The only way to find out the nature of the knot
Neither ultrasound, nor blood tests, nor scintigraphy can reliably distinguish a benign node from a malignant one. They only estimate the probability. The answer is given only by studying the cells, and they are obtained by fine-needle aspiration biopsy.
The procedure is performed on an outpatient basis and takes a few minutes. Under ultrasound guidance, a thin needle is inserted into the node - thinner than the one used to take blood from a vein - and the material is aspirated into a syringe. Ultrasound guidance is fundamental: the doctor sees the tip of the needle and takes the material from the suspicious area, bypassing the vessels and cystic areas where there are no cells. Anesthesia is usually not needed, the sensations are comparable to a regular injection.
The result is formulated according to the international Bethesda classification in six categories: from non-informative material and benign node to suspected malignancy and malignant tumor. The tactics directly depend on the category - observation, repeated puncture or surgery. Indications for the procedure are determined by a combination of the size of the node and its ultrasound characteristics: a small node with suspicious signs is punctured, but a large one, but completely benign according to ultrasound, is often not.
Thyroid nodules: what is important to know
Thyroid nodules are very common and in the vast majority of cases are benign. The doctor’s task is to identify those few that require intervention, and not subject the rest to unnecessary procedures.
The selection is carried out according to ultrasound characteristics: shape, contours, echogenicity, the presence of microcalcifications and the nature of blood flow. Based on their totality, the node is assigned a TI-RADS category, which, together with its size, determines the indications for puncture.
The role of the recurrent laryngeal nerve
The recurrent laryngeal nerve runs directly along the posterior surface of the thyroid gland and controls the vocal cords. Its damage leads to hoarseness, and if bilateral, to respiratory failure.
That is why thyroid surgery is performed by a specialized surgeon, and the mobility of the vocal cords is assessed before and after the intervention. Modern techniques include visual identification of the nerve, and in some cases, intraoperative neuromonitoring.
Hormonal control after intervention
Removing part of the gland can lead to decreased hormone production. Therefore, 4–6 weeks after surgery, the TSH level is determined and, if necessary, the dose of levothyroxine is adjusted.
Blood calcium is separately controlled: next to the thyroid gland there are parathyroid glands that regulate calcium metabolism. Their temporary dysfunction after surgery is possible and is manifested by numbness and tingling in the fingers and around the mouth.