MULTINODULAR GOITER WITH 2 LOBES: SIGNS, CAUSES AND DIAGNOSIS
2-lobed multinodular goiter is the second cause of hyperthyroidism with symptoms: anxiety, sweating, fatigue, nervousness, palpitations, etc. At the same time, it can also lead to thyroid cancer. . The disease rarely has any symptoms, so people need to go for regular health check-ups for timely detection and treatment, and improve their quality of life.
What is a 2-lobed multinodule?
The thyroid gland is located in front of the neck, consisting of two lobes: the right lobe and the left lobe, connected by the isthmus of the thyroid gland, and has the function of producing hormones that regulate metabolism, blood circulation, growth, etc. lobar lobe is a condition in which both lobes of the thyroid gland have nodules. This condition may or may not affect thyroid function.
Two-lobed multinodular thyroid gland consists of 2 types:
- Non-toxic 2-lobed multinodular thyroid gland: Thyroid nodules only change thyroid structure, not affect hormone production function.
- Toxic 2-lobed multinodular thyroid gland: both changes the structure and affects thyroid function. Along with the thyroid, each thyroid nodule produces hormones, causing hyperthyroidism. Toxic multinodular thyroiditis is the second most common cause of hyperthyroidism, after Graves’ disease (an autoimmune disorder).
Causes of 2-lobed multinodular goiter
The cause of multinodular thyroid nodule is unknown at this time; however, the following factors are considered to be the cause of the disease:
- Iodine deficiency for a long time.
- Heredity causes the follicular cells of the thyroid gland to be dysfunctional.
- Women are more at risk of thyroid disease than men.
- During development, abnormalities in the structure and function of the thyroid gland occur.
- Thyroid hormone synthesis goes wrong.
- Smoke.
- Infection, inflammation of the thyroid gland.
- Exposure to radioactive material.
Signs of 2-lobed multinodular goiter
Bilobular multinodular goiter is usually asymptomatic. The patient discovers it during a physical examination or when an ultrasound or test is indicated for another disease; sometimes due to multinodular goiter presenting as a tumor in the front of the neck. A large goiter causes difficulty breathing, hoarseness, or a feeling of tightness around the throat.
Patients also detect 2-lobed multinodular goiter when there are symptoms of hyperthyroidism: weight loss, tremor, palpitations, anxiety…; hypothyroidism: weight gain, dry skin, cold intolerance, constipation…
How to diagnose bilobular multinodular goiter?
1. Physical examination
When going to the doctor, the doctor will feel the neck area to detect abnormalities such as tumors, cervical lymph nodes… Does the doctor also take a history of having a goiter? Do you have a family member with goiter? Have you ever had radiation therapy to your neck, head, or chest? In addition, the doctor will ask for information about: weight, hair loss, sweating, anxiety, palpitations, tremors …
2. Ultrasound
Ultrasound is the most commonly used method to check the thyroid gland. Thereby, the doctor assesses the thyroid gland size, thyroid nodule characteristics: number, calcification, contour, shape…
3. Blood test
Blood tests to measure thyroid hormone (TSH, FT3, FT4), to see if the thyroid gland is working normally. Based on the blood test results, the doctor also determined whether the 2-lobed multinodular goiter was toxic. From there, come up with an appropriate treatment plan.
4. Biopsy
When thyroid cancer is suspected, the doctor will order a biopsy. The doctor uses a thin needle to poke the thyroid nodule with the help of ultrasound, take cells, and then send them to a laboratory. Doctor of Pathology examines cells under a microscope. Biopsy results include:
- Undiagnosed: due to insufficient cells, aspiration for re-biopsy is required.
- Benign: most biopsy results are benign. Patients with benign results are continued to be followed up every 6 months.
- Malignant: patients with cancer, need surgery to the whole thyroid gland.
- Indeterminate: about 15%-20% of biopsy results are indeterminate. This means that it is unlikely that these cells are cancerous, but that they are abnormal.
Treatment of multinodular goiter with two lobes of the thyroid gland
1. Non-toxic 2-lobed multinodular thyroid treatment
Non-toxic 2-lobed multinodular goiter does not affect thyroid function, but patients need to be monitored periodically for 6 months or as prescribed by a doctor. Because goiter can turn toxic, causing thyroid cancer. In case of non-toxic 2-lobed multinodular goiter with large size, affecting breathing and swallowing, the patient is indicated to have surgery to remove the nucleus or use radioactive iodine. The dose of radioactive iodine is prescribed by a doctor of Endocrinology – Diabetes . After taking radioactive iodine, the patient is prone to hypothyroidism, so thyroid hormone medication is required.
In addition, there is a method of radiofrequency ablation to treat 2-lobed multinodular goiter. Accordingly, the doctor uses high-frequency current to reduce the size of the nucleus, leaving no scars, and preserving the healthy thyroid parenchyma.
2. Treatment of toxic 2-lobed multinodular thyroid gland
A toxic 2-lobed multinodular goiter will cause hyperthyroidism with symptoms: fatigue, anxiety, sweating, nervousness, palpitations, weight loss, insomnia, muscle weakness… Therefore, when detected, people disease should be treated promptly. Depending on the condition of the disease, the doctor will discuss with the patient to choose an appropriate and effective treatment plan. Treatment methods for 2-lobed multinodular goiter include: radioactive iodine, antithyroid drugs, surgery.
Antithyroid drugs: Thioamide is a class of antithyroid drugs commonly used to help return thyroid function to a normal state. Endocrinologists – Diabetics often use antithyroid drugs in preparation for surgery or radioactive iodine. Patients take antithyroid drugs for 2-8 weeks and stop taking them at least 4 days before radioactive iodine therapy to avoid thyroid storm.
Antithyroid drugs can cause side effects: fever, digestive disorders, leukopenia, liver damage… Therefore, doctors usually prescribe the lowest dose of antithyroid drugs.
