Thyroid nodules ("cold" and "warm/hot" nodules)

Nodular changes in the thyroid generally represent the development of benign thyroid tumors that can produce hormones ("warm/hot" nodules) or be hormonally inactive ("cold" nodules). They appear isolated, or individually, so we are talking about a single-nodular thyroid. There is also a form where we find two or more nodes (multi-nodular  thyroid). At the same time, the thyroid gland can be normal in size or enlarged. The basic disorder in all the mentioned forms is a mutation of the gene for the TSH receptor or its intracellular subunits on thyroid cells. Nodules are clusters of thyroid cells that act autonomously and are not subject to the control mechanisms of the pituitary gland and hypothalamus.

Clinical picture

The nodes are not painful to the touch. In the case of "warm/hot" nodules, patients present with clinical and laboratory signs of accelerated thyroid function, i.e. hyperthyroidism. Cold nodules can be benign (e.g. cysts and adenomas) and sometimes they can be thyroid cancer or metastases of other malignant tumors that spread to the thyroid gland.

Diagnosis and treatment

The diagnostic procedure includes a specialist and ultrasound examination of the thyroid gland, determination of TSH and thyroid hormones and possibly antibodies. Very often it is necessary to perform scintigraphy and cytological puncture, especially in the case of "cold nodules" larger than 1 cm or nodules smaller than 1 cm that show ultrasound criteria of possible malignancy. Genetic testing is carried out in selected cases.

In the case of "warm/hot" nodules, the goal of treatment is to suppress the production of excess thyroid hormone, while in the case of "cold" nodules medical treatment is not carried out, but if there is an indication, it is necessary to carry out surgical treatment (in case of unfavorable cytological findings, nodule growth, pressure on the surrounding anatomical structures or difficulties with swallowing and breathing).