Thyroid adenoma

Neoplasm of a benign character that forms in the tissue structures of the thyroid gland is an adenoma of the thyroid gland.

This disease occurs against the background of increased production of thyroid hormones, as a result of which hyperthyroidism develops, the synthesis of hormones of the pituitary gland, responsible for the activity of the thyroid gland, is inhibited.

Pathology more often develops in women, especially at the age of 45-55 years, while the decisive role in the development of this neoplasm is played by ecology.

Such a tumor rarely acquires a malignant course, but this does not mean that you do not need to treat it. Adenoma brings a lot of troubles and discomfort, affects the overall hormonal background, and in some cases is still malignant, so treatment should be prescribed as soon as possible.

Causes of thyroid adenoma

Concerning the causes of the appearance of thyroid adenoma, we can say the following: unfortunately, they are still thoroughly grounded. There are only assumptions that the tumor appears as a result of increased release of the hormone produced in the anterior lobe of the pituitary gland, or in the period of vegetative disorders (when there is an irregular course of regional sympathetic innervation).

It should be noted that if a failure occurs in the system of interaction between the pituitary system and the thyroid gland, a large tumor is rarely formed: if the amount of thyroid hormones increases excessively, the secretory activity of the pituitary gland decreases, and the growth gradually decreases in size.

Among other things, experts identified possible factors that can cause the formation of adenoma in the tissues of the thyroid. Here are some of them:

• hereditary factor (the possibility of a transfer of a predisposition to a disease by inheritance is not excluded);
• adverse environmental conditions (excessive radiation background, lack of iodine compounds in drinking water, air pollution from industrial waste and exhaust fumes);
• constant and prolonged intoxication of the body (harmful production, etc.);
• violation of the balance of hormones due to stress, disease, etc.

[1], [2], [3], [4]

Symptoms of thyroid adenoma

Most adenomas have a latent asymptomatic course. However, sometimes you can pay attention to the following symptoms:

• spontaneous weight loss, not related to diets and increased physical activity;
• unmotivated irritability;
• the appearance of intolerance to a hot climate, which had not previously been observed;
• increased heart rate, regardless of the presence of stress (the heart "pounding" even during sleep);
• constant fatigue, even in the absence of physical labor.

With the progression of the disease there are malfunctions with the digestive system, the blood pressure may rise, sometimes (not always) the temperature rises.

Often, with a relatively hidden course of the disease, the only signs can be drowsiness and increased heart rate at rest. However, over time, the symptomatology will expand, and violations of the cardiovascular system - aggravated: there is a violation of the rhythm of the heart and dystrophic changes in the heart muscle. The result of such changes may be heart failure.

Adenoma of the right lobe of the thyroid gland

Normally, the thyroid gland consists of the right and left lobes and isthmus. The lobes adjoin from both sides to the trachea, and the isthmus is located closer to the anterior surface of the trachea.

In the normal state, the right lobe may be slightly larger than the left lobe, but this does not affect the development of the neoplasm in the right lobe.

According to statistics, more often one of the two shares of the thyroid gland is affected, more rarely all of the gland. At the same time, the right side is more often affected than the left side. Meanwhile, the biggest danger is the isthmus tumor, which has a much higher percentage of transition to a malignant state.

The adenoma of the right lobe of the thyroid gland at considerable sizes can lead to the appearance of an aesthetic defect in the neck, below and to the right of the Adam's apple. This sign at the first time can be noticed only when swallowing. In this case, the lesion of the left lobe of the thyroid gland gives the same symptom on the left side.

[5], [6], [7]

Adenoma of the left lobe of the thyroid gland

The size of the left lobe of the thyroid gland, as a rule, is somewhat smaller, compared with the right lobe. Neoplasm can occur on either side of the gland, but according to statistics, tumors of the left lobe may be somewhat smaller in size than the nodes on the right side. Nevertheless, the adenoma of the left lobe of the thyroid gland can be determined by palpation, a slight deformation is observed in the neck region, and a feeling of discomfort often arises in the throat. If the tumor reaches a large size, then shortness of breath, widening of the veins of the neck, difficulty in swallowing are added to the listed signs.

Therapeutic and diagnostic procedures are prescribed irrespective of the proportion of the thyroid gland that is affected.

[8], [9]

Types of thyroid adenoma

Toxic adenoma of the thyroid gland (Plummer's syndrome) is the formation of one or more nodular formations that overproduce thyroid hormones. This neoplasm has a round or oval shape, has a small volume, but is determined by palpation. Cell growth can be accelerated with an increase in the level of iodine in the bloodstream: simultaneously with growth, the amount of pituitary hormones increases. After detection of the tumor, further tactics largely depends on its size: neoplasm up to 20 mm can be treated conservatively, and neoplasms with large dimensions - preferably operative. If the nodular formations are many and they are distributed over the entire surface of the thyroid, a complete resection of the gland is performed. Thyrotoxic adenoma of the thyroid gland can occur in an already existing non-toxic node.

Follicular thyroid adenoma - often found at a young age. Such a neoplasm originates in follicular cells, hence the name. The follicular form, in turn, is divided into trabecular, fetal, simple and colloid (depending on what other cells are present in the tumor). The follicular tumor has a spherical shape in the form of a capsule with a smooth surface and a dense structure. The capsule is amenable to free movement during laryngeal movements. In general, the cells of the follicular form are benign, but in 10% of such pathologies later malignant adenocarcinoma is diagnosed. The difficulty is that at the initial stage the tumor is difficult to detect: the follicular species does not produce hormones, and for this reason develops imperceptibly. Few patients turn to the endocrinologist, having felt an increase in sweating, a constant desire to sleep and lose weight. More often doctors are treated already when the tumor starts to press on the esophagus and respiratory tract.

Papillary adenoma of the thyroid gland is a cyst-like formation containing inside it dark liquid contents and papillate growths on internal walls.

Oncocytic adenoma of the thyroid gland (second name: adenoma of Gurtle cells) - occurs more often in women 20-30 years old, suffering from autoimmune thyroiditis. Pathology basically has a latent course, only a clinical picture of thyroiditis can be observed, a decrease in thyroid function. The neoplasm itself looks like a yellowish-brown tumor, often with small hemorrhages, consisting of several cellular types. Such a disease is often mistaken for a cancerous tumor.

Atypical adenoma of the thyroid gland - a characteristic feature of the atypical form is the presence of different follicular and proliferating cellular structures with a rounded, oval, oblong and spindle-like shape. The cell nuclei are hyperchromic, and the cytoplasm is often smaller than the size of the nuclei. This type of neoplasm can transform into a malignant course: in such cases, the appearance of malignant cells can be observed during microscopy.

Oxifil adenoma of the thyroid gland is the most aggressive tumor of the thyroid gland, in which the danger of malignant degeneration is extremely high.

Most of the nodal formations in the thyroid gland are benign. They can have a dense consistency, or remind cysts - capsules with a liquid. Such formation can be single, or multiply spread over the surface of the gland.

Benign adenoma of the thyroid gland rarely degenerates into a cancerous tumor. But it is impossible to unequivocally deny the possibility of such a transition. That's why patients with neoplasm should regularly consult a doctor and undergo preventive examinations.

Diagnosis of thyroid adenoma

Virtually any pathological condition of the thyroid (inflammatory reactions, traumatic injuries, metabolic disorders, the appearance of tumors) is accompanied by the formation of nodular or other formations. For this reason, the main task of diagnosis can be called differentiation of a benign process from a malignant one. Any one study will not provide an opportunity to determine an accurate diagnosis, so more often designate several studies, based on the cumulative results.

• Physical examination and assessment of clinical symptoms. What should attract the attention of the doctor:
  • tumor growth rate;
  • its consistency;
  • presence of pressure on the nearest organs (respiratory tract and esophageal tube);
  • adhesion or mobility of education;
  • difficulty swallowing;
  • hoarseness during conversation;
  • condition of the cervical lymph nodes.
• Laboratory and instrumental diagnostic measures, assessment of the working capacity of the body:
  • the phenomena of thyrotoxicosis are detected in the thyrotoxic form of the disease. Such a neoplasm is benign in most pathological cases;
  • reduced functioning of the thyroid gland allows to refute the presence of malignant tumor;
  • calcitonin is the standard index of medullary cancer, especially if the amount of calcitonin increases within the next few minutes after intravenous injection of 0.5 μg / kg pentagastrin;
  • The test treatment with thyroid hormones is sometimes carried out in order to distinguish a benign process from a malignant one. Under the influence of large doses of thyroid hormones, the tumor can disappear if it is benign. In other cases, surgery is indicated;
• Ultrasound of thyroid adenoma helps to distinguish cysts from adenomas. In some cases, light circles or spots can be found near the tumor, which until recently was considered one of the reliable signs of a benign neoplasm. But not so long ago this opinion was refuted. Since histological signs can not be determined with the help of ultrasound, it is not justifiable that ultrasound is justified in the following situations:
  • For the definition of multiple formations.
  • For examination of a pregnant woman, when it is impossible to conduct isotope studies.
  • For differential diagnosis, adenomas and cysts are thyroid.
  • To control the dynamics of the process.
  • To facilitate aspiration biopsy of a small tumor that can not be localized by the probing method (so-called ultrasound-guided biopsy).
• Scintigraphy of the thyroid gland. This is an additional research technique that indicates the presence of cold formations (without isotope inclusions), hot formations (isotope inclusions stronger than the remaining thyroid tissue), or formations with an intermediate number of isotope inclusions. In this case, large malignant formations are often cold, and benign - often hot.
• Computer and magnetic resonance imaging can be used to monitor the condition of tissues after tumor removal.
• The method of aspiration biopsy is, perhaps, the main method of determining the nature of thyroid tumors:
  • Cellular material is withdrawn by means of a thin needle and a special syringe. Take only the amount of material that will be sufficient for cytology. This is a fairly simple procedure, relatively inexpensive, safe and can be performed on an outpatient basis. The spread of tumor cells with the movement of the needle is excluded;
  • In follicular form, in addition to biopsy, histological analysis of tissues withdrawn during surgery is required. Often, follicular tumors end up being papillary or follicular carcinomas (in 28% of cases), follicular adenomas (34% of cases) or colloidal goiter (in 38% of cases).

Most of the neoplasms are not manifested by any clinical symptoms and are detected accidentally, for example, with a medical examination.

[10], [11], [12]

Treatment of thyroid adenoma

Drug treatment is based on the use of medications that suppress the production of thyroid-stimulating hormone: this therapy is called suppressive. This type of treatment implies the administration of thyroxin in an amount of 2-5.2 μg / kg of body weight per day. The average daily dosage ranges from 150 to 200 μg. Suppressive therapy is considered quite serious and responsible, therefore it is carried out only according to the purpose and under the supervision of a doctor.

Possible consequences of such therapy are known: mainly, they include the phenomena of osteoporosis and cardiovascular system disorders.

Suppressive therapy can give a positive result in about 80% of cases of neoplasm, formed with iodine deficiency, or in 15% of cases of thyrotoxic form.

Against the background of drug treatment of thyroid adenoma, the use of phytotherapy - treatment with the use of medicinal plants is welcomed. It is recommended to use plants that can inhibit the production of hormones or have harmful effects on the affected tissue. To such herbal remedies can be attributed black head, European zuznik, catarrhatus (pink periwinkle), autumn cucumber, yew, etc.

Among the most effective and common drugs are levothyroxine, L-thyroxine, propitsil, micro-myodite, carbimazole, etc.

Suppressive treatment with levothyroxine is the most preferred form of therapy. However, it should be recognized that the suppression method does not always allow the tumor to regress completely. In addition, often taking levothyroxine may become life-long, to prevent the re-growth of the tumor.

Treatment of toxic thyroid adenoma can be carried out with the help of radioiodine therapy. In most countries of Europe, such treatment is considered preferential and safe, small doses can be taken even on an outpatient basis. Usually the patient is offered a preparation of radioisotopes of iodine in the form of a capsule or an aqueous solution. The essence of this method - in the property of the thyroid cells to bind and accumulate the radioisotope of iodine I¹³¹, which damages the thyroid tissue. This helps reduce the size of the neoplasm and inhibit the secretion of her hormones. The method is considered absolutely safe, although a small amount of a radioisotope can be found in the cells of the kidneys and intestines: this is considered an acceptable phenomenon, which does not go beyond the limits of physiological boundaries.

Treatment of follicular adenoma of the thyroid gland is often carried out with the help of the ethanol destruction method. Such treatment is narrowly focused on tumor suppression and is based on the use of a sclerosing drug that is injected into the depth of tumor tissues. Directly into the neoplasm is introduced 1-8 ml of ethanol (depending on the size of the tumor). This procedure is repeated until the tumor completely disintegrates and the production of hormones stops. Ethanol destruction can be used for small numbers and not very large tumors.

Operation with thyroid adenoma

Operative surgery for adenoma of the thyroid gland is connected in such cases:

• with ineffectiveness of drug therapy;
• with follicular form;
• at tumor pressure on the nearest tissues and organs;
• with concomitant thyrotoxicosis;
• with a large tumor for aesthetic reasons.

Of the many surgical interventions for thyroid adenoma, the optimal option is chosen, from which the best effect should be expected. Usually these are the following types of operations:

• the removal of a portion of one share;
• removal of parts of both lobes;
• hemithyroidectomy - resection of the gland half, that is, completely one lobe with an isthmus;
• subtotal resection - almost complete removal of the organ with the preservation of a small part;
• thyroidectomy - complete removal of the organ.

In order for benign thyroid adenoma to require surgical intervention, it must reach a large size or provoke the patient difficulty breathing or swallowing. The operation is recommended in case of active production of hormones with a change in the total level of hormones in the bloodstream.

If a patient has one benign adenoma of the thyroid gland, which has indications for surgical intervention, then as a rule, hemithireectomy is performed - removal of the proportion of thyroid gland on which the tumor is contained. If the tumor is of considerable size, partial resection can only increase the risk of re-development of the pathology. In such cases, as well as with numerous tumors, complete organ removal is performed - thyroidectomy.

Operation with follicular adenoma of the thyroid gland is the removal of the proportion of the gland containing the tumor. The removed share after operation is directed on a histology, and after 3-5 days the doctor receives an evaluation of the structure of the tumor. If the diagnosis of "follicular adenoma" is confirmed, then further treatment is not required, and the operated patient continues life with the remaining proportion of thyroid, which usually produces enough hormones for normal life. If the histology showed that the follicular tumor was malignant, then another operation is performed to remove the remaining lobe of the gland to prevent a relapse of oncology.

Removal of thyroid adenoma

In some cases, the doctor may prescribe to the patient an additional preparation for the operation. The preparatory stage includes:

• bringing to normal the total number of hormones T3 and T4 in the bloodstream. To do this, you may need to increase the dose of thyreostatics (propylthiouracil, mercazolil, tyrosol, etc.);
• correction of systolic and diastolic pressure, as well as cardiac activity in elderly patients;
• Assessment of the patient's condition by the therapist and, if necessary, by other specialists.

Before going to bed, on the eve of the date of surgery, the patient is given a sedative to relieve stress and to ensure a good sleep. In the morning the doctor makes markings on the patient's neck for a neat operation. Intervention is performed under general anesthesia, possibly using endoscopic equipment. The main type of surgery involves carrying out a cut in the area of the projection of the thyroid gland length of 6 to 8 cm. The surgeon divides the tissues and exposes the thyroid gland. After the examination, he begins to remove the affected area with a small vessel ligation, then assesses the area of operation and controls its condition. If all is well, the doctor proceeds to suturing with the restoration of all the structures of the neck. Sometimes a drainage is inserted into the incision - a thin rubber or silicone tubing, from which the interstitial fluid and residual blood can be removed immediately after the operation. Drainage is removed for the next day.

Most patients are discharged from the hospital after 2-5 days. If the patient has been removed all the gland, then immediately after surgery, he is prescribed hormone replacement therapy to maintain a normal level of hormones in the bloodstream. Most often, this treatment involves taking thyroxine daily in the morning, half an hour before a meal. With the right choice of dosage, taking the drug does not cause side effects.

After 1-3 months, the wound completely heals. Within 1 month after the operation, the patient can return to his usual lifestyle.

Prophylaxis of thyroid adenoma

Among preventive measures, a major role is played by the way of life:

• regular exercise (aerobics, yoga, swimming pool);
• presence of interesting work and friendly team, calm and settled everyday life in the family, lack of stress;
• periodic trips to the sea.

The sea is the source of rest and the sea salt necessary for the body. If there is a possibility, at least once every two years, it is necessary to go to sanitation closer to the sea. In the rest of the time, iodized salt should be consumed (in areas poor in iodine). The diet should be reviewed:

• use sour-milk products (kefir, cottage cheese, yoghurt);
• Several times a week, enter the menu of seafood and sea kale;
• eat nuts, sunflower seeds, dried fruits, citrus fruits, greens, vegetables, drink green tea with honey and broth of rose hips.

Limit the following foods in the diet: sugar and sweets, margarine, spirits, preservatives, fast food, fast food products, crackers and chips, sauces.

To increase the resistance to stress, it is necessary to adjust the sleep and rest regime: one should sleep enough time for the organism, arrange a full weekend with trips to nature and active rest.

Prognosis of thyroid adenoma

In our time, many specialists prefer to observe the neoplasm, postponing the operation only in case of emergency. Sometimes this is justified, because the operation can lead to a number of complications, for example:

• paresis of the recurrent nerve;
• postoperative hypoparathyroidism (parathyroid gland function disorder);
• postoperative hemorrhage (in 0.2% of cases);
• subcutaneous hematoma;
• joining purulent infection (in 0.1% of cases).

However, all possible complications with a timely and adequate approach are completely cured. The patient, preparing for the operation, should be informed of possible complications, but this should not become an excuse for refusing the operation. Surgery in the last decade has reached great heights, and surgical treatment continues to be the most effective and safe. Naturally, the appointment of the operation requires direct indications, it is important to remember this.

The prognosis of thyroid adenoma is more favorable in young people than in patients older than 40 years.

When the process is maligned, the prognosis becomes unfavorable, especially if there are metastases in the lymph nodes and organs.

Thyroid adenoma is initially a benign disease, so with a timely treatment, the prognosis can be favorable.