Thyroid Goitres, Cysts, Nodules & Tumors



So do you have a Goitre, a nodule, a cyst or a tumor? 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:

  1. 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.

  2. 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.

  3. 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 be found on people who come from areas where IODINE is scarce within the diet. This tends to be areas that are in land-locked areas that are remote from the sea, or where Iodine has been depleted from the soils that have been farmed.

In many Western areas of the World, Iodine has now been added to table salt, and therefore the primary causes of thyroid dysfunctions 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:

  1. A single Nodule (defined as being either 'Hot' or 'Cold', based on whether it is producing thyroid hormones or not)

  2. A fluid-filled cyst

  3. A tumour (based on size and speed of growth)

  4. Multiple 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:

  1. The Cell type (very important for a meta health, or root cause analysis)

  2. The size of the tumour

  3. Where the tumour is located

  4. Whether 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.