What is a thyroid keloid cyst?

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What does thyroid keloid cyst mean?

Kloid cyst nodules are a common type of benign thyroid nodule that is filled with a fluid called keloid. Colloid is a gelatinous and clear substance that is inside the follicles of the thyroid gland and is the storage place for thyroid hormones (T3) and (T4). In general, a nodule or thyroid nodule is formed when the thyroid tissue grows abnormally. In keloid cyst nodules, this growth is excessive It can be extensive. Fortunately, keloid nodules do not spread outside the thyroid. Many thyroid keloid cysts do not need to be treated, but follow-up examinations are necessary to check for any growth or change in these cysts

Kloid thyroid cyst versus other types of thyroid nodules

Thyroid keloid cysts are just one type of thyroid nodule. Thyroid nodules are very common and approximately 60% of adults have at least one nodule. Fortunately, about 95% of thyroid nodules are non-cancerous. A thyroid nodule is not always full of fluid. But when it is filled with fluid (such as thyroid keloid cysts), it is called cystic.

Colloid nodules can be completely filled with liquid or contain a mixture of liquid and solid parts. Purely cystic nodules (meaning they are 100% fluid-filled) are rarely cancerous. Although a keloid thyroid nodule may increase in size, it usually stays within the thyroid and does not spread to other parts of the body.

While keloid nodules are the most common type of thyroid nodules; But it is also possible to create other types of nodes such as pleuritic nodes or follicular adenoma. Some people may experience more than one node at the same time. Benign thyroid nodules are classified into non-functional and functional categories.

Most thyroid nodules are non-functional; This means that despite the presence of the nodule, the thyroid hormone level remains normal. In contrast, "functioning" nodules produce too much thyroid hormone. Functional nodes can become overactive, in which case the entire gland is affected and becomes hyperactive.

Symptoms of thyroid keloid cyst

Most thyroid keloid cysts do not cause any specific signs or symptoms; Unless they grow to the extent that they affect the surrounding tissues or are visible in the neck.

When thyroid keloid cysts become symptomatic, they may cause the following symptoms:

Visible neck swelling or palpable lump
Harness of voice or changes in voice
Pain in the neck
Difficulty in swallowing

In some cases, thyroid nodules may cause symptoms of an overactive thyroid (hyperthyroidism) by producing too much thyroid hormone, including:

Sudden and rapid weight loss
Rapid or irregular heartbeat
Anger or anxiety

Also, in some cases, you may experience symptoms of hypothyroidism (hypothyroidism); Including:

fatigue
Dry skin
weight gain
Constipation

Causes of thyroid keloid cyst

The causes of thyroid keloid cysts are complex and often a combination of different factors play a role in their development. Although a lot of research has been done in this field; But more studies are needed to fully understand the mechanism of creating these cysts. The following factors are the most important factors involved in the development of thyroid keloid cysts:

Overgrowth of thyroid tissue:

One of the main causes of keloid cysts is abnormal and excessive growth of thyroid tissue. This growth can occur for various reasons that are still not completely clear.

Destruction of thyroid tissue:

Sometimes, the breakdown of dead or damaged thyroid cells can cause cysts. This process may occur due to various factors such as inflammation or infection.

Material accumulation:

Accumulation of some substances in thyroid tissue (such as keloid) can cause cyst formation over time.

Genetic factors

Genetic factors also play a role in the development of keloid cysts. This means that some people are more susceptible to thyroid keloid cysts due to hereditary factors.

Underlying thyroid problems:

Some underlying conditions can contribute to the formation of thyroid keloid cysts; Including thyroiditis (an autoimmune disease that causes inflammation of the thyroid gland). Goiter Multinodule (enlargement of the thyroid gland) can also be one of the causes of keloid cyst; Because keloid nodes are often created at the same time as thyroid enlargement. An enlarged thyroid gland may have multiple thyroid nodules.

Long-term low TSH:

People whose thyroid stimulating hormone (TSH) levels have been low for a long time are more likely to develop keloid nodules than others. If the TSH level remains low, a nodule may grow in size, detach, and secrete hormones. Large keloid nodules can cause pressure on nearby structures, including vocal cord nerves.

Iodine deficiency:

In some cases, the lack of iodine in the body can cause the thyroid gland to enlarge and thus increase the possibility of developing cysts.

Environmental factors:

Some environmental factors such as exposure to radiation may also play a role in the development of thyroid cysts.

Lifestyle factors:

Some lifestyle factors can play a role in creating or aggravating thyroid keloid cysts; For example, smoking, chronic stress, improper diet and...

Risk of cancer in thyroid keloid cysts

Most thyroid keloid nodules are cystic; That is, they are completely or largely filled with liquid. In general, one out of every 20 thyroid nodules may become cancerous. Examples of cancerous thyroid nodules include papillary or follicular carcinoma, medullary carcinoma or anaplastic carcinoma. Also, the risk of cancer of non-functioning nodes (that is, those that do not produce thyroid hormone) is 14 to 22%; In contrast, hyperactive nodes (nodes that produce thyroid hormones) rarely become cancerous.

However, the risk of cancerous thyroid keloid cysts is much lower. The chance of pure keloid cysts (that is, those that are 100% liquid) turning into cancer is less than 2%.

Genetic factors, a history of perfusion therapy in the head and neck area, a history of thyroid surgery, etc. increase the risk of thyroid keloid cysts becoming cancerous.

Diagnosis of thyroid keloid cyst

Often thyroid keloid cysts are asymptomatic; That is, patients do not notice them by themselves and they are randomly diagnosed during clinical examinations or thyroid function tests. In general, the methods of diagnosing thyroid keloid cyst are as follows:

Clinical examination:

Depending on the size and location of the keloid nodule, the doctor may feel it during the physical examination of the thyroid gland. In about 5% of women and 1% of men who live in areas with iodine deficiency, thyroid nodules can be detected by physical examination.

Blood test:

If the doctor detects a keloid cyst during examination or suspects it, he will prescribe a blood test that includes checking the level of thyroid stimulating hormone (TSH) as well as the levels of T3 and T4.

Ultrasound:

If the TSH, T3 and T4 levels are unbalanced, an ultrasound is performed to determine the type of node and also check the condition of the lymph nodes around the neck. Ultrasound can help determine the type and size of the nodule and also check whether the nodule has penetrated the surrounding tissues or is putting pressure on the nearby nerves or lymph nodes.

Fine needle aspiration :(FNA)

In the case of non-functional nodules, it may be necessary to perform "fine needle aspiration"; According to ultrasound findings and node size. In this procedure, the doctor inserts a thin needle through the skin into the thyroid nodule to collect cells for testing.

Performing FNA while using the ultrasound machine helps ensure correct needle placement. A medicine to numb the neck area may be used to prevent discomfort. The doctor collects several cell samples from different areas of the node to analyze the characteristics of cancer and sends them to the laboratory.

Read more: Thyroid sampling What is it and how is it done?

Molecular testing:

FNA results are sometimes interpreted as "inconclusive"; This means that the results are not definitive about whether the cells are cancerous or benign. In this case, the doctor may send the sample for molecular testing. Molecular testing analyzes the genetic sequence of cells' DNA or RNA to check for gene mutations.

Radioactive iodine absorption test:

This test is used for patients who have a thyroid nodule and their TSH level is lower than normal. In this test, a radionuclide (radioactive iodine) is given to the patient in the form of tablets or capsules or by injection. A few hours after consuming radioactive iodine (6 hours later or even the next day), images of the thyroid gland are taken using a gamma camera.

These images show how much radioactive iodine has been absorbed by the thyroid gland. The normal absorption of iodine indicates the normal functioning of the thyroid gland. Excessive iodine uptake may indicate hyperthyroidism, Graves' disease, or the presence of a functional thyroid nodule. Low iodine absorption refers to hypothyroidism, thyroid inflammation or the presence of a non-functional nodule.

Treatment of thyroid keloid cyst

Treatment options depend on the size and type of keloid cyst. Cysts that are non-cancerous or do not cause problems do not require treatment. Most thyroid keloid cysts remain constant in size. Some of them may shrink on their own or even disappear completely without any treatment.

In the case of non-cancerous keloid cysts that do not grow significantly, regular follow-up and periodical ultrasound are sufficient. In case of worrisome growth of thyroid keloid cysts, it may be necessary to perform a biopsy to rule out the possibility of cancer, and then appropriate treatment is prescribed based on the results.

Surgery

Thyroid keloid cysts are usually benign, but in some cases they can contain cancer cells. Even benign keloid cysts may require surgery if they grow significantly.

Removal of thyroid keloid cyst through surgery is recommended in the following cases:

Diagnosis of Thyroid cancer or results of genetic tests that indicate the possibility of cancer.
The presence of a large nodule that causes pain, difficulty breathing, difficulty speaking, or difficulty swallowing.
The effect of nodule on the production of thyroid hormones.

Two of the most common thyroid surgeries to remove thyroid keloid cysts are:

Thyroid lobectomy: Surgical removal of one of the two lobes of the thyroid gland, which may be done for thyroid nodules or thyroid cancers.

Thyroidectomy: Surgical removal of the entire thyroid gland or almost all of it, recommended for the treatment of certain thyroid cancers or goiters.

It is noteworthy that any thyroid surgery should be performed by an experienced and skilled thyroid surgeon in order to complications of thyroid surgery be minimized.

Dr. Seyed Ahmed Fanai, a thyroid and parathyroid surgeon with more than 5000 successful thyroid surgeries, is a member of the American Thyroid Association. He, who is known as the Golden Paw thyroid surgeon, performs surgeries with the most up-to-date medical equipment such as a neurometer to minimize the complications of surgery.

Other treatment options

If the keloid cyst is affecting thyroid function, it may be treated with radioactive iodine or surgery to remove the nodule. Other treatment options that may be used alongside thyroid surgery or alone include:

Some medications: An alternative to radioactive iodine may be thyroid-blocking medications such as propylthiouracil (PTU) and methimazole (Tapazole).

Thyroid radiofrequency ablationThyroid radiofrequency ablation: This minimally invasive option involves using an ultrasound-guided needle to deliver an electrical current to the nodule, heating it, and then shrinking it. This type of method is usually recommended for large benign nodes.

Can thyroid keloid cysts become cancerous?

Kloid thyroid cysts rarely become cancerous; But there is a possibility of this issue. Therefore, regular examination of these cysts is very important. If there are several nodules in the thyroid, each of them should be examined separately.

How is cancerous thyroid keloid cyst treated?

If the thyroid keloid cyst is diagnosed as cancerous, surgery is usually performed. Other treatments such as chemotherapy or radiation therapy may also be recommended.

Concluding remarks

Thyroid keloid cysts are fluid-filled cavities in the thyroid gland that are often considered benign. Although most of these cysts do not require treatment; But in some cases, due to excessive growth or causing symptoms, surgery or other treatment methods may be needed. Various factors such as age, family history of thyroid cancer, exposure to radiation, and the presence of multiple thyroid nodules can increase the risk of developing thyroid cancer in people with keloid cysts. Therefore, regular tests and medical follow-up are very important for these people.

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