What is nodular goiter?
Most of the causes are simple diffuse goiter. Due to the repeated progress of the disease, follicular epithelium has changed from diffuse hyperplasia to focal hyperplasia, and some areas have degenerated. Finally, due to the repeated alternation of long-term proliferative lesions and degenerative lesions, nodules at different developmental stages appear in the glands. Its pathological changes are actually the late manifestations of simple goiter. In patients with nodular goiter, 5% ~ 8% may have toxic symptoms, namely plummer's disease or toxic nodular goiter. Some nodular goiter, due to excessive proliferation of epithelial cells, can form embryonic adenoma or papillary adenocarcinoma, and can also form thyroid cancer.
The clinical manifestation is 1. The patient has a long history of simple goiter. The onset age is generally over 30 years old. There are more women than men. The degree of goiter is different and asymmetrical. The number and size of nodules vary, usually multiple nodules, and there may be only one nodule in the early stage. Nodules are soft or slightly hard, smooth and without tenderness. Sometimes the nodule boundary is unclear, and only the feeling of irregularity or lobulation is felt when touching the thyroid surface. The disease progresses slowly and most patients are asymptomatic. Larger nodular goiter can cause compression symptoms such as dyspnea, dysphagia and hoarseness. Acute hemorrhage in the nodule can cause sudden enlargement and pain of the mass, the symptoms can subside within a few days, and the enlarged mass can shrink within a few weeks or longer.
2. Nodular goiter with hyperthyroidism (plummer's disease), patients have symptoms such as fatigue, weight loss, palpitation, arrhythmia, fear of hyperhidrosis and irritability, but there is no vascular murmur and tremor in thyroid gland, and exophthalmos and finger tremor are rare. The symptoms of elderly patients are often atypical.
3. Whether the patient has a history of radiotherapy, oral medication and family history, and whether the area where the patient comes from is an endemic goiter area. Generally, nodular goiter has a long history and no symptoms of oppression and hyperthyroidism, so patients often don't care. They came across thyroid nodules and came to see a doctor for examination.
4. If it is a hot nodule, also known as toxic nodule, the patients are mostly over 40 to 50 years old, with moderate hardness, hyperthyroidism symptoms and even arrhythmia manifestations such as atrial fibrillation. If there is bleeding, there may be pain or even fever. When the nodule is large, there may be compression symptoms, such as dysphonia, dyspnea, chest tightness, shortness of breath, irritating cough, etc.
5. For example, patients with nodular goiter from iodine-deficient areas have low thyroid function, and may also have slow heart rate, edema, rough skin and anemia in clinic. A few patients may also become cancerous. Nodules with warm nature are common and can be treated with thyroid preparations, and swollen glands can be reduced. Cold nodules are rare, and clinical hypothyroidism can be treated with thyroid preparations, but surgery is often needed.