Thyroid nodules: when is fine needle aspiration necessary?

Find one or more nodules to the thyroid It's a very common occurrence that has become increasingly frequent in recent years. Women are more affected than men, and there's a certain hereditary component. But what exactly are these nodules, and when is it necessary to investigate further with a doctor? needle aspiration?

As anticipated, finding one or more nodules inside the thyroid is a very common event, increasing in recent years, with a higher incidence in women and a hereditary predisposition. The nodules can be single (benign or malignant), hyperfunctioning (excessive production of thyroid hormones) or not working; other times they can be multiples, usually in the context of a multinodular goiter.

Often there are no symptoms and the finding is incidental, usually during an ultrasound performed for other reasons. Sometimes the symptoms are related to the growth of the nodule and may consist of a feeling of bulk or a foreign body in the neck, or difficulty swallowing (dysphagia), voice alteration (dysphonia) or, more rarely, breathing difficulties (dyspnea). Sometimes they can compress or displace the esophagus and/or trachea, even without causing obvious symptoms. Other times, if hyperfunctioning, they can cause hyperthyroidism with characteristic symptoms (agitation, insomnia, nervousness, weight loss, excessive sweating, diarrhea, etc.).

So what to do if you find a lump? The recommended test is a neck ultrasound.thyroid ultrasound must answer certain questions and must indicate specific characteristics of the nodules (echogenicity, border, morphology, characteristics of the margins, presence or absence of calcifications, type of vascularization, relationship with the capsule, position), for which It MUST be performed by someone who specifically deals with this pathologyBased on their ultrasound characteristics, nodules are classified as “ultrasonographically suspicious” or “ultrasonographically non-suspicious”.

As indicated, based on the ultrasound characteristics, the nodules are divided into “ultrasound suspicious"Ed"not suspicious from an ultrasound perspective”. Suspicious nodules should be subjected to ultrasound-guided fine needle aspirationThis procedure involves taking a small sample of cells from the nodule using a thin needle, under ultrasound guidance. Cytological examination (analysis of the sampled cells) allows the nature of the nodule (benign or malignant) to be determined.

International guidelines recommend fine needle aspiration in several situations:

The “non-suspicious” nodules, on the other hand, are generally subjected to periodic ultrasound follow-up to monitor any changes over time.

In summary, when faced with the discovery of a thyroid nodule, it is essential to consult your doctor, who will direct the patient to a endocrinologist for a specialist evaluationThe endocrinologist, after a careful medical history and a thyroid ultrasound, will assess the need for fine-needle aspiration. Unsuspected nodules should undergo periodic ultrasound follow-up to monitor any changes over time.

Il ultrasound follow-up It is essential to monitor the evolution of thyroid nodules considered "non-suspicious". The frequency of checks is established by the endocrinologist based on the characteristics of the nodule and the individual risk of the patient, generally varying from 6 to 18 mesiDuring follow-up, ultrasound allows for the nodule to be evaluated. If suspicious changes are detected, fine-needle aspiration may be indicated, even for nodules previously considered benign.

It's important to emphasize that follow-up isn't limited to nodules initially considered unsuspecting. Even after a benign fine-needle aspiration, periodic monitoring may be recommended in some cases, especially if the nodule exhibits certain ultrasound characteristics or if the patient has risk factors.

With regard to the preventionThere are no specific strategies to prevent the formation of thyroid nodules. However, it is important to:

It is important to consult your doctor in case of:

If you have noticed a lump in your neck, have a family history of thyroid disease, or have suspicious symptoms, do not hesitate to contact the Hub Vicenza Medical Center, a point of reference for the health of your thyroid.