Thyroid Issues: Treatment Options for Goiter and Cysts

About the thyroid gland?

Hello, Dr.
Zhao...
My sister has an enlarged thyroid due to a cold, but she is afraid of surgery, so she is controlling it with medication.
I saw your response indicating that there are methods to aspirate it.
What conditions need to be met, or what recommendations can you provide? Thank you.

For simple thyroid cysts, there are no dietary restrictions, and diet cannot improve the condition.
Generally, Western medicine uses steroids and antibiotics, while Traditional Chinese Medicine employs blood invigorating and stasis-resolving herbs.
An endocrinologist may use fine needle aspiration to remove fluid and make the cyst disappear.
If it cannot be completely cleared and frequently recurs, surgical intervention may be considered.
For chocolate thyroid cysts that bleed repeatedly, the injection of a sclerosing agent, such as acidic chemicals or alcohol, should be considered to prevent further bleeding.

Anita, 20~29 year old female. Ask Date: 2004/09/07

Dr. Zhao Chongliang reply Internal Medicine

Hello! The aspiration method you mentioned in your response refers specifically to thyroid cysts, particularly in cases of recurrent hemorrhagic events, which is different from general goiter.
The cause of general goiter was previously attributed to iodine deficiency, but since the nationwide iodization of salt, the situation has improved significantly.
However, there are still some regions and ethnic groups that experience goiter.
Research conducted by my seniors suggests that humic acid in drinking water may be a contributing factor, while other studies indicate that bacteria in water, as well as foods such as bamboo shoots, cassava, cabbage, cauliflower, mustard, turnips, radishes, millet, walnuts, and seaweed can also lead to goiter.
Our recent study in Jian Shi Township suggests a correlation with ethnicity (Holo people are more affected) and autoimmune antibodies related to the thyroid.

It's important to note that thyroiditis can initially cause thyroid tissue destruction, leading to goiter and hyperthyroidism.
You mentioned that your sister developed thyroid enlargement after experiencing cold-like symptoms; it is crucial to consider the possibility of thyroiditis rather than general goiter.
This condition can often be managed with standard anti-inflammatory medications, occasionally supplemented with antithyroid drugs, and over time, the symptoms of goiter and hyperthyroidism may resolve.
However, some patients may develop multinodular goiter, while others may experience hypothyroidism, necessitating long-term follow-up with an endocrinologist.
Surgery is not required for this condition, nor is it necessary to aspirate the contents of the thyroid.

Reply Date: 2004/09/07

More Info

Understanding thyroid issues, particularly goiter and cysts, is essential for effective management and treatment. Goiter refers to an enlargement of the thyroid gland, which can occur due to various reasons, including iodine deficiency, autoimmune diseases like Hashimoto's thyroiditis or Graves' disease, and even infections. Cysts, on the other hand, are fluid-filled sacs that can develop within the thyroid gland.
In your sister's case, the goiter has been attributed to a recent illness, possibly a viral infection, which can lead to transient thyroid enlargement. It's important to note that not all goiters require surgical intervention, especially if they are asymptomatic and not causing any complications such as difficulty swallowing or breathing.

For treatment options, medication is often the first line of defense. Antithyroid medications, such as methimazole, can be used if hyperthyroidism is present. However, if the goiter is due to hypothyroidism, thyroid hormone replacement therapy with levothyroxine may be indicated. In cases where cysts are present, particularly if they are symptomatic or causing discomfort, a fine needle aspiration (FNA) may be performed. This procedure involves using a thin needle to extract fluid from the cyst for analysis and can sometimes lead to resolution of the cyst.

If your sister is hesitant about surgery, it's crucial to have a detailed discussion with her healthcare provider about the risks and benefits of various treatment options. The decision to proceed with surgery often depends on factors such as the size of the goiter or cyst, the presence of symptoms, and the results of any imaging studies or biopsies.

In terms of dietary considerations, while there are no specific food restrictions for simple thyroid cysts, maintaining a balanced diet rich in iodine can support thyroid health. Foods such as fish, dairy products, and iodized salt can be beneficial. However, excessive iodine intake should be avoided, especially in individuals with autoimmune thyroid conditions.

Regular monitoring of thyroid function tests is essential, especially if your sister is on medication or has a history of thyroid issues. This includes checking levels of thyroid-stimulating hormone (TSH) and free thyroxine (T4) to ensure that her thyroid function remains stable.

In summary, the management of goiter and thyroid cysts can vary widely based on individual circumstances. Non-surgical options, including medication and aspiration, may be effective in many cases. It's vital for your sister to work closely with her healthcare provider to determine the most appropriate approach for her situation, considering her concerns about surgery and her overall health. Regular follow-ups and monitoring will help ensure that any changes in her condition are promptly addressed.

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