By Kyle J. Norton
Health article writer and researcher; Over 10.000 articles and
research papers have been written and published on line, including
world wide health, ezine articles, article base, healthblogs,
selfgrowth, best before it's news, the karate GB daily, etc.,.
Named TOP 50 MEDICAL ESSAYS FOR ARTISTS & AUTHORS TO READ by
Disilgold.com Named 50 of the best health Tweeters Canada - Huffington
Post
Nominated for shorty award over last 4 years
Some articles have been used as references in medical research, such as
international journal Pharma and Bio science, ISSN 0975-6299.
Thyroid disease
Thyroid disease is defined as a condition of malfunction of thyroid gland.
Thyroid disease: Thyroid adenoma
Thyroid adenoma is a benign tumor started in the layer of cell lined the
inner surface of the thyroid gland. The disease is relatively common
among adults living in the United States. Most thyroid nodules are
Thyroid adenoma.
A. Risk factors
1. According to the study by the University of Campinas
a. Graves’ disease
The prevalence of thyroid nodules and thyroid carcinoma in Graves' disease was 27.78% and 5.05%, respectively.
b. Older age with larger thyroid
volumes are associated to increased risk of
nodules.
c. Younger age and larger thyroid
volume are associated to risk of thyroid carcinoma.
d. In patient with Hashimoto’s thyroiditis, the prevalence of thyroid nodules and
carcinomas was 50.7% and 7.8%, respectively(8).
2. Metabolic syndrome
Metabolic
syndrome such as hypertension, prediabetes and diabetes was all
associated to independent risk factors for thyroid nodules(TN) after
adjustment for sex, age, body mass index, blood lipid levels, smoking
status, and alcohol consumption(10)
4. Insulin resistance (IR)
According to the study by the Baskent University Faculty of Medicine,
patients with impaired glucose metabolism have significantly increased
thyroid volume and nodule risks(11)(12).
5. BRAF mutations
BRAF mutation (BRAFmut) was significantly associated with increased risk of thyroid lesions including Hashimoto´s
thyroiditis, nodular goiters, hyperplastic nodules, follicular adenomas
(FA), etc., according to the study by the King Abdulaziz University(13).
B. Causes
1. Iodine deficiency and excess
Iodine,
as a trace element, is essential for thyroid gland to produce thyroid
hormones thyroxine (T4) and triiodothyronine (T3). According to study,
iodine deficiency
can cause hypothyroidism, developmental brain disorders and goiter,
leading to mental
retardation and brain damage as well as induced miscarriages,
stillbirths,
and other complications in in pregnant women(4). On the other hand,
iodine excess induced colloid goiter, the benign, noncancerous
overgrowths of thyroid tissue with diagnosis of normal serum T4 and
slightly decreased
TSH. Depending to the severity of iodine
deficiency or extent of iodine excess, each condition
has a different thyroid tumor promotion mechanism(5).
2. Radiation therapy
Patients received radiotherapy to the head, neck, and upper thorax are at increased risk of developing subsequent thyroid malignancies, according to the University of Western Ontario(6).
3. Hashimoto’s thyroiditis
B-Raf protein is responsible for cell signalling inside cells in regulation of cell growth.
According
to the study by the University of Crete, deregulation of B-Raf showed
to postpone onset of benign and malignant thyroid
disease by more than 10 years(7).
C. Symptoms
Most
people with thyroid adenoma are experience no symptoms. Symptoms may
include the below, if the tumor has been growth large enough to
interfere
the function of nearby cells or organs or if it is a functional tumor,
which
produce excessive thyroid hormone to cause hyperthyroidism.
1. Difficulty breathing and swallowing
If the tumor is growth large enough, it may interfere with breathing of the
lung such as partial blocking the air way or the food passing to the
pharynx.
2. Voice changes
If the tumor is growth large enough, it may interfere with the voice box.
3. Neck pain
If the tumor is growth large enough, it may suppress the nerve cell in the neck.
4. Hypertension
Hyperthyroidism is associated with unpleasant symptoms and hypertension
due to increased adrenergic tone, according to the study by the Harran
University Faculty of Medicine(1).
5. Other symptoms
Depending
to the age of the patients with thyroid adenoma, the
presence of hyperthyroidism may be experience certain symptoms of
tachycardia, fatigue, and weight loss, hyperactive reflexes, increased
sweating, heat intolerance, tremor, nervousness, polydipsia, and
increased appetite, anorexia, atrial fibrillation and goiter,
according to the study by the Centre Hospitalier et Universitaire de
Rouen(2).
6. If thyroid adenoma is presented in people who have Hashimoto’s disease
According
to the article by Dr. Bethany Taylor, posted in Steadyhealth, patients
with Hashimoto’s disease may experience “general muscle slow-down leads
to tiredness, while reduced body
metabolism causes dry skin, hair loss, constipation and weight gain.
Joints commonly swell up, while shortage of breath may develop due to
effects on the heart. In women, periods may become heavy and slower
brain activity might result in memory loss or poor concentration.
Youngsters may fail to grow and may not do well at school”(3).
D. Complications and Disease associated to Thyroid adenoma
D.1. Complications
Hyperfunctioning
nodules of the thyroid, found mostly in younger and predominantly
female population contribute to 3% of thyroid cancer, according to the
University of Texas Southwestern Medical Center(14).
D.2. Disease associated to Thyroid adenoma
1. Laryngopharyngeal primary squamous cell carcinoma
Laryngopharyngeal primary squamous
cell carcinoma is found to coexist with thyroid nodules in some patients and patients with advanced malignancy of the
upper aerodigestive tract(15).
2. Gastric adenocarcinoma than urine iodine level
Iodine deficiency, is more likely to
be associated with gastric adenocarcinoma compared to the existing
iodine deficiency itself(16).
3. Papillary thyroid carcinoma
Although
thyroid nodules are less common among children than among
adults, In children cwith thyroid cancer, the finding of a thyroid
nodule is 20%, according to the study by the University of Pittsburgh
Medical
Center(17).
E. Misdiagnosis
1. Hyalinizing trabecular tumors (HTT)
Hyalinizing
trabecular tumors (HTT) are very rare and difficult diagnosed thyroid
tumors. The disease in some cases are misdiagnosed as papillary
carcinoma initially(18).
2. Totally cervical thymoma
Totally
cervical thymoma arised from ectopic thymic tissue is extremely rare .
In some case it may be misdiagnosed as a thyroid nodule(19).
3. Papillary thyroid carcinoma (PTC)
Papillary thyroid carcinoma (PTC) may be diagnosed as papillary thyroid carcinoma
(PTC) by FNA cytology(20).
4. Pharyngoesophageal diverticulum
A
pharyngoesophageal diverticulum can be mistaken for a thyroid nodule on
ultrasound scan as a result of nonthyroidal lesions can mimic thyroid
nodules on imaging, according to the study by the Alexandra
Hospital, Singapore(21).
5. Primary thyroid paraganglioma
Thyroid
PGs are exceptionally rare tumors. In some cases, the diseases were
misdiagnosed as medullar thyroid carcinoma (MTC) due to its anatomically
mimic MTCs(22).
6. Anaplastic thyroid cancer
Riedel’s thyroiditis with a rapidly growing, hard, fixed, thyroid mass may mimic anaplastic thyroid
cancer(23).
7. Hodgkin’s lymphoma
Hodgkin’s lymphoma of the thyroid is rare and can mimic a primary thyroid epithelial tumor or thyroiditis clinically(24).
F. Diagnosis
After recording the past and present history and completing a physical
exam, including searching the nodule in the surrounding tissue and
abnormal lymph nodes nearby. The tests ordered may
include
1. Blood test
The aim of the test is to
measure the level of thyroid stimulating
hormone (TSH) and free thyroid hormones (FT4 and FT3),
anti-thyroperoxidase antibodies (anti-TPO), stimulating antibodies (TSI)
levels for exclusion of other thyroid diseases(25).
2. Echography and Thyroid scintigraphy
Echography is the first line examination to evaluate thyroid nodules by providing information of their
structure, as well as abnormalities associated
with thyroiditis. Thyroid scintigraphy not only allows establishing
the functional characteristics of thyroid nodules (warm or cold) but also precises the origin of a hypothyroidism(25).
3. Ultrasonography
All
ultrasound examinations for thyroid nodule should include a
malignancy risk assessment based on tissues or structures nature of
the nodule. In patients with multinodular thyroid gland, precise nodule
mapping is necessary to allow accurately identify the nature of
nodule(s) on iodine scan. Guide fine needle aspiration (FNA) is used for
suspicious
nodules(26).
4. Fine-needle aspiration biopsy (FNA) and Core needle biopsies (CNBs)
Ultrasound-guided fine-needle aspiration biopsy (FNA)is the most commonly used diagnostic method for the preoperative diagnosis
of thyroid nodules. Core needle biopsies
(CNBs) is used for the diagnosis of papillary thyroid
carcinoma and other non-follicular thyroid lesions and in cases if FNA finding is suspicious for malignancy(27).
The below sections only apply, if Thyroid adenoma has become cancerous excepted section of Treatments in conventional medicine.
G. Preventions
G.1. Diet
1. Legumes, organic soy and peanut
Daidzein,
is a phytochemical in the Isoflavones, belonging to the group
of Flavonoids (polyphenols), found abundantly in food of the family of
legumes, soy, peanut, etc. Combination of N-t-Boc-hexylenediamine
derivative of 7-(O)-carboxymethyl daidzein (cD-tboc) and cytotoxic drugs
showed to inhibit human
thyroid cancer cell growth through deduction of tumor volume with no
apparent toxicity(28).
2. Organic Soybean
An acidic methanolic extract and . Genistein from soybeans inhibited thyroid peroxidase-(TPO) catalyzed
reactions essential to thyroid hormone synthesis(29).
3. Green tea
Epigallocatechin-3-gallate
(EGCG), a major catechin found abundantly in green tea, showed to
possess remarkable therapeutic potential against various types
of human cancer cells including thyroid cancer in vitro and in vivo
models(30).
G.2. Phytochemicals
1. Epigallocatechin-3-gallate (EGCG)
According
to the study by University
of Calabria, Epigallocatechin-3-gallate inhibited cell proliferation and
reduced motility of human anaplastic thyroid carcinoma cells through
suppression of EGFR/ERK pathway and cyclin B1/CDK1 complex in cell
division(32).
2. Isoflavone derivatives
Isoflavone derivatives, N-t-Boc-hexylenediamine
derivative of 7-(O)-carboxymethyl daidzein (cD-tboc) exhibited anti
proliferative effect through increased apoptosis and cell
necrosis(death of most or all of the cells), according to study
by the Tel-Aviv University(33).
3. Phytoestrogens
Epidemiological
and pathological data suggest that thyroid cancer may
well be an estrogen-dependent disease. Dietary phytoestrogens
(including isoflavones, daidzein and genistein, daidzein lignan,
secoisolariciresinol) containing both estrogenic and antiestrogenic
properties, showed to strongly associate with risk reduction,, according to the
present data
from a multiethnic population-based case-control study of thyroid cancer
conducted in the San Francisco Bay Area. Of 817 cases diagnosed between
1995 and 1998(34).
G.3. Antioxidants
1. Alpha-lipoic acid (ALA)
ALA, a potential agent could be used as an adjunctive agent to increase efficacy
of radioiodine therapy if combined with a strategy to increase NIS
protein in transport iodide into follicular cells of the thyroid gland, according to the study by the
University of Ulsan College of Medicine(35).
2. Selenium
According
to the study by the Cancer Registry of Norway, mineral selenium (Se)
might reduce the risk of cancer and according to a pre-diagnostic
case-control study from 1986, patients with low levels of selenium are
associated to increase risk of thyroid cancer(36).
3. Vitamin D
According to study, vitamin D(3), 25(OH)D(3)
and 1,25(OH)(2)D(3) all exhibit antiproliferative effect on two thyroid
cancer cell lines(37).
4. Coenzyme Q
Coenzyme Q was found in reduced levels in
the thyroid tissue of patients with Graves’ disease and follicular and
papillary thyroid carcinomas(38).
H. Treatments
H.1. In conventional medicine perspective
1, Watchful waiting
In most cases of benign thyroid nodules, diagnosed by fine-needle
aspiration biopsy differentiating benign from malignant thyroid nodules,
your doctor may suggest only simply watching your condition with
regular interval physical exam and thyroid function tests(39).
2. Radiofrequency ablation
Audio frequency ablation is an effective and well tolerated treatment
option for benign thyroid nodules. Radiofrequency ablation of recurrent
thyroid cancers may be an alternative to surgery in patients at high
surgical risk(41).
3. Surgery
If the tumor is growth large enough to interfere with function of nearby tissues or organs, surgery may be necessary.
5. In case of nodules that cause hyperthyroidism
a. Radioactive iodine
RAI
therapy combined with lithium showed a higher cure rate, safe and time
to cure was less than RAI alone(42). Treatment with radioactive iodine
in patients with hyperthyroidism such as Graves' disease patient may induce swelling of the tissue(40).
b. Medication such as methimazole (MMI)
The aim of the medication is to reduce the symptoms of the disease but causes serious side effect(42a).
c. Surgery
In some cases if treatment with radioactive iodine or anti-thyroid
medications has not been effective, surgery may be
necessary.
H.2. In Herbal medicine perspective
1. Green tea
Epigallocatechin-3-gallate (EGCG), a major catechin in green tea, was
shown to possess remarkable therapeutic potential against various types
of human cancer cells in in vitro and in vivo models(43).
2. Polentilla alba
The
main tasks during treatment of hyperplastic thyroid disease is to stop
the growth of thyroid nodules. compensation of hypothyrosis;
normalization of thyroid size. Pphytodrug of Polentilla alba could be
recommended for monotherapy in combination with conservative therapy,
according to the strudy by Kvacheniuk AN and Kvacheniuk EL(44).
Polentilla alba in other study, also showed to reduce the volume of thyroid, normalize its function(45).
3. Shilajit (Fulvic Acid)
Shilajit is a multi-component natural occurring mineral substance used
in Ayurveda and Siddha systems of medicine originated in India.
According to the article of A NATURAL CURE FOR THYROID NODULES, posted
in Coffey’s place, fulvic acid acts as a a chelator and detoxifier of heavy metals, chemical toxins and
radiation from the body for treatment of n thyroid nodules(46).
H.3. In traditional Chinese medicine perspective
1. Ruanjian Xiaoying Decoction
Ruanjian Xiaoying
Decoction (RJXYD), according to
Shanghai University of Traditional Chinese Medicine, showed to shrink and soften the enlarged thyroid gland and thyroid
nodules and improved the immune function of human(47).
2. According to TCM assistant
a. In case of thyroid nodules as a result of Qi and Blood Deficiency
Xiang Bei Yang Rong Tang with function to tonifiy Qi, regulates the Qi nourishes Blood and transforms Phlegm.
b. In case of thyroid nodules as a result of stagnation of Dampness,
phlegm, Qi, and Blood in the area between the skin and flesh on the
neck.
Hai Zao Yu Hu Tang with function to transform Phlegm, softens what is hard, reduce thyroid nodules; Eliminates thyroid nodules.
c. In case of Goiter or thyroid nodules due to a lack of iodine or Phlegm accumulation
Hai Zao Wan with function to eliminate thyroid nodules and releases the tension(48).
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References
(1) http://www.ncbi.nlm.nih.gov/pubmed/22571552
(2) http://www.ncbi.nlm.nih.gov/pubmed/8537590
(3) http://www.steadyhealth.com/articles/Hashimoto_s_Disease___Hyperthyroidism_a261.html
(4) http://www.ncbi.nlm.nih.gov/pubmed/23297615
(5) http://www.ncbi.nlm.nih.gov/pubmed/1475583
(6) http://www.ncbi.nlm.nih.gov/pubmed/25286003
(7) http://www.ncbi.nlm.nih.gov/pubmed/23263826
(8) http://www.ncbi.nlm.nih.gov/pubmed/23762596
(9) http://www.ncbi.nlm.nih.gov/pubmed/9789594
(10) http://www.ncbi.nlm.nih.gov/pubmed/23720025
(11) http://www.ncbi.nlm.nih.gov/pubmed/23395200
(12) http://www.ncbi.nlm.nih.gov/pubmed/19633072
(13) http://www.ncbi.nlm.nih.gov/pubmed/22925390
(14) http://www.ncbi.nlm.nih.gov/pubmed/23641736
(15) http://www.ncbi.nlm.nih.gov/pubmed/18344472
(16) http://www.ncbi.nlm.nih.gov/pubmed/23844325
(17) http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2933378/
(18) http://www.ncbi.nlm.nih.gov/pubmed/21839358
(19) http://www.ncbi.nlm.nih.gov/pubmed/21766278
(20) http://www.ncbi.nlm.nih.gov/pubmed/19798886
(21) http://www.ncbi.nlm.nih.gov/pubmed/20665743
(22) http://www.ncbi.nlm.nih.gov/pubmed/19816814
(23) http://www.ncbi.nlm.nih.gov/pubmed/19059128
(24) http://www.ncbi.nlm.nih.gov/pubmed/16258502
(28) http://www.ncbi.nlm.nih.gov/pubmed/21600982
(29) http://www.ncbi.nlm.nih.gov/pubmed/9464451
(30) http://www.ncbi.nlm.nih.gov/pubmed/21725973
(32) http://www.ncbi.nlm.nih.gov/pubmed/21725973
(33) http://www.ncbi.nlm.nih.gov/pubmed/22776298
(34) http://www.ncbi.nlm.nih.gov/pubmed/11815400
(35) http://www.ncbi.nlm.nih.gov/pubmed/22995901
(36) http://www.ncbi.nlm.nih.gov/pubmed/22664335
(37) http://www.ncbi.nlm.nih.gov/pubmed/22992568
(38) http://www.ncbi.nlm.nih.gov/pubmed/9537635
(39) http://www.ncbi.nlm.nih.gov/pubmed/?term=thyroid+nodule+watch
(40) http://www.ncbi.nlm.nih.gov/pubmed/245496015
(41) http://www.ncbi.nlm.nih.gov/pubmed/21841482
(42) http://www.ncbi.nlm.nih.gov/pubmed/25285284
(42a) http://www.ncbi.nlm.nih.gov/pubmed/25178068
(43) http://www.ncbi.nlm.nih.gov/pubmed/21725973
(44) http://www.ncbi.nlm.nih.gov/pubmed/23356147
(45) http://www.ncbi.nlm.nih.gov/pubmed/23786024
(46) http://coffeysplace.blogspot.ca/2010/04/natural-cure-for-thyroid-nodules.html
(47) http://www.ncbi.nlm.nih.gov/pubmed/16834970
(48) http://www.tcmassistant.com/symptoms/thyroid-nodule.html
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