What is a 2-lobed nodular goiter?

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Nodular goiter is the term for the abnormal growth of thyroid cells forming a mass. Bilobular goiter is when thyroid nodules appear in both lobes of the thyroid gland. Although the majority of cases with 2-lobed thyroid nodules are benign, a small percentage of thyroid nodules contain cancerous cells.

1. What is a 2-lobed nodular goiter?

The thyroid gland is an endocrine gland in the shape of a butterfly and located in the front of the neck. The thyroid has 2 lobes located on either side, the right lobe and the left lobe, connected together into a mass with a very small waist lobe. The function of the thyroid gland is to make thyroid hormones, which are secreted into the bloodstream and then transported to all tissues in the body. Thyroid hormone helps the body use energy, stay warm, and keep the brain, heart, muscles, and other organs working as they should. A nodular goiter is an abnormal growth in the thyroid parenchyma of a mass of thyroid cells. If the thyroid gland has only one nodule, it is called a solitary thyroid nodule; If there are 2 or more nodules, it is called 2 or multiple thyroid nodules. In cases where a goiter has nodules and the nodules are in either lobe, it is called a bilobular goiter.
Whether 1 core, 2 cores or multiple nuclei, the number or location of the nucleus will be less concerned than the size, the endocrine capacity of the nucleus. If the patient has a large nodule and secretes thyroid hormone, early intervention should be considered.

2. What are the symptoms of a 2-lobed nodular goiter?

If small in size and do not secrete thyroid hormone, most thyroid nodules cause no symptoms. Often, a bilobular goiter is discovered incidentally during a routine physical exam or on imaging tests such as CT scans or ultrasound of the neck. In addition, some patients find thyroid nodules on their own by noticing a lump in the neck when palpating or looking in the mirror, having difficulty buttoning a collar or wearing a necklace.
In addition, thyroid nodules can also produce too much thyroid hormone causing clinical hyperthyroidism syndrome. On the other hand, when the thyroid nodule increases in size, the patient will seek medical attention because of pain in the neck, jaw or ear. If the nodule is large enough to press on the trachea or esophagus, the disease can cause difficulty breathing, swallowing, or a ticking sound in the throat. Even hoarseness can be present if the thyroid nodule invades the nerves that control the vocal cords and this is usually a sign of malignant nodules or thyroid cancer.
A small number of cases where a 2-lobed thyroid nodule is found is when thyroid function tests are abnormal in a routine blood test kit.

3. What are the causes of 2-lobed nodular goiter?

To date, the causes of bilobular goiter are not clearly understood, although the occurrence of nodules in the thyroid gland is extremely common. By age 60, approximately 50% of the population has a thyroid nodule that can be found on physical examination or with imaging. Fortunately, more than 90% of such nodules are benign.
Several epidemiological studies suggest that Hashimoto's thyroiditis is the most common cause of hypothyroidism and is associated with an increased risk of thyroid nodules. In addition, dietary iodine deficiency, although becoming very rare in modern life, is also known to cause thyroid nodules.

4. How is 2-lobed nodular goiter evaluated and diagnosed?

Once thyroid nodules have been detected, the doctor will attempt to determine if the rest of the thyroid parenchyma is healthy or if the entire thyroid gland has been affected by a general condition called hyperthyroidism or hypothyroidism.
The doctor also needs to do a manual examination to feel the thyroid gland, to see if the entire thyroid gland is enlarged, how many nodules there are, and the location and size of the nodules.
Initial laboratory tests may include measuring the levels of thyroid hormone (thyroxine or T4) and thyroid-stimulating hormone (TSH) in the blood to determine if the thyroid gland is functioning properly. or not. Simultaneously, the investigation by imaging tools also allows to determine the abnormal structure in thyroid tissue is thyroid nodule or thyroid cyst or nodule in thyroid cancer. The method of choice is usually thyroid ultrasound.
Indeed, thyroid ultrasound is an important tool for evaluating the presence of nodules in the thyroid gland. The mechanism of action of ultrasound in general, and thyroid ultrasound in particular, is to use high-frequency sound waves to obtain images of the thyroid gland. This tool allows the thyroid gland to be visualized with accuracy, distinguishing the mass in the thyroid parenchyma as nodules, cysts or nodules, balanced thyroid or enlarged thyroid nodules. Furthermore, ultrasound can also help identify nodules that are suspected to be benign thyroid nodules or thyroid cancer.
Also, for this distinction to be the “gold standard”, ultrasound will be used to guide thyroid aspiration by needle aspiration, cytology, and biopsy.

5. How to treat 2-lobed nodular goiter?

In case the patient has a small 2-lobed goiter, does not affect the surrounding, does not unbalance the thyroid hormone levels in the blood, the treatment of 2-lobed goiter can be delayed. . The patient does not need any internal and external intervention but is scheduled for periodic follow-up.
On the contrary, if there is only one thyroid nodule but it is large in size, causing compression around it, increasing the production of thyroid hormone causing hyperthyroidism syndrome or thyroid nodule causing compression of the normal thyroid parenchyma, reducing Thyroid hormone production causes hypothyroidism syndrome, treatment is indicated and should be done as soon as possible. The intervention should be laparoscopic thyroidectomy or surgery to remove the thyroid nodule. In which, if this is thyroid cancer, the possibility of total thyroidectomy and surrounding lymph node dissection should be selected. At the same time, patients can have combined medical treatment such as taking thyroid suppressants if hyperthyroidism or artificial thyroid hormone supplementation after total thyroidectomy.
However, regardless of the condition, whether radical intervention or not, all thyroid nodules from the time of detection cannot exclude the possibility of containing thyroid cancer cells. From there, the follow-up ultrasound combined with needle aspiration biopsy should be performed periodically after 6 to 12 months and thyroid examination at a specialist every year. If there is evidence of abnormal growth, it is important to consider early surgery, to avoid poor outcomes later.
In summary, bilobular goiter is a benign diagnosis given the presence of 2 thyroid nodules on either side of the thyroid lobe. However, any condition should be examined and tested, including a needle biopsy, to rule out thyroid cancer as well as the effects of thyroid nodules.
Thyroid diseases are often left undiagnosed in 20 - 60% of the total population. That is the reason for Vinmec to launch a package of screening and screening for thyroid diseases. Screening & early detection of common thyroid diseases such as simple goiter, hyperthyroidism, hypothyroidism, thyroiditis, thyroid nodules, thyroid cancer, etc. appropriate and timely treatment.

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