What are those thyroid lumps?
You touch your neck and notice some lumps that were not there before. You get scared and, you are likely to ask yourself a disturbing question: “Will it be a tumor? But don't let such an overwhelming idea paralyze you: it may just be about thyroid nodules. For your peace of mind, you should know two things: that the probability of them being evil is very small; and, second, that, if they are benign, They can be operated without resorting to surgery traditional. Several medical specialists in this problem clarify our doubts.
What are thyroid lumps?
"Are some small solid or liquid filled lumps that form within the thyroid, a small gland that is located at the base of the neck, just above the sternum, ”explains dr. Jesús Aldea, radiologist at the University Hospital of Burgos. That gland is fundamental in our life, since it regulates vital functions, such as heart rate, metabolism and the rate at which the body burns calories.
Many times those bumps are palpable, that is, they are large enough for they feel when touching the neck. Some even come to appreciate with the naked eye. These are the "simple packages". But it can also happen that they are only perceived through a ultrasound indicated by the doctor, who asks for it because he suspects its presence. Or, even, that they end up being located by accident, when carrying out tests that had nothing to do with the initial purpose. It is, for example, relatively frequent to be revealed in a resonance of cervical spine.
These packages also have another feature: practically 75% of cases occur in women. "There's a genetic factor that conditions its appearance. There are also hormonal binding factors, such as menopause; or environmental situations, such as a lower presence of environmental iodine or poor absorption. But although women have more, it is also true that they tend to be less serious than those of men, which are potentially more dangerous, ”warns dr. Pedro Pablo Ortiz, director of the Ultrasound Thyroid Nodules Treatment Unit of the Santa Elena Clinic.
How do they occur?
Its origin remains a mystery. "Its frequency increases with age and in geographical areas where there are low levels of iodine, ”says dr. Village.
A thyroid that develops nodules does it because it is not working properly. It seems that in the face of this malfunction, some groups of thyroid cells join together to form "small thyroid" inside the gland. "These cell clusters sometimes they work more than the thyroid itself, with an exaggerated formation of thyroid hormone. Sometimes they fill with liquid and increase very quickly in size, ”says dr. Ortiz In addition to the presence of lumps in the neck, we should check if we notice difficulty breathing or swallowing and symptom hyperthyroidism (lose weight without cause, sweating, palpitations, nervousness, insomnia …).
How can we know if they are malignant lumps?
"He thyroid cancer it represents only a small percentage of thyroid nodules, ”warns Dr. Ortiz, a specialist at the Santa Elena Clinic in Madrid. According to statistics, the packages that are maligned do not amount to 10% of the total. Of course, it is not possible to differentiate from each other only by symptoms.
Most cancerous thyroid nodules are from slow growth and they can be tiny or very small when discovered. That is why it is necessary for the doctor to evaluate any unusual inflammation that occurs in the neck to rule out any possibility of cancer, however minimal.
"For to diagnose if they are benign thyroid nodules or not, a sample is obtained, which is then analyzed, from the cells obtained through a puncture or even a biopsy of the gland, ”says dr. Ortiz
Can you avoid removing the thyroid?
Until a few years ago, the traditional surgery It was the only alternative to eliminate the nodules. It consisted, directly, in remove the thyroid gland. But in the neck there are many sensitive areas (such as the trachea, the carotid artery, the nerves that control the vocal cords, the esophagus, the autonomic nervous system …) that make the radical thyroid surgery have, in addition to those of any surgery, some added risks, such as vocal cord paralysis, with the possibility of dysphonia, bleeding and bruising.
"They all are assumable risks when it comes to thyroid cancer. What is not so clear is whether this surgery is necessary if the nodules are ultimately benign. In addition, when your thyroid is removed, you have to take into account that you should take substitute medication for life and sometimes it is not easy to control, ”says Dr. Ortiz. That's why specialists have looked for other less invasive options to this intervention … and fortunately they have already been found.
And in the future?
Progress in the treatment of benign thyroid nodules has been numerous over the past decade. There are already ongoing investigations to advance, above all, in a better and early diagnosis, but also to shorten the treatment time and make it more comfortable for the patient. “The lines of current research are aimed at genetic studies that help the most accurate diagnosis of benignity or malignancy of the thyroid nodules, ”explains dr. Village, radiologist of the University Hospital of Burgos.
On the other hand, the use of nuclear medicine They also contribute to improving the rescue of recurrences of cancers that are difficult to locate, and help the surgeon to locate them. The efforts must be at the same time technological and approach to society, so that, when a benign thyroid nodule is detected, it is not allowed to grow so much that there is no choice but to go through the swallow of traditional surgery. "The initial diagnosis, the monitoring of the nodule and its treatment by ultrasound in an early way will avoid many uncertainties in patients, waiting lists, healthcare expenses and improve the quality of life of patients who are, in short, our priority," he says. The doctor. Ortiz
When do we have to operate?
Thyroid nodules tend to grow and get bigger over time. Those between 2 and 18 mm They can double their size in a short time.
What are the non-surgical options?
There are three: radiofrequency, laser and ultrasound ablation. "Its about selectively destroy the thyroid nodule by heat. Literally, you burn it and leave the rest of the thyroid intact, ”explains dr. Ortiz
–Radiofrequency ablation. It produces electromagnetic waves (microwaves), which create heat around a needle that is used to "clean" the affected area. It is performed under local anesthesia, on an outpatient basis and in a single session. After this intervention, the size of the nodule is reduced to 95%, symptoms disappear and all normal thyroid functions are restored.
–To be. It consists of a puncture of the thyroid nodule with an ultrasound-guided needle. A very fine optical fiber is introduced, through which a laser light is produced that produces intense heat in a millimeter area of the affected tissue. This favors necrosis (cell death) in a controlled manner and only in the area of interest to eliminate.
–Ultrasound. The drawback of the laser and radiofrequency, although they are minimally invasive techniques, is that both need a needle to reach the nodule. “But ultrasound is even better. They are not invasive and treat the nodule with heat through the skin, without wounds, scars or punctures of any kind, ”says Dr. Ortiz. With the ultrasound, an effect similar to that of the sun's rays is achieved through a magnifying glass: when concentrating them at one point, the local temperature rises until the target on which you want to act is burned. This state-of-the-art technique is a breakthrough. Not requiring punctures, the patient returns to normal life within a few hours. "From the least invasive to the most aggressive, it is clear that the sequence in the treatment of benign thyroid nodules should start with ultrasound, complement with laser or radiofrequency, when necessary, and leave surgery as the last choice," summarizes this specialist. .