The thyroid gland is an endocrine gland located in the anterior region of the neck: the main task of the thyroid gland is to produce thyroid hormones that are functional to the whole body. These hormones control important biological processes such as, for example, the regulation of numerous metabolic functions.
Professor Furio Pacini, Specialist Doctor of Endocrinology and Diabetology at Humanitas, talks about thyroid disorders.
Thyroid disorders: goiter, nodules, hyperdysfunction and hypothyroidism
The goiter is just an increase in the volume of the thyroid; its size can vary: in most cases it is a small increase, which does not cause symptoms or discomfort but, in some cases if it can be more challenging leading to disturbances, for example, of breathing and swallowing.
Nodules, on the other hand, are real swellings, i.e. solid formations (in some cases full of liquid) that form inside the gland. According to the Istituto Superiore di Sanità they are the most frequent thyroid disease, but they are almost always benign. Only 3-5% of the cases have malignant characteristics (thyroid tumors).
To date, thyroid disorders such as goiter and thyroid nodules are very frequent in the general population, especially in women after the age of 40-50. Since they are very often due to iodine deficiency – a very important element that affects the production of hormones and the proper functioning of the thyroid gland – diseases and disorders related to this organ could be prevented from the diet, increasing the intake of iodine in the diet, for example through the use of salt with added iodine (iodine salt).
Other thyroid diseases are, in fact, malignant tumors, due to a malignant transformation of one or more thyroid cells with consequent uncontrolled growth: these tumors tend to be very slow and not very aggressive.
When the thyroid produces too many thyroid hormones, it is the case of hyperthyroidism, the most frequent symptoms being weight loss, nervousness, anxiety and mood changes; while if the thyroid does not produce enough thyroid hormones, hypothyroidism occurs, which could cause, among other things, problems with metabolism and overweight.
Diagnosis
The use of new technologies (mainly ultrasound) to diagnose these disorders has led, in the last 10 years, to the discovery of an increasing number of thyroid nodules: it is estimated that the incidence of “clinical” nodules, that is, large enough to be discovered by the patient or doctor by simple neck inspection, is 5-10% of the population. Thanks to ultrasound scans, it is possible to diagnose and monitor even small thyroid nodules, which on palpation would not be discovered.
The consequence is that in ultrasound cases the incidence of thyroid nodules after the age of 50 reaches as much as 30-40% of the population, thus representing a phenomenon of medical and social importance. Of these, only 3-5% of all thyroid nodules are malignant, regardless of their size.
The diagnosis is made by various steps and analyses in agreement with the doctor. First of all, the thyroid hormones are ultrasonographed and dosed. If there is a disorder of thyroid function (hypothyroidism or hyperthyroidism), proceed with the appropriate treatment, which is usually medical in nature. If, on the other hand, we are faced with a thyroid nodule, we continue with the execution of a needle aspiration that serves to obtain groups of cells that, analyzed under a microscope, give us indications of the benignity or malignancy of the nodule itself. Once the final diagnosis has been obtained, the doctor will provide the most appropriate therapy.
Therapies
Obviously the therapy of thyroid nodules varies according to the benign or malignant nature: non-functioning benign nodules “generally do not need any therapy, unless they are very large, that is, more than 3-4 cm, such as to cause ‘collateral’ symptoms such as neck compression, such as dysphagia, compression and tracheal deviation or dysphonia. In these cases, it may be necessary to have surgery which, in the case of a single nodule, will be lobectomy, reserving total thyroidectomy only for multinodular goiters”, explained the endocrinologist at Humanitas.
In the case of malignant nodules, however, surgical therapy is mandatory and consists of partial or total removal of the thyroid. After surgery, the vast majority of malignant thyroid tumours (more than 90%) heal perfectly and definitively.
Customization of therapies
As it happens now in the therapies of most of the pathologies of our body, also with regard to thyroid diseases the key word is “customize”: “over the years the treatment of malignant neoplasms is increasingly directed to a therapy tailored to the clinical characteristics of the patient – said Pacini -. No longer a therapy equal for all, but a therapy based on the real individual risk. This allows the execution of less invasive therapies for cases with a good prognosis, reserving the most complete therapies to the only aggressive forms”, concluded.
