of a thyroid gland at a puncture receive pus.
By means of a tonkoigolny punktsionny biopsy of a cyst of a thyroid gland it is possible not only to receive material for a research and to define symptoms of suppuration or a malignization of band education, but also to make full aspiration of the accumulated liquid, and also to inject skleroziruyushchy drugs. About a half of cysts of a thyroid gland after depletion are fallen down and cease to accumulate contents.
For the purpose of assessment of violation of functions of a thyroid gland carry out determination of level of tireoidny hormones (TTG, T4, T3). At a stsintigrafiya – scanning of a thyroid gland define character of knot, its hormonal activity, a condition of surrounding tireoidny fabric by radioactive isotopes of I-123, I-131 iodine or technetium of the CU-99.
Knots are divided education and surrounding fabrics by ability of accumulation of radioactive iodine on:
- "warm" - the knots absorbing the same amount of radio iodine, as well as extra nodal fabric of gland (the functioning knots);
- "hot" - the knots accumulating bigger amount of radio iodine than not changed surrounding tissue of a thyroid gland (independently functioning knots);
- "cold" - the knots which are not accumulating radioactive iodine; diagnostic substance is distributed in not changed tissue of a thyroid gland. Treat "cold" knots cancer of a thyroid gland, however, only 10% of "cold" knots are malignant.
At the considerable sizes of knots and cysts of a thyroid gland or at their malignant character the computer tomography is carried out. At symptoms of a sdavleniye of structures of a neck carry out a laringoskopiya (for survey of vocal chords and a throat) and a bronkhoskopiya (for survey of a trachea). From radiological techniques at knots and cysts of a thyroid gland are applied pneumography of a thyroid gland (to specification of germination of surrounding fabrics), an angiography (to identification of violations of vascular network), gullet roentgenoscopy with barium and a trachea X-ray analysis (to definition of germination or a sdavleniye a tumor).
Treatment of cysts and knots of a thyroid gland
Knots and cysts of a thyroid gland with a diameter less than 1 cm are subject to dynamic observation and punktirutsya in case of increase in their sizes. Treatment of cysts of a thyroid gland is begun with their punktsionny depletion. Benign cysts of a thyroid gland without inflammation signs in case of a recurrence can be punktirovat repeatedly. Sometimes sklerozant (in particular, ethyl alcohol) for the best adhesion of walls enter into a cyst cavity after its depletion. If the cyst of a thyroid gland quickly accumulates contents, in a week reaching the initial sizes, better to remove it quickly.
Knots, small by the sizes, and cysts of a thyroid gland which are not followed by violation of health of the patient are treated conservatively, with use of the same pharmsredstvo that are applied to treatment of a diffusion not toxic craw: medicines of tireoidny hormones and iodine. Treatment process by medicines of tireoidny hormones is controlled by a TTG level research (each 3-4 weeks) and ultrasound examination of a thyroid gland (1 times in 3 months).
Treatment by iodinated medicines is performed under control of ultrasonography and existence in blood of antibodies to tissue of a thyroid gland (in 1 month after the beginning of therapy). The research of antibodies is necessary for an exception of the autoimmune tireoidit which sometimes is developing in the form of the knot and which is becoming aggravated against the background of treatment by iodine medicines. When determining in blood of a high caption of antibodies medicines of iodine cancel.
In the presence in a cyst of a thyroid gland of signs of inflammatory process carry out definitions of the activator and its sensitivity to antibiotics and connect anti-inflammatory treatment by antibacterial medicines.
As indications to expeditious removal of a benign cyst of a thyroid gland serve its big sizes, a sdavleniye of bodies of a neck, a bystry recurrence of accumulation of liquid after punktsionny depletion. More often in the presence of a cyst of a thyroid gland the gemistrumektomiya (gemitireoidektomiya) – removal of a share of a thyroid gland is carried out. Function of a thyroid gland after such operation usually is not broken. In the presence of good-quality knots in both shares of a thyroid gland resort to a bilateral subtotal strumektomiya - a resection of the most part of a thyroid gland.
As the absolute indication to expeditious removal of nodal education serves its malignization. During operation urgent patogistologichesky definition of a zlokachestvennost of knot and its form is carried out. At confirmation of existence of a malignancy in a thyroid gland sometimes resort to its full removal (a total strumektomiya) together with surrounding fatty tissue and lymph nodes.
After a total strumektomiya heavy hypofunction of a thyroid gland develops that dictates need of appointment to the patient in the postoperative period of reception of tireoidny hormones. As removal of a thyroid gland is carried out together with parathyroid glands, also calcium medicines are appointed. A frequent complication after a thyroid gland operations is violation of functions of vocal chords.
Forecast and prevention of knots of a thyroid gland
The forecast at nodal formations of a thyroid gland is defined by their histologic form. At good-quality structure of knots and cysts of a thyroid gland possibly full treatment. Cysts of a thyroid gland can recur again. Tumors of a thyroid gland of a moderate zlokachestvennost in the absence of metastatic eliminations recover at 70-80% of patients. The worst forecast at the malignant new growths sprouting the next bodies and giving the remote metastasises.
The prevention of formation of knots and cysts of a thyroid gland means daily consumption of iodine in limits of age physiological norm, enough vitamins, prevention of insolation, radiation, performing physiotherapy on area of a neck. After treatment of a cyst of a thyroid gland performing control ultrasonography is necessary once a year. Patients with small knots and cysts of a thyroid gland have to stay on the registry and dynamic observation at the endocrinologist.