Therapy

TreatMENT OPTIONS

Follow-up without treatment

When the nodule is benign, small and does not cause any symptoms, no immediate treatment is needed. It should, however, be followed up regularly.

Medications

Hot nodules
Hot nodules (see also: What are hot and cold nodules?) are “overactive”. Hot nodules are first treated with medicines, called “thyroid blockers”. These reduce the formation of thyroid hormone or block it completely. Unfortunately, this can also cause reduced function of the thyroid.
Medicine called thyrostatics can ease the symptoms. However, the autonomous regions are not removed by this treatment, which is why medicines are generally used only as a bridging treatment until a definitive procedure is undertaken.

Cold nodules
If the nodules are small and cold (see also: What are hot and cold nodules?), and are therefore benign, thyroid hormone is given. This should prevent the growth of the gland tissues.

Radioiodine therapy

Radioiodine therapy is considered when nodules became toxics. The iodine is then given in the form of capsules or fluid. The thyroid cells, named toxic adenoma in the nodule, take up the iodine and then die. Pregnant women should not receive this treatment because of the exposure to radiation.

In many patients treated for toxics nodules, the thyroid functions return to normal after the radioiodine therapy. Sometimes, however, the treatment can lead to reduced function. In that case, the missing thyroid hormone must be replaced for the rest of the patient’s life by means of tablets.

Thyroid operations

When malignancy is suspected, or when the nodules cause symptoms because of their size or excessive function, they should be removed. To date, this usually means an operation under full anaesthetic. During the operation, depending on the situation, the doctor either removes the entire thyroid, a lobe of the thyroid or the nodule itself. The operation can be performed as open or minimally invasive (with small cuts) surgery.

Risks during a thyroid operation include bleeding, injury of the parathyroid glands (small glands located close to the thyroid) and damage to the vocal cord nerves, which could lead to vocal cord paralysis. However, these all occur relatively rarely. Usually, too much tissue is removed, which means sufficient hormones are no longer produced. These missing hormones must then be replaced for the rest of the patient’s life by ingesting thyroid hormones every day. In order to avoid weight gain, this should be taken relatively quickly and necessary adjustment should always be followed up.

Thermoablation

For some years, there is the option of thermoablation as radiofrequency and laser where needles or probes are inserted into thyroid with a small incision or echotherapy which is performed without a single incision. The vocal cord nerves can be also injured during these minimally or non invasive procedures.

Thermoablation is not suitable for malignant tumours, but offers a gentler alternative to surgery when dealing with benign nodules.

Echotherapy

Recently, a non-invasive and gentle form of treatment using therapeutic ultrasound for benign thyroid nodules – the so-called echotherapy – has become available (see also – What is echotherapy?). During this treatment, nodules are “melted down” using concentrated ultrasound waves. The tissues that are destroyed by the ultrasound waves are gradually degraded by the body over time. This method can be performed on an outpatient basis and is performed entirely without cutting, thus eliminating scar formation, anaesthetic risks and the risk of infection related to surgery. The main benefit: The thyroid maintains its normal function and the intrusion into the hormonal balance is greatly reduced.