Hypoechogenic thyroid mass: rounded, with clear, fuzzy contours

Ultrasound diagnostic examination is used for various diseases and suspicions of them - ultrasound allows you to detect many disorders and changes in the body. For most doctors, decoding the results of ultrasound does not present any difficulties, which cannot be said about ordinary patients. For example, such an ultrasound term as "hypoechoic formation of the thyroid gland" raises a lot of questions for people not associated with medicine. We will try to answer some of them today.

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Epidemiology

Experts acknowledge that over the past thirty years, the prevalence of hypoechoic lesions in the thyroid gland has increased significantly. And this, without a doubt, determines the physical and mental state of the population.

Regularly changing ecological and radiological features of the environment contribute to the growth of thyroid diseases and changes in the structure of thyroid diseases. Mass violations of the nature of nutrition play a significant negative role in our area. This is expressed in extremely low consumption of seafood, meat and dairy products. An additional factor was the well-known event at the Chernobyl nuclear power plant, which affected not only the incidence of diseases, but also the increased risk of developing malignant pathologies.

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Causes of a hypoechogenic thyroid mass.

If an ultrasound specialist (sonologist) indicates reduced echogenicity (hypoechoicity) of the thyroid gland, this may indirectly indicate the presence of the following conditions:

• the appearance of a “nodule” in the thyroid gland, which often occurs as a result of iodine deficiency in humans;
• presence of hypoplasia;
• presence of diffuse goiter;
• the presence of a tumor process.

In some cases, specialists do not exclude the possibility of a hereditary predisposition to the formation of hypoechoic formations in the thyroid gland.

Risk factors for the formation of hypoechoic nodules may be the following:

• living in an ecologically unfavorable region (high radiation levels, iodine-depleted areas, etc.);
• insufficient and improper nutrition (malnutrition, long-term strict and “starvation” diets, unbalanced diet);
• regular and severe stressful situations;
• taking certain medications;
• bad habits, chronic alcoholism and smoking.

Pathogenesis

The concept of "echogenicity" reflects the property of tissues to conduct ultrasound. Since all tissues of the human body have different densities and structures, ultrasound penetrates them differently, or does not penetrate at all.

Such features allow us to highlight several key values of ultrasound imaging. Let's consider the main types of visualization by tissue density:

• Isoechogenicity is the normal density of a healthy thyroid gland, which appears as a uniform gray mass on the image.
• Hypoechogenicity is a characteristic of less dense tissues that appear dark (almost black) on an ultrasound monitor.
• Hyperechogenicity is a term that defines denser tissues relative to healthy glandular tissues. A hyperechogenic formation appears as a light area on the image.
• Anechoicity is a term that means that there is no echogenicity in a given area (the formation is echo-negative). An anechoic formation on the image is distinguished by a dense black color.

Of course, in addition to echogenicity, other organ quality indicators are also taken into account during ultrasound: granularity, contours, homogeneity, etc. However, in this material we will only consider the concept of tissue hypoechogenicity.

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Symptoms of a hypoechogenic thyroid mass.

Often, a person accidentally learns about the presence of a hypoechoic formation of the thyroid gland - for example, during a routine ultrasound - since this condition is not always accompanied by any symptoms. Even relatively large nodes can be painless and not cause discomfort in the neck area.

When carefully palpating the neck, a slippery and dense node can sometimes be found in the area of the thyroid projection. Large nodes – more than 30 mm in diameter – become noticeable even to the naked eye: they clearly disrupt the normal contours of the neck.

The first signs of a hypoechoic formation in the form of a node are observed only with its persistent enlargement:

• foreign body sensation;
• dryness and sore throat;
• hoarseness, difficulty in vocal production;
• pain in the front of the neck.

Large nodes can exert mechanical pressure on nearby organs and vessels. If the formation is malignant, nearby lymph nodes will enlarge painlessly.

If the appearance of a hypoechoic formation is accompanied by a dysfunction of the thyroid gland, then symptoms such as increased heart rate, arrhythmia, hot flashes in the body, excessive excitability, and exophthalmos can be detected.

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Stages

The stages of growth and development of formations in the thyroid gland may be different, depending on the course and stage of the pathological process. The characteristics of such stages are determined by the degree of their echogenicity on ultrasound:

• anechoic stage – characterized by an increase in the degree of blood flow and expansion of the vascular network near the hypoechoic formation;
• stage of resorption of the internal contents of the cyst;
• scarring stage.

The transition from one stage to the next is a rather long process, the course of which depends on the size of the formation, the degree of immune protection, the balanced functional state of the thyroid gland and the body as a whole.

Forms

When describing an ultrasound image obtained on the monitor, the doctor does not always limit himself to the concept of "hypoechoicity" of the formation, but also uses other medical terms. Let's briefly talk about what they can mean.

• A hypoechoic thyroid nodule is a rounded formation that develops from the glandular tissues of the thyroid gland and is a nodule-like lump. Most often, such nodules are formed as a result of iodine deficiency in the body: the thyroid gland absorbs iodine to produce hormones, and its deficiency is replenished with drinking water and food.
• A hypoechoic thyroid formation with unclear contours may be a sign of colloid goiter, a malignant formation. However, most often, unclear contours are found in recently formed nodes - and this is a fairly favorable sign.
• An isoechoic thyroid formation with a hypoechoic rim is a section of healthy thyroid tissue surrounded by a perceptible contour, which determines the presence of a node. Such a formation develops as a result of increased blood flow and expansion of the capillary network around a section of healthy tissue.
• A hypoechoic heterogeneous thyroid lesion is a hypoechoic node whose structure is heterogeneous. Such changes in the node may be caused by edema and/or an inflammatory reaction.
• Hypoechoic thyroid formations with blood flow are most often detected. In this case, the blood flow may have different localizations. Increased blood flow may indicate that the formation is prone to structural changes and division.

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Complications and consequences

Cystic formations in the thyroid gland are characterized by the development of an inflammatory reaction with the formation of purulent internal contents. Further growth of the cyst can provoke not only inflammatory processes, but also internal hemorrhages and even the transformation of the node into a malignant tumor.

Inflammatory processes in the nodular formation can cause pain in the heart, increased temperature, enlargement and inflammation of the lymph nodes, and signs of general intoxication.

Cysts and other large formations can cause discomfort in the form of pressure on nearby organs and vascular beds.

Diagnostics of a hypoechogenic thyroid mass.

A hypoechoic formation is not a diagnosis, but merely a characteristic of the image: this is how the doctor describes what he saw on the ultrasound monitor. To reliably find out a more accurate diagnosis, it is necessary to use a number of other additional studies.

• External examination, palpation of the thyroid gland projection area.
• Blood tests to determine the levels of free and bound thyroxine and triiodothyronine.

Analysis of antibodies to thyroid-stimulating hormone receptors.

Blood test for tumor markers.

Histological examination of material taken during puncture (biopsy).

• Instrumental diagnostics:
  • magnetic resonance imaging;
  • computed tomography;
  • scintigraphy (radioisotope scanning method).

In most cases, only a comprehensive approach to diagnostics allows for a correct diagnosis.

Differential diagnosis

Differential diagnostics when detecting a hypoechoic formation in the thyroid gland is carried out between the following pathologies:

• diffuse goiter – may be accompanied by the appearance of multiple hypoechoic formations (cysts);
• hypoplasia – a decrease in the size of the gland compared to normal values;
• papillary cancer, cyst, lymphoma, adenoma, lymphadenopathy.

Treatment of a hypoechogenic thyroid mass.

If a person is diagnosed with a hypoechoic formation in the thyroid gland, which is subsequently diagnosed as a cyst, then he is prescribed a specific therapeutic regimen, depending on the specific characteristics of the pathology.

If several formations are detected, the size of each of which does not exceed 10 mm, then such a patient is placed under observation for further clarification of the appropriate treatment tactics.

A single small formation (several millimeters in diameter) also requires periodic medical observation: usually the condition of the gland in such cases is checked once a quarter.

Large formations, as well as malignant tumors, are treated surgically.

The main goal of treating hypoechoic formations is to determine the cause of their appearance with subsequent elimination. In addition to the possible prescription of medications, a diet with increased consumption of iodine-containing products is definitely recommended.

Medicines

If the doctor has to treat colloid goiter, he will prescribe a medication such as L-thyroxine. Its action consists in blocking the division of the cellular structures of the neoplasm, which leads to the cessation of its growth.

Antithyroid drugs such as Espa-carb, Propicil or Thiamazole can affect the reduction of the diffuse volume of formations.

If the cause of the nodes is a lack of iodine in the body, then regular intake of drugs with a sufficient iodine content is used.

Good results are achieved by preparations based on white cinquefoil - these are Endocrinol, Alba, Zobofit or Endonorm.

	Method of administration and dosage	Side effects	Special instructions
L-thyroxine	The amount of the drug is determined individually. The drug is taken daily in the morning, half an hour before breakfast.	Recommended doses rarely lead to the development of side effects such as weight gain, renal dysfunction.	Self-medication with this drug is not permitted under any circumstances.
Propicil	Usually 75-100 mg of the drug is taken per day. The interval between doses should be about 7 hours.	Treatment with Propicil may be accompanied by the development of arthritis, abdominal pain, swelling, and skin rash.	Propicil is contraindicated in patients with agranulocytosis and active hepatitis.
Iodomarin	Take 200-500 mcg daily after meals.	Hyperkeratosis may develop.	Iodomarin is not prescribed for hyperthyroidism.
Yosen	Take 1 tablet once a day with food.	In recommended quantities, Yosen does not cause side effects.	Not prescribed to children under 12 years of age.
Endocrinol	Take 2 capsules up to 2 times a day immediately before meals.	Endocrinol can cause headaches, nausea and dizziness.	The drug is not prescribed to children under 12 years of age.

Vitamins

Below we present to your attention a number of vitamins that are especially important for people prone to thyroid disease.

• Vitamin D3 ₊ calcium – they are taken together, since these substances are not absorbed without each other.
• Vitamin K is essential for normal blood clotting processes.
• Vitamins A and E are necessary to facilitate the functioning of the thyroid gland.
• B vitamins in combination with copper, manganese and selenium normalize the function of the nervous system, which also has a beneficial effect on the thyroid gland.

In order for vitamins to be better absorbed and bring maximum benefit, it is advisable to drink less coffee - this drink increases the excretion of calcium from the body, and also inhibits the properties of B vitamins, trace elements zinc and potassium.

Physiotherapy treatment

Not all physiotherapeutic procedures are indicated for thyroid diseases. Since a hypoechoic formation may be a pathology that is a contraindication to physiotherapy, you should not rush to use this method before making an accurate diagnosis.

The following thyroid diseases are considered contraindications to physiotherapy:

• nodular toxic goiter;
• severe form of thyrotoxicosis;
• children under 3 years of age.

In addition, it is necessary to take into account general contraindications for each specific procedure individually.

Folk remedies

Food products are the main suppliers of all substances necessary for the thyroid gland. For stable thyroid function, it is necessary to pay special attention to such truly healing products:

• Walnuts and honey – these products are highly recommended for improving the thyroid gland. To prepare the medicine, you need to grind four walnut kernels, add 1 tbsp. of natural honey and consume in the morning on an empty stomach. This should be done daily for at least 14 days.
• Lemon is a valuable and useful citrus. To facilitate the thyroid gland, prepare the following medicine: wash two or three lemons well, grind them in a blender or grate them together with the peel (you get about a cup of lemon mass). Then mix the chopped lemon with one glass of honey. Take this mixture in the amount of one tablespoon three times a day 1-1.5 hours after meals.
• Seaweed is a valuable product with a high iodine content. Seaweed salad should be consumed daily, and at least 3 times a week.
• Persimmon - in the autumn-winter season, you should pay special attention to this fruit: persimmon is rich not only in iodine, but also in magnesium, sodium, iron, vitamins A, P and ascorbic acid.

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Herbal treatment

If the doctor has detected a hypoechoic formation on ultrasound, then there is no need to rush with folk treatment until the final diagnosis is known. Herbal treatment cannot be the same for all thyroid diseases: there are many contraindications, and it is also necessary to take into account the stage of the pathology, the individual characteristics of the patient and the presence of concomitant diseases.

For maximum effectiveness of herbal treatment, it is necessary to follow all recommendations for the preparation of tinctures and other medicinal products, according to folk recipes.

For thyroid pathologies, it is most often recommended to use herbs such as prickly cocklebur, meadowsweet, seaweed, eucalyptus, broom, coltsfoot, date fruits, burdock and nettle leaves, immortelle, and thyme.

Specific recipes are used depending on whether the thyroid gland function is decreased or increased.

Homeopathy

Homeopathic treatment can be started as soon as the final diagnosis of the disease is known. The effectiveness of homeopathic medicines is individual - in different patients, improvement may occur at different times, which depends on many reasons.

There are practically no contraindications to such treatment. The only exception is intolerance to any ingredient of a particular drug.

In case of glandular insufficiency, it is recommended to take Thyreodinum, Graphites in combination with Fucus and Spongia in small concentrations.

Thyroid hyperplasia is treated with Aurum iodatum or Hamamelis.

For cystic formations of the thyroid gland, Barium or Aurum iodatum, as well as Conium, can be used.

In the postoperative period after removal of a malignant thyroid tumor, Conium, Calcium Fluoricum or Acidum Fluoricum are used.

The duration of homeopathic treatment in the above cases can be from one and a half to two months. Then take a break, at the discretion of the doctor.

Homeopathic medicines can be used as the main therapy or as a supplement to drug treatment.

Surgical treatment

Surgery may be required if the hypoechoic formation is rapidly increasing or already has a volume of more than 10 mm in diameter and puts pressure on nearby organs. In such cases, a hemistrumectomy is performed, which involves resection of one of the thyroid lobes. After such an operation, in most cases, it is possible to preserve the function of the gland.

If pathological formations – for example, cysts – are found in two lobes, then a bilateral subtotal strumectomy is performed – that is, an operation to completely excise the thyroid gland.

If the formation is an oncopathology, the entire gland with the surrounding fat layer and lymph nodes must be removed. This intervention is considered quite complex and traumatic, but in such a situation it is impossible to do without it.

One of the possible complications after removal of the gland is a violation of the function of the vocal cords. In addition, throughout life after the operation, the patient will have to take drugs that replace the thyroid gland's own hormones, as well as drugs containing calcium (total removal also implies resection of the parathyroid glands).

Prevention

In order to prevent the appearance of hypoechoic formations of the thyroid gland, it is recommended to consume iodine daily according to individual physiological norms. The daily diet must necessarily include drugs or food products with sufficient iodine content. For example, most problems with iodine deficiency can be solved by consuming regular iodized salt.

In addition, an important element in preventing the appearance of thyroid nodules is considered to be the minimization of radiation exposure – X-rays and radiation.

If a person is diagnosed with cysts, the doctor will usually prescribe basic therapy. After the necessary treatment, it is very important to monitor the thyroid gland, monitoring it with ultrasound annually.

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Forecast

The prognosis of hypoechoic formations found in the thyroid gland depends on the histology (structure) of these nodes.

Thus, benign formations make it possible to assume the patient's complete recovery. Cysts are prone to relapses and the development of complications.

In malignant neoplasms, the prognosis depends on the size and age of the tumor, as well as the presence of metastases. If the malignant process is detected at the initial stages, it is removed, and the patient often fully recovers without further development of the pathology. In old tumors - for example, adenocarcinoma - the outcome may be less favorable.

Let us repeat that hypoechoic formation of the thyroid gland is not a diagnosis, but only an ultrasound sign, so hasty conclusions should not be made. According to statistics, the vast majority of such cases do not pose any serious threat to a person.