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Struma Nodosa – Causes, Symptoms & Treatment

Struma nodosa is a nodular enlargement of the thyroid gland, involving one or multiple nodules. It is one of the most common thyroid conditions worldwide.

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Things worth knowing about "Struma nodosa"

Struma nodosa is a nodular enlargement of the thyroid gland, involving one or multiple nodules. It is one of the most common thyroid conditions worldwide.

What is Struma Nodosa?

Struma nodosa, also known as nodular goiter, refers to a condition in which one or more nodules form within the thyroid gland. It is one of the most prevalent thyroid disorders globally. A distinction is made between a uninodular goiter (a single nodule) and a multinodular goiter (multiple nodules). The vast majority of thyroid nodules are benign; however, medical evaluation is always recommended to rule out malignancy.

Causes

The development of struma nodosa can be attributed to several factors:

Iodine deficiency: Insufficient dietary iodine is the most common cause of thyroid changes worldwide. The thyroid gland enlarges in response to the deficiency and may develop nodules over time.
Genetic predisposition: A family history of thyroid nodules increases individual risk.
Autoimmune disorders: Conditions such as Hashimoto thyroiditis or Graves disease can be associated with nodule formation.
Age and sex: Women and older individuals are more frequently affected.
Radiation exposure: Prior radiation to the neck or chest area increases the risk of thyroid nodules.

Symptoms

Many individuals with struma nodosa experience no symptoms initially. As the condition progresses, the following symptoms may occur:

Visible or palpable swelling in the neck
Pressure or tightness in the throat
Difficulty swallowing
Hoarseness or changes in voice quality
Shortness of breath in cases of very large goiters, especially with retrosternal extension
Symptoms of hyperthyroidism if nodules autonomously produce thyroid hormones (so-called autonomous adenomas)

Diagnosis

The diagnosis of struma nodosa involves several examination methods:

Physical examination: Palpation of the thyroid gland by a physician.
Ultrasound (sonography): The primary imaging method for assessing the size, number, and structure of thyroid nodules.
Blood tests: Measurement of thyroid hormones (T3, T4) and TSH (thyroid-stimulating hormone) levels.
Thyroid scintigraphy: A nuclear medicine technique used to assess the metabolic activity of nodules (hot vs. cold nodules).
Fine-needle aspiration (FNA) biopsy: Sampling of cells from the nodule to evaluate for malignant changes.

Treatment

Treatment of struma nodosa depends on the underlying cause, the size of the nodules, and the presence of symptoms:

Conservative Treatment

Iodine supplementation and/or levothyroxine: In iodine-deficiency-related goiter, iodine supplementation alone or combined with levothyroxine (a synthetic thyroid hormone) may help reduce nodule size.
Watchful waiting: For small, asymptomatic nodules without any signs of malignancy, regular monitoring may be sufficient.

Interventional and Surgical Treatment

Radioiodine therapy: Used for autonomous adenomas or hyperthyroidism; leads to reduction of thyroid volume.
Thermal ablation (e.g., laser ablation, radiofrequency ablation): Minimally invasive procedures to reduce nodule size.
Surgery (thyroidectomy or hemithyroidectomy): Indicated in cases of suspected malignancy, large goiters causing symptoms, or at the patient's request.

Prognosis

The prognosis for struma nodosa with benign nodules is generally favorable. Regular follow-up examinations are important for detecting any changes at an early stage. Only a small proportion of thyroid nodules (approximately 5–10%) are malignant. Early diagnosis and treatment significantly improve long-term outcomes.

References

Haugen BR et al.: 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid. 2016;26(1):1–133.
Gharib H et al.: American Association of Clinical Endocrinologists, American College of Endocrinology, and Associazione Medici Endocrinologi Medical Guidelines for Clinical Practice for the Diagnosis and Management of Thyroid Nodules. Endocr Pract. 2016;22(Suppl 1):1–60.
World Health Organization (WHO): Assessment of Iodine Deficiency Disorders and Monitoring their Elimination. 3rd edition, WHO Press, 2007.

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