Thyroid nodules: how to detect and treat them in the fastest way

The thyroid is a small gland in the front of the neck, just above the breastbone. Its function is to produce the hormones responsible for regulating the body’s metabolism and it can suffer, among others, a series of disorders in its morphology (increase in size or appearance of nodules). Nowadays, according to the Spanish Society of Vascular and Interventional Radiology (SERVEI), they are “very frequent” and their detection is increasing, mainly thanks to the increase in the performance of diagnostic imaging tests in our environment (ultrasound, CT or RM). Dr. Manuel Gargallo, head of the Thyroid Nodule Unit of the Endocrinology and Nutrition Service of the Jiménez Díaz Foundation in Madrid, and a national reference in thyroid diagnosis and treatment, explains that, despite the fact that thyroid nodules are very common in the general population, fortunately most of them are benign, do not require treatment or surgery, and are found by chance during an examination, or in some radiological test, such as those mentioned above. «Thyroid nodules, solid or fluid-filled lumps that form inside the thyroid, the gland at the base of the neck, are very prevalent in the general population and are usually asymptomatic, which is why they are usually discovered by chance when palpating the neck, or when performing a clinical examination or imaging test, ”the specialist details. According to the SERVEI, thyroid nodules are usually more frequent in women, the incidence being up to three times higher than in men, at the same time that it indicates that they tend to appear more in patients of advanced age. Moreover, depending on their location or size, they can give symptoms such as respiratory distress, a foreign body sensation or local discomfort; sometimes they even represent an aesthetic problem, for which the patient identifies the lump in the neck, causing concern and discomfort. For this reason, the head of the Thyroid Nodule Unit of the Endocrinology and Nutrition Service of the Jiménez Díaz Foundation in Madrid recalls that, although most are benign, “some can grow enough to be visible or make breathing or swallowing difficult », As he warns. It also emphasizes that once a nodule is detected, it may be necessary to carry out a study to confirm its benignity and rule out the possibility of thyroid cancer, and the corresponding need for a surgical approach to remove it. Once a nodule is detected, it may be necessary to carry out a study to confirm its benignity and rule out the possibility of thyroid cancer, and the corresponding need for a surgical approach to remove it. When diagnoses are delayed As described by Dr. Gargallo, it is a process that, on occasions, can be prolonged with numerous consultations and the performance of ultrasounds and other tests, which translates into a wait that entails uncertainty, concern and anguish for the patient until they know their final diagnosis. «In the presence of a thyroid nodule, a specific study is required to rule out that it is malignant nodules. On many occasions these studies are prolonged by different consultations, request for ultrasounds, punctures, etc., with the consequent concern of the patient until the definitive diagnosis is achieved. Faced with this situation, the FJD’s Thyroid Nodule Unit has designed a format by which patients are referred from Primary Care to the unit’s consultation, without the need for intermediate consultations or prior tests, ”the doctor highlights. The Thyroid Nodule Unit is made up of professionals specially dedicated to this pathology and “with great experience in its management, offering integrated and high-resolution care,” says its coordinator, Dr. Manuel Gargallo. “Patients are referred directly from Primary Care, without any intermediate step,” says the specialist from the Endocrinology and Nutrition Service of the Madrid hospital. An expert in this pathology performs an exhaustive assessment, which includes the history and clinical examination of the patient but, in addition, the ultrasound is performed in the same act of the consultation In the consultation of the Thyroid Nodule Unit an expert in this pathology performs an exhaustive evaluation, which includes the history and clinical examination of the patient, but also, the ultrasound is performed in the same act of the consultation. In this way, at the end of this the doctor has a complete vision of the problem and can inform the patient of the characteristics of his nodule, its prognosis, and, in each case, the attitude to take. «When there is suspicion of malignancy, it would be advisable to perform a puncture aspiration. In this case, the doctor will summon you within a few days to perform the test within the Unit and the results will be provided by phone within a period of no more than one week. In this way, patients, in a short period of time, and with a maximum of two face-to-face consultations, can have the type and characteristics of their nodule fully assessed, and, in this way, determine the treatment or procedures to follow in each patient, “adds Dr. Gargallo. In most cases it will be a benign nodule that will either be discharged or a summons will be sent for subsequent review in the Unit; in cases of suspected malignancy, they will be referred directly to the surgery consultation. All this process within the same unit and being attended by a single specialist who attends you from the beginning of the process until discharge. Regarding the diagnostic material, this specialist highlights the endowment of the unit with state-of-the-art equipment that makes accurate diagnosis even easier, having a state-of-the-art ultrasound machine that has a multifrequency matrix linear probe (6-15 mHz) of 50mm viewing width. A state-of-the-art ultrasound system is available that has a linear matrix multifrequency probe (6-15 mHz) with a 50 mm vision width. “With this ultrasound, shear wave elastography (SWE) can be performed on thyroid nodules, which allows us to determine the rigidity of the nodule, both with quantitative measurements and with a 2D color-coded elastogram,” says the coordinator of the unit, underlining that “this novel technology helps to establish the benignity or malignancy of the nodule.” In the opinion of Dr. Gargallo, the design and equipment (technological and professional) of the Unit allows the problem of the increasingly frequent thyroid nodules to be solved in a very agile and efficient way, minimizing the number of consultations and delay times. This allows us, in some cases, to quickly send patients who need it to surgery and, in all cases, avoid the uneasiness that waiting for a definitive diagnosis for weeks or months for patients.

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