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Thyroid nodules and carcinomas

Thyroid nodules occur frequently, are usually found randomly, are rarely malignant and are therefore generally not responsible for the patient’s complaints. However, thyroid carcinomas have very good prognoses and a very low mortality rate.

The following observations are reasons for visiting an endocrinologist:

  • A feeling of pressure on the throat
  • A visible swelling on the throat
  • A twinge when inhaling and/or exhaling
  • A newly developed, palpable node on the throat
  • A random finding on the throat during an ultrasound examination by a physician
  • A random finding during a CT or MRI scan of the throat

Thyroid nodules are clarified by means of palpation findings, laboratory tests, ultrasound and scintigraphy. Fine needle aspiration is also occasionally required.

In the case of scintigraphy, technetium scintigraphy is first carried out. If this reveals a cold nodule (without hormone production), it can be followed by MIBI scintigraphy if the nodule is large enough and sonographically suspicious. If this reveals a ‘match’ finding, i.e. also no multiple storage, it is highly certain that the nodule is benign.

Nodules that are irregularly delimited, anechoic and calcareous in the ultrasound scan are suspicious. If these are stored multiple times in the MIBI scintigram, surgery should be performed. In the event of surgery, a frozen section analysis is first carried out. Depending on the findings, this is followed by complete removal of the thyroid gland or cervical lymph node surgery.

The prognosis is usually very good for patients with thyroid carcinomas, as radiotherapy also removes metastases in the majority of cases.

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