The difference between thyroid enlargement and thyroid nodules

Written by Chen Xie

Endocrinology

Updated on December 07, 2024

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Thyroid enlargement generally refers to simple thyroid enlargement, which is typically diffuse thyroid enlargement, mainly caused by iodine deficiency, commonly seen in endemic goiter and physiological thyroid enlargement. Thyroid nodules, on the other hand, are nodular hyperplasia of the thyroid caused by certain physical and chemical factors. Thyroid nodules can manifest as benign hyperplasia or malignant hyperplasia. Therefore, the risks associated with thyroid nodules are relatively greater than those of thyroid enlargement. However, some patients with thyroid enlargement, as the disease progresses, can develop nodular hyperplasia of the thyroid. These are the differences between the two.

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Written by Hu Jian Zhuo

Nephrology and Endocrinology

1min 14sec

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Do thyroid nodules affect pregnancy?

This decision should be based on the nature of the thyroid nodules. If the thyroid nodule is benign, pregnancy generally will not be affected, and it is possible to conceive. However, if the patient has malignant thyroid nodules, I would advise against rushing into pregnancy. Firstly, prioritize treating the malignant thyroid nodules promptly. If you become pregnant during this time, the risks associated with surgery and medications for both the pregnant mother and the fetus are very high. Nevertheless, after receiving timely and standardized treatment and once the patient's condition has stabilized, it is possible to conceive. However, it should be noted that surgery may lead to reduced thyroid function. In the first 12 weeks of pregnancy, the fetus relies on the mother for thyroid hormone supply. If the mother's thyroid hormone levels are too low, it can lead to delayed fetal development, and even abnormal brain development, resulting in a baby born with intellectual disabilities. Therefore, women with a history of thyroid disease should develop a treatment plan under the joint collaboration of an endocrinologist and an obstetrician-gynecologist.

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Written by Hu Jian Zhuo

Nephrology and Endocrinology

1min 25sec

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Differentiation between benign and malignant thyroid nodules

Generally speaking, whether benign or malignant, thyroid nodules show blood flow signals. For benign nodules, blood flow signals can be seen around the perimeter, with internal blood flow no different from normal thyroid tissue. In such cases, the nodules are typically diagnosed as thyroid adenomas, and they usually appear round or oval in shape with a uniformly echoic internal substance. If liquefaction occurs, mixed or cystic changes can appear; the tumor’s capsule tends to be intact, with clear boundaries. If a nodule has abundant internal blood flow with disorganized vessel distribution and high flow velocity, showing a high-resistance flow pattern, and has relatively less peripheral blood flow, it generally needs to be assessed for thyroid cancer. These nodules are often hypoechoic with irregular shapes, and the ratio of their longitudinal to transverse diameter is greater than 1. They have unclear boundaries, lack a capsule, and have no halo. In typical cases, microcalcifications like sand grains can also be observed. From the above analysis, we can see that the blood flow signals in thyroid nodules are complicated and reflect the extent of the nodular pathology. These signals can help in differentiating benign from malignant nodules, but when a rich and disorganized blood flow is observed, the nodule is more likely to be malignant.

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Written by Hu Jian Zhuo

Nephrology and Endocrinology

53sec

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Thyroid nodule biopsy pros and cons

Currently, thyroid nodule puncture is performed under ultrasound guidance, so it is relatively safe. Fine needle aspiration causes minimal damage to the thyroid and almost no complications occur. Generally speaking, the following few adverse reactions may occur: One is bleeding, because the thyroid is a blood-rich organ, so bleeding may occur post-puncture. It can be controlled by applying local pressure immediately after the puncture. The second is pain, which is generally mild and can be relieved within 1-2 days. The third is skin infection, which is more likely in patients who are obese, have numerous skin folds, and sweat easily. In such cases, antibiotic treatment may be necessary. The fourth is injury to the trachea and nerves, although this is very unlikely and typically resolves on its own.

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Written by Hu Jian Zhuo

Nephrology and Endocrinology

33sec

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Does thyroid nodule puncture hurt?

Fine needle aspiration is an invasive examination, but it is currently an important and most efficient method for assessing benign and malignant conditions, generally conducted under ultrasound guidance. Thyroid nodule aspiration does not cause much pain, similar to that of an injection. Anesthetics are used during the procedure, so the pain is not very noticeable. However, as the effect of the anesthetic wears off, there may still be some pain at the puncture site, but the patients do not need to carry a heavy psychological burden.

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Written by Hu Jian Zhuo

Nephrology and Endocrinology

59sec

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Should thyroid nodules be punctured?

Thyroid fine needle aspiration is a reliable and highly valuable diagnostic method we use to distinguish between benign and malignant thyroid nodules. Generally, thyroid nodules with a diameter >1 cm are considered for fine needle aspiration. Fine needle aspiration is not routinely considered in the following situations: (1) The nodule has already been evaluated with a nuclear scan indicating a hyperfunctioning adenoma due to hyperthyroidism; (2) The nodule is purely cystic; (3) The nodule is highly suspected to be highly malignant. In cases where the nodules grow rapidly and significantly enlarge, causing compression of the surrounding trachea and symptoms such as breathing difficulties and hoarseness, these thyroid nodules requiring surgery do not necessitate further fine needle aspiration treatment.