What is found on an ultrasound
The ultrasound diagnostic doctor describes the structure of the formation, and it is this that determines the tactics. A simple cyst looks like a cavity with homogeneous liquid contents, smooth edges and is almost always benign. A cystic-solid formation contains both fluid and dense tissue - such nodes require a more careful evaluation. To standardize findings, the TI-RADS system is used, where each finding is assigned a category based on a combination of characteristics: structure, echogenicity, shape, contours and the presence of microcalcifications. It is the category, and not the size, that primarily determines the need for puncture.
- Simple cyst - purely liquid contents
- Cystic-solid node - mixed structure
- Colloid nodule with cystic degeneration
- TI-RADS assessment
- Warning signs: microcalcifications, uneven contours, vertical orientation
Why do cysts appear?
The thyroid gland consists of follicles filled with colloid. With increased load on the gland, primarily with a lack of iodine, individual areas grow, the outflow of colloid is disrupted, and a cavity is formed. The second common mechanism is hemorrhage into an existing node: then the formation appears suddenly and may be accompanied by neck pain. The Central Asian region belongs to areas with insufficient iodine intake, so nodules are common here. A separate significant risk factor is irradiation of the head and neck area in childhood.
- Iodine deficiency in diet
- Impaired outflow of colloid from follicles
- Hemorrhage into an existing node
- Chronic autoimmune thyroiditis
- Female gender and age
- Hereditary predisposition
- Irradiation of the neck area in childhood
Symptoms
Most cysts are discovered by chance during an ultrasound for another reason - they do not hurt and do not manifest themselves in any way. Complaints appear when the tumor is large in size, when the formation begins to put pressure on the surrounding structures: there is a sensation of a lump in the throat, discomfort when swallowing, a feeling of compression of the neck, and, less often, hoarseness of the voice. Sudden pain in the neck with rapid enlargement of the mass usually indicates hemorrhage into the node. The hormonal function of the gland in cysts, as a rule, is not impaired, therefore weakness, palpitations or chilliness are more often associated with other causes and require a separate assessment.
- Most often asymptomatic
- Feeling of a lump in the throat
- Discomfort when swallowing
- Visible or palpable mass on the neck
- Sudden pain due to bleeding into the node
- Hoarseness with large sizes
Survey
The basic set includes thyroid ultrasound with TI-RADS description and TSH test to assess function. If TSH is abnormal, free T4 is added, and if an autoimmune process is suspected, antibodies are added. Ultrasound-guided fine-needle aspiration biopsy is not performed on everyone: indications are determined by the TI-RADS category in combination with the size of the lesion. Purely liquid cysts are usually not punctured for diagnostic purposes. The procedure is performed on an outpatient basis, takes a few minutes and allows you to obtain cells for research.
- Ultrasound of the thyroid gland with TI-RADS assessment
- TSH, with deviations - free T4
- Antibodies to TPO according to indications
- Ultrasound-guided fine-needle aspiration biopsy
- Examination and palpation of the lymph nodes of the neck
- Examination of the larynx for hoarseness
Observation and treatment
A small benign cyst without complaints does not require treatment: a control ultrasound with a frequency determined by the endocrinologist is sufficient. If the mass is large and causes pressure symptoms, the contents can be aspirated with a needle, but the fluid often re-accumulates; in such cases, sclerotherapy is used, in which a substance is injected into the cavity, causing the walls to collapse. Surgery is considered for large symptomatic nodules, suspicious or indeterminate biopsy results, and recurrent fluid accumulation. It is important to understand that iodine preparations and dietary supplements do not dissolve the cyst, and uncontrolled iodine intake can be harmful.
- Dynamic observation with control ultrasound
- Aspiration of contents for symptoms of compression
- Sclerotherapy for re-accumulation of fluid
- Surgery for large or suspicious nodes
- Adequate intake of iodized salt
- Refusal to self-administer iodine and dietary supplements
- TSH monitoring as prescribed by a doctor