Why are there more thyroid nodules after age 40?

2024-10-15 18:00:00

It is estimated that up to a third of the population will have thyroid nodules at some point in their lives. We spoke to an expert on the subject to explain how to identify and treat them.

Last update: October 15, 2024

The thyroid is a small gland located in the neck, responsible for regulating metabolism and controlling various body functions. When disorders or diseases that affect it appear, we can suffer from hypothyroidism, hyperthyroidism or nodules. The latter, in particular, become more widespread as we age.

Doctors detect more thyroid nodules in patients over age 40. In general these are benign lesions. Only a small percentage, 3% to 6%, progress to thyroid cancer.

To understand more and find out what treatments are available, we interviewed Doctor Pedro Pablo Ortiz Remachaendocrinologist and expert in thyroid diseases. In his experience, “nodules tend to appear after age 40 because they have had enough time to grow and generate symptoms.” But they are not a problem without a solution.

What do thyroid nodules look like?

The thyroid gland is located in the front of the neck. It can only be felt with the hand, through the skin, if it is inflamed or if it has a lump that increases in size. Otherwise it is imperceptible.

“The thyroid has two lobes, the right and the left”, clarifies the specialist, “united in its central part by a smaller area called the isthmus”. We would say that its shape resembles a butterfly.

Nodules can form anywhere on the gland. Most of them have a diameter less than 1 centimeter. However, despite their small size, they are capable of altering the functioning of the thyroid.

The gland secretes the hormones T3 and T4. The second becomes the first depending on the specific needs of the organism and both are transported through the blood, bound to proteins. When released from these transporters, they become free hormones capable of acting in almost all tissues, explains the doctor.

This means that a thyroid nodule can have long-term consequences on other organs.as the hormonal balance could be altered. Although there are also local problems, in the neck area, when the lesion grows rapidly.

“The most common thing is that the thyroid nodule grows slowly,” explains Dr. Ortiz Remacha. “However,” he adds, “there are rapidly growing lesions that cause pain and compression in nearby structures, such as the trachea, esophagus, carotid, jugular, or laryngeal nerves.” In these cases the patient has difficulty swallowing, breathing and moving his neck.

Types of thyroid nodules

As the endocrinologist explains to us, there are two forms of nodules:

• Hot or hyperactive: They are structures that produce hormones and lead, in many cases, to hyperthyroidism.
• Cold or not working: They do not produce hormones and are usually associated with a context of hypothyroidism and thyroiditis.

Both types can appear due to high hormonal stimulation, explains Ortiz Remacha. For example, if the pituitary hormone that regulates the thyroid (called TSH) significantly increases its concentration, clumps of cells will form in the gland and form nodules. Chronic inflammation is also a cause, as occurs in autoimmune thyroiditis.

These processes take time to develop. That’s why after 40 they become more noticeable, as enough years have passed for the damage to occur.

Among younger women the situation is particular postpartum thyroiditisappearing after childbirth. “There are also other cases in which the gland is compromised early, presenting what is called subclinical hypothyroidism,” the expert tells us. This is a condition where diagnosis is more difficult, as the symptoms are not yet evident, but the damage is ongoing.

“Women have more thyroid problems than men, including nodules,” says Dr. Ortiz Remacha (photo).

How are they detected?

In his clinical practice, the doctor states that starting from the age of 40 there are clearer symptoms to suspect thyroid problems. And that’s where more diagnoses arise.

Especially in postmenopause, “the prevalence of hypothyroidism increases significantly, due to hormonal changes, which can be a trigger,” says the doctor. Therefore, he insists, Surveillance and early diagnosis are essential to avoid complicationsespecially in older women.

At the visit, if the presence of nodules, hyperthyroidism or hypothyroidism is suspected, the professional will request a blood test. Thyroid hormone and TSH levels will be measured. Additionally, an ultrasound of the gland will be performed.

Is it possible to prevent thyroid problems?

According to Dr. Pedro Pablo Ortiz Remacha, We must perform self-care actions to reduce the risk of thyroid disease. Among them, he recommends the following:

What treatments are available?

When hypothyroidism is accompanied by nodules, healthy habits will have little influence and will not be enough to reverse the problem. If there are obvious symptoms or the size of the gland affects the aesthetics, The specialist recommends using non-invasive thermoablation techniques, such as HIFU ultrasound.

This is an innovative treatment, underlines the endocrinologist. “By directing heat directly onto the lump, we destroy it and prevent it from continuing to grow,” he explains.

Since these are non-invasive ultrasounds, the technique is outpatient. «There is no provision for hospitalization; side effects, if they appear, are minimal; and has more benefits than surgery or radiofrequency,” the doctor lists the benefits.

In any case, when signs or symptoms related to thyroid disorders appear, Medical consultation to order a blood test and ultrasound is essential. Furthermore, “it would be advisable that routine farm and health checks include the determination of thyroid hormones, given the prevalence of disorders and their impact on quality of life”, concludes Ortiz Remacha.