The Complex Thyroid
So do you have a Goitre, a nodule, a cyst or a
Tumour?
After finding a lump in the front of your neck, you probably had several tests before receiving your diagnosis.
You may now know that your thyroid is not functioning correctly, but there may still be a lot of confusion around what that lump in your neck really is.
During the process of the diagnosis, and later visits to the GP's, Specialists and Consultants you might hear the label of "goitre" freely intertwined with other interchangeable terms, such as 'nodules', 'multi-nodular goitre', 'simple' or 'diffuse' goitre...and if you are anything like me, and want to understand more about your thyroid issue, it can become very confusing to know what these all mean.
You can be forgiven for being unsure what your diagnosis really is, because all the interchangeable terminology can become confusing.
Anyhow, the labels are as they are, and the best that we can do is to educate ourselves and understanding that having a goitre may mean that your thyroid gland could be:
Over-producing thyroid hormones: and you may receive a diagnosis of being 'hyperthyroid' once blood tests confirm the raised thyroid hormone levels in your blood (or that you have a low TSH, which indicates your body has high thyroid hormone levels). This might also be referred to as a HOT NODULE.All that extra thyroid tissue may not be doing anything at all! You may not be producing any additional thyroid hormone (beyond the normal levels of your thyroid gland, excluding the additional 'lump'). Again this will be confirmed by a blood test that will indicate your TSH is in 'normal' range, or your thyroid hormones are in range. This might also be referred to as a WARM NODULE.
Under-producing thyroid hormones: and you may receive a diagnosis of being 'hypothyroid' once the blood tests confirm your TSH is high, or that you hormone levels are high. However, even though this is not recognised in tradition medicine, in meta health we can deduct that if you do currently have a goitre that has grown on your neck - you would definitely have had (or might still be having) a 'stressed' thyroid: one which is trying to produce extra thyroid hormones, or was once trying to produce extra hormones! (But more about that in the 'Thyroid Detective' section below). This might also be referred to as a COLD NODULE.
In short - Goitres can be found in people who are both hypothyroid and also hyperthyroid!
They may also be found in people whose thyroid hormone production is now 'normal'.
They vary in size and shape, from barely noticeable to HUGE!
Most often those goitres which are enormous, tend to effect people who come from areas where IODINE is scarce within the diet. This tends to be within land-locked areas, remotely located from the sea, or where Iodine has been depleted from the soils that have been over-farmed.
In many Western areas of the World, Iodine has now been added to table salt, and therefore the primary cause of thyroid dysfunction tends now to be through auto-immune conditions, such as Hashimotos or Graves Disease.
Thyroid Nodules
Made of thyroid tissue - nodules can appear singularly on the thyroid. Statistics show that 30% of 30 year old females have at least one thyroid nodule. The figures of incidence rise correspondingly over time: 40% at 40 years old; 50% at 50 years old and 60% at 60 years old and so on.
Nodules can be caused by a simple overgrowth of normal thyroid tissue.
They may contain thyroid tissue, or they may contain colloid.
Depending upon their size & condition they will be tested and may be further diagnosed as being either:
A Single Nodule (defined as being either 'Hot' or 'Cold', based on whether it is producing thyroid hormones or not)
Multiple Nodules
A fluid-filled cyst
Nodules
The term 'nodule' and goitre are often interchanged. This is because a goitre is generally made up of one or more nodules.
You can clearly see the 'light coloured' nodules on this biopsied thyroid gland. In this example - although there is more than one nodule evident, they are well spaced apart and clearly independent of one another.
Equally, many people may have nodules on their thyroid and never be aware of them! If it is a single, or small nodule, it may not be noticeable unless palpated and felt within the structure of the neck.
However, if they become enlarged, and are positioned on the periphery of the gland, they can become troublesome and affect swallowing or breathing.
Cysts
Nodules can also be fluid-filled cysts. These are encapsulated pockets of general body-fluid (not colloid) within the thyroid gland, or they may contain blood.
They can be seen in the scan image bellow. They are seen as the dark 'circles' on the scan, with the lighter imaging being more solid material, such as thyroid tissue, or 'calcification' (which is the white 'specks' within the black circles.
The Mayo clinic says that most cysts are degenerating adenomas (otherwise also known as a 'benign tumour'), that may be completely fluid filled, or may also contain some small particles of thyroid tissue.
Tumours
A nodule may be biopsied if it is over 1cm in diameter. The ranges are changing, and can vary from region to region and in different countries.
A nodule is measured in various ways to identify if it is considered 'cancerous', or 'malignant'.
Measurements are made to identify 'tumour markers' and define its 'staging' and 'grade'.
Staging is a measurement of important information including:
The Cell type (very important for a meta health, or root cause analysis)The size of the tumourWhere the tumour is locatedWhether it has spread outside of the primary organ or tissue (i.e. to lymph for example)
Staging levels from 0 to 4 rate the cells from
0: 'Abnormal' but not yet labeled as cancerous. Not having moved elsewhere - it remains in the primary location.
1-3: Cancer is diagnosed. The higher the number, the 'more' cancer is present and the more it has moved out of the primary location.
4: The Cancer has spread to distant parts of the body.
Grading refers to how 'abnormal' the cells look. Also how likely it looks to grow or spread.
This looks at the structure of the cells, to see how they are organised.
A "well-differentiated" cell, that looks structurally 'sound' is a low grade risk (G1); whilst the most "undifferentiated" cells, which look structurally unsound, would be considered a high grade risk (G4).
Tumour markers may also be used, such as Thyroglobulin, which can be measured to see if the thyroglobulin hormone is still in the body after a full thyroidectomy has occurred. (This is usually the suggested treatment for a thyroid cancer). In general practice they would not expect to see any of this hormone in the body, and if it is found they take this as an indicative marker that thyroid cells (assumed to be cancerous) are still in the body.
So whats in a 'Goitre'?
Put simply, a GOITRE is simply an 'enlarged' thyroid gland.
However, there are multiple terms used to describe different ways that the thyroid becomes 'enlarged' - so we will look at a few of them:
A Simple Colloid Goitre
Colloid is the fluid that fills the space between the thyroid tissue. It is a 'gel' like substance and the thyroid hormones are held in its suspension.
Also called a Simple Goitre, it is when T3 levels are so low that the increased TSH levels continue to encourage the thyroid to produce more thyroid globulin (colloid) to try to produce and hold more thyroid hormone.
You will often see a general 'thickening' of the neck with a simple goitre:
A Multi-Nodular Goitre
Also called a multi-nodular colloid goitre, or a 'diffusely enlarged goitre'.
The thyroid gland will appear to have many 'nodules' built up, one upon another, that increases the thyroids overall size over time.Therefore the 'enlargement' of the gland is due to multiple layers of nodules:
A Toxic Goitre
A toxic goitre is made up of one or more 'hot nodules'.
A Hot Nodule is a nodule that is generating extra thyroid hormone.
It can be thought of as a way that the body is creating 'extra' thyroid tissue - in order to be able to make more thyroid hormones!
As this video from Nottingham University shows, a goitre will be called 'TOXIC' if it is both enlarged and simultaneously releasing large amounts of thyroid hormones.
The word 'toxic' can be scary!
Non of us want to think that a part of our body is toxic, or that it is doing something that is potentially toxic to the rest of the body. I often think it would be far less scary if the names given indicated the activity better - such as an overproductive goitre, rather than a toxic goitre.
Treatments
In general, unless you are having specific issues with the goitre itself, either due to its size &/or location, or due to its overproduction of thyroid hormone, or unless it is considered to be malignant; it will most likely be ignored by your physician, and not referred to again. However, it will mean that you are likely to have your thyroid levels checked initially when it is discovered and diagnosed, and is likely to continue to be monitored after it is diagnosed.
There is no specific allopathic 'treatment' for reducing the size of a goitre or a nodule, other than to remove it surgically. This may be suggested if it is very large, or obstructing your swallowing or breathing.
If you have been told that your thyroid is hyperactive (over-active), or that you have a 'toxic goitre', you may have treatment suggested to reduce the overproduction of thyroid hormone. The traditional approach is to have either:
A full thyroidectomy, or a partial thyroid lobotomy. You might be considered to Receive RAI (Radio-Active Iodine) Treatment.
If you are considering either of these as an option, it may be worth considering that RAI can completely destroy the thyroid gland, and will make you hypothyroid (even though you are currently hyperthyroid). And as unwanted that hyperthyroidism is, hypothyroidism is not necessarily a great alternative option (ask the many who live with daily hypothyroid symptoms)!
So I think it is always worth asking questions before embarking on non-reversible procedures. Whilst a surgical procedure may be more complicated, it has the benefit of not destroying the whole thyroid - which might be preferable to many!
So, if you are inquisitive (like me), you may want to question whether a goitre that is overproducing thyroid hormone right now might always continue to do so? Or if it is possible that the goitre might at some point stop producing the excessive amounts of hormone that are seen in a 'toxic goitre'?
Developing Meta-Consciousness, or
a Meta-Perspective of your Health is really very helpful in allowing us to focus, or analyse the particular emotional triggers, (which we might think of as being the specific 'stress' or 'trauma') that might be making the thyroid gland produce excessive amounts of thyroid hormone. Working with the Mind Body Detective and becoming your own 'thyroid detective' is one way to consider your options before you commit to irreversible surgery. Working on the stresses that affect the thyroid is also a way to address your health directly and is compatible with other treatments and allopathic medicine (assuming that RAI or a full thyroidectomy via surgery has not been chosen immediately).
If you would like to know a little more about how the mind-body connection affects your thyroid function, you can sign up to a COURSE entitled
The Emotional Impact of a Diagnosis
When you have found a lump or growth becoming evident on your neck, there are often fears that are associated with that! Especially at the beginning, before a diagnosis has been made!
When I discovered a lump growing in the front of my neck, just after my first child was born, I also feared the worst. At the time I was so fearful that I did not want to face going for a diagnosis - and I even put it off for several weeks, fearing the worst!!
But I knew that I could not ignore this fast-growing lump, as it was increasing in size fairly dramatically week after week!
I wish that when I was going through all of the hospital visits, the biopsy and the iodine testing. The imaging and the long waits for news, that I had known about emotional techniques or emotional support.
EFT would have been a life-line to me then!
I was extremely fearful at that time, and there was no one to turn to that I felt I could really open up to and be completely honest with!
I had a new baby to think about, but at the same time my head was filled with the 'what ifs' that kept me from sleeping well. I had to stop feeding my baby on the doctors advice (as the test results were awaited) and I found myself considering the possibility that just after saying hello to my new 6 week old daughter, that I might not live to see her grow!
You may think this is an over-reaction, but it was the grim reality of my world for a good few months, as I went through the process of acknowledging the lump, considering visiting the doctor, and then going for many multiple test. It is a long and a lonely time.
Today, twenty two years later, the internet can be a helpful place to go to first research options. There are chat groups and support groups online, and many charities and places to go for advice. However, the internet may not alleviate your emotional turmoil, and this is where it is important to find someone who can support you through this time.
Acknowledge the fear you are facing, and find ways of expressing the things you are bottling up.
More than ever, if you cannot do that with someone local to you, or you feel you need to work with someone who is at more of a distance than your family or friends, then find a professional who will remain impartial and support you in what you want!
The Thyroid Detective Series
In terms of Meta Health, a goitre or a nodule is really the same thing!
It is the bodies intelligent way to find a solution to a stressful situation, that is keeping us in a state of imbalance.
For the time that we remain in stress, or that we keep going back into stress, the body will adapt to find a biological program that it believes (through your unconscious mind) is the best 'program' to deal with the problem you believe you are experiencing.
There are two main types of issues that you would be looking at:
An increase in tissue results from remaining in a state of stress!
Stress that is important to how your thyroid is functioning includes the following:
A state whereby you may be feeling threatened and unable to escape a situation that may feel uneasy or dangerous. It is likely to be in relation to a position or a relationship that affects your whole life, or your belief that you can not go on and live your life, where, or how, or with whom you would like to live it!
Another stressor that you can look to address is that of not having enough time, of feeling time pressured and that you are running out of the time or energy to get things done!
The key to working with these stresses is to get very clear on them and be very specific about how you go about Recognising your stressors, Relieving your stress, Reducing the reoccurrence of the same types of stresses.
If you would like to know a little more about how the mind-body connection affects your thyroid function, you can sign up to a COURSE entitled
Sources
https://www.endocrineweb.com/conditions/thyroid/thyroid-nodules
http://www.thyroidawareness.com/thyroid-nodules
http://usa.healthcare.siemens.com/ultrasound/ultrasound-point-of-care/acuson-p500-ultrasound-system
http://www.mayoclinic.org/diseases-conditions/thyroid-nodules/symptoms-causes/dxc-20307264
https://www.youtube.com/watch?v=Lbw_g330ZRA
https://www.cancer.gov/about-cancer/diagnosis-staging/staging
https://www.cancer.gov/about-cancer/diagnosis-staging/prognosis/tumor-grade-fact-sheet