Cold nodules are inactive areas of nodular form in the thyroid gland.
They no longer produce hormones and indicate a more or less pathological change in the tissue.

The causes of a cold nodule in the thyroid gland can be versatile. Both benign conditions such as cysts, scars or adenomas ( benign tumors ), as well as malignant diseases such as malignancies ( malignant tumor ) must be clarified.

A cold knot may be associated with hypofunction of the thyroid gland.
That is, the thyroid does not produce adequate levels of hormones, which has various effects on the whole organism.

In any case, a close examination is required if such a conspicuous finding is found.


Benign causes

A cold knot does not necessarily have a bad cause.
There are several benign appearances, which are in the scintigraphic picture as an inactive area. Benign means that they are usually not devastating, but they still need to be examined and usually treated.
The prognosis, however, is usually better in contrast to confirmed diseases.

The group of benign causes of cold nodules in the thyroid gland include cysts.
Cysts are chambers that can form in a wide variety of tissues. They are lined with capillaries ( epithelial cells ) and contain a thin or thick inflammatory secretion.

By encapsulating the surrounding tissue, inflammation does not spread rapidly, but the size of the cyst may increase over time.
This may require surgery to remove the cyst.

At the point where the cyst is, there are no normal thyroid cells left. As a result, no radioactive contrast agent can be stored in a scintigraphy there, which results in a cold node in the image.

Furthermore, scars (also fibrosis ) may represent inactive thyroid areas. Scarring or fibrosis can develop as a result of inflammation that has healed on its own, but also through surgery. When scarring ( fibrosis ), the substance fibrin increasingly accumulates in the tissue, which forms part of the coagulation system and hardens the corresponding area. When a part of the thyroid gland is removed, such as when a cyst or tumor needs to be treated, the tissue usually scarred at the sites where cuts were made. Scarred tissue is harder than other tissue and loses its functions in this remodeling. Cold knots caused by scars are, therefore, as long as the function of the thyroid is not too limited, completely harmless. If the fibrous areas are overgrown, as may be the case after a very serious inflammation, there is the possibility of developing hypothyroidism.

If traumatic events, such as an accident, cause damage to the cervical region or the thyroid gland, this can lead to bleeding in the latter. Even pathological vascular changes that involve acute damage to the pathways can be responsible for bleeding. Bleeding can cause damage to surrounding tissue, causing inactive areas in the thyroid gland. These represent themselves as usual in the scintigraphic picture as colorless cold knots.

Thyroid adenomas are benign tumors. They develop from the follicular epithelial cells of the thyroid (thyroid), the so-called thyrocytes.
Follicular epithelial cells are cover cells, which arrange themselves around smallest cavities, in which in the case of the thyroid, the thyroid hormones are formed and stored.
Thyroid adenomas are mainly associated with hyperthyroidism.

If this is not the case and the proliferating cell aggregates are inactive cells, an adenoma can also be the cause of a cold nodule. Unfortunately, most cold nodules associated with tumors are malignant in nature and are referred to as thyroid cancer.

Malignant causes / cancer

Cold knots are not uncommon in scintigraphic findings.
Often benign diseases are the background of such eye-catching images. However, a malignant tumor disease should be excluded at any time.

Thyroid cancer is characteristically of sufficient size as a cold knot in the tissue.
Since the laboratory findings are usually rather inconspicuous, the picture or a questionable tactile findings can give the first indications of a thyroid carcinoma .

One distinguishes between different types of thyroid cancer. The forms are very different in their course as well as in the probable chances of recovery.

The best prognosis are papillary thyroid carcinomas, which account for approximately 65% ​​of all malignant tumors.
They are followed closely by similar follicular thyroid cancer accounting for approximately 25%.

Less common is the medullary thyroid carcinoma that forms from the thyroid C-cells .
These cells produce the hormone calcitonin, which regulates the calcium balance.

This circumstance causes a separate symptomatology in the medullary tumor, which is accompanied by an increased hormone level of calcitonin and a subsequent hypocalcemia, a calcium deficiency.

Very rare are anaplastic thyroid carcinomas, which have the lowest chance of recovery at the same time.
Due to the strong dedifferentiation of the cells, the tumor grows extremely fast. Dedifferentiation means that the cells have nothing in common with the surrounding tissue - they do not resemble any cell found in the thyroid gland. Therefore, the fewest therapeutic measures can influence, let alone stop, the malignant tumor. Another possibility for cold nodules of malignant origin are metastases. However, the thyroid gland is extremely rarely affected by metastasis.


Cold knots can go completely unnoticed clinically.
Depending on the cause and size, they may not be noticed for a long time and may be detected as incidental findings.

If the nodes are in pain, it is more likely to be an acute cause such as bleeding or other injury.

If the nodes can be palpated or visualized after a painful period, a previous thyroid inflammation ( thyroiditis ) is likely.

As already mentioned, the blood levels (hormone levels) in neoplastic (tumor-related) diseases are not necessarily changed.
However, if there is an increase or decrease, follow-up diagnostics should be followed with closer examination of the thyroid gland.

If there are oversized cold nodules that actually affect thyroid function, the clinical picture of hyperthyroidism - hypothyroidism develops .

underactive thyroid

The thyroid is responsible for the iodine balance of the body and the production of important hormones. With the help of absorbed and stored iodine in the organ T 3 (triiodothyronine) and T4 (thyroxine) are produced.
These hormones are important components of the regulation of energy metabolism, as well as the growth control of all cells and the body itself. They are formed in the thyroid cells, unlike the hormone calcitonin. This is produced in so-called C-cells and controls together with the parathyroid hormone, which comes from the parathyroid gland, the calcium balance of the body. Calcitonin is responsible here for the lowering of the calcium level in the blood and parathyroid hormone the corresponding antagonist.

An under-function usually develops creepingly and is not noticed by many patients at first.

The performance is reduced by the disturbed energy metabolism. This is followed by a lack of concentration and muscle, but also a general tendency to tiredness.
Patients are often impotent and often freeze because the body does not produce enough energy.

Also in digestion, the downscaled energy supply settles in blockages.

There may be confusion with a depressive phase, especially in older patients. Due to the non-powered and depressive nature of hypothyroidism, the symptoms can be misinterpreted.
Also, memory disorders or loss of appetite can be common clinical signs that can be differentiated by a blood test.

Underactive function also has an influence on the vital signs of the patient: the pulse and the blood pressure decrease permanently, there is an unwanted loss of weight, the skin is rough and overall the patient makes an unhealthy impression. Gender-specific symptoms are manifest in men due to lack of sex drive and erectile dysfunction, in women due to disturbances in the female cycle or nodular changes in the breast. Childlike hypothyroidism can lead to developmental disorders or delays in growth, which does not have to be the case.

The most severe form of hyperthyroidism can be a so-called hypothyroid coma .
The vital signs continue to decrease. The heart sounds are difficult to perceive, the pulse slows down again. Also, the blood pressure and body temperature are lowered and worsen the condition of the patient.
The patient continues to be noted for his shallow breathing and weak to absent reflexes.

Characteristically, the patient shows a myxedema .
It comes to the incorporation of components of the connective tissue ( glycosaminoglycans ) in the subcutaneous tissue. Since these substances have a water-attracting effect, following a general subcutaneous suspension, which leaves the patient bloated despite its often low weight.

This maximum increase in the clinical picture hypothyroidism is rather rare, as the signs are usually interpreted early and counteracted with the help of hormone preparations of the disease.

hair loss

Thyroid hyperthyroidism, which can develop in the presence of cold nodules, affects hair growth in some patients.
This happens because the thyroid hormones have essential functions in the development of cells of all types of the human body. So they also affect the hair structure.

The under-function causes in part that the hair has only a poor stability - they lose strength and have a smaller diameter than healthy hair. Visually, this is seen in a loss of density. Patients report an increasing fatigue of their hair and increased brittleness. All of these aspects have a negative impact on the hair's retention - they are easier to lose and bald spots are formed.

Another cause of hair loss from previous cold nodules in the thyroid can be treated tumors.

The treatment of choice for tumors is the removal of the thyroid and subsequent administration of thyroid hormone preparations in order to achieve a hormonal balance.
As a result of the surgery, radioiodine therapy can be used to eliminate the last remnants of the thyroid gland.

For this, the patient is injected with radioactive iodine, which destroys the remaining thyroid tissue. It can happen that a treatment-related hypothyroidism is triggered. Also as a result of which it may come in addition to other symptoms to hair loss.


The concept of a cold nodule in the thyroid gland is derived from the findings of scintigraphy. Scintigraphy is a method of nuclear medicine imaging.
The patient is injected with radioactive but not harmful substances, which are stored in certain tissues, for example in the thyroid gland.
With the help of a so-called gamma camera, the radiation can then be displayed in an image that emanates from the radioactive substance.

If the thyroid gland is shown in this way and there is a colorless area on the otherwise colorful picture, this is called a cold knot. Cold, because the colorlessness means an inactivity of the area in question and knots, because the structures are mostly round.

Furthermore, the attending physician can examine the thyroid gland by means of ultrasound or by palpation. The ultrasound makes cysts particularly good, as the sound can not penetrate the fluid in the cyst and thus cast a shadow. In differentiating the origin of other abnormalities, the possibilities of an ultrasound examination are limited . If the node can already be palpated or is even visible from the outside, this indicates an advanced finding.

The laboratory parameters can also provide clues to the cause of existing nodes. If the thyroid parameters T3 (triiodothyronine) and T4 (thyroxine) are lowered, but the TSH (thyroid stimulating hormone, thyroid = thyroid) is normal or elevated, the hypothyroidism of the organ is self-defeating and there is extensive damage to the thyroid tissue.

If the thyroid hormones are unremarkable, the restriction is limited - there may still be cysts, scarring or tumors.


Cold Knot - What to do?

If you feel a knot in yourself, you should go to the doctor as soon as possible.

Not always, such an abnormality has a bad cause, but it must be controlled, which is behind a change.
Often, a cold knot is a coincidental find discovered in other investigations.

If the node is visualized by ultrasound or scintigraphy during further diagnosis, a malignant disease must always be ruled out.

Frequently, biopsies are performed, ie the smallest tissue samples, which are examined in the tissue tissue.

You should definitely keep calm and let the medical examination clarify.

Medical therapy

Especially in young patients with hypothyroidism, hormone therapy is absolutely indicated.

If it comes to a hypothyroidism, it should always be adjusted to medication to avoid long-term problems.

The dose of prescription hormone preparations must be tailored to each patient.
Initially, small doses are administered which can be gradually increased to the desired therapeutic value.
Thus, side effects can be avoided as best as possible.

The subjective feeling of the patient plays an important role in stopping the medication between 50 and 150 micrograms per day.
Likewise, the level of TSH is controlled after one and a half to two months. This gives a longer-term guideline for the correct drug delivery.

Special attention is required in very young patients. Depending on age, fluctuations in hormone levels may occur. Likewise, deficiency symptoms such as growth retardation or weight loss should be kept in mind. Control of blood levels at reduced intervals is more important in people who are still growing than in adults. However, adults should also regularly have their thyroid hormone levels checked.

If it comes to the clinical picture of the hypothyroid coma, it requires a more complex treatment. As life is acutely threatened, the patient must be admitted immediately to an intensive care unit. The vital signs must be continuously monitored and the body temperature normalized, as the patients usually suffer from hypothermia ( hypothermia ).

The drug treatment is carried out with the help of glucocorticoids (cortisone) and glucose, as well as with an intravenous dose of L-thyroxine, a thyroid hormone.


Cold nodules in the thyroid do not always have to be the reason for an operation.

In many cases, a resulting condition, such as hypothyroidism, can be controlled by medication.
It often happens that the lump remains clinically completely silent and no symptoms develop, even if nothing is done in the longer term.

However, if the cold knot is due to a malignant tumor disease, this nodule or even the entire thyroid gland must be removed.
This can be done in various ways.

Removal of the individual components, as well as the entire organ is possible, but not always necessary. Especially with benign tumors one often resorts to removing only the knot with a certain safety margin.


Before starting surgery, some questions should be answered that influence the procedure during the procedure from the beginning.

So it must be clear whether only the node should be removed, or more extensive tissue shares.
While there is no need for total resection (removal) of various other thyroid diseases, total removal of thyroid cancer is almost always indicated. Rarely, the risk is taken to obtain tissue. There is almost always the danger that tiny tumor components will be overlooked due to their minimal size and later lead to recurrence ( recurrence ).

The operation is performed under general anesthesia. Access to the operating area is from the front over a cross section directly on the neck.
It is often made in a skin fold to be able to achieve a better optical result at later healing.
The skin layers, the connective tissue and the neck muscles are severed to penetrate deep into the thyroid gland.

If the thyroid gland is gradually removed from the surrounding tissue, hemostatic measures should be taken throughout as the organ is well supplied with arteries and veins.

A hemithyroidectomy, a half-sided removal of the thyroid gland, can be used in an early recognized papillary thyroid carcinoma ( see above ) .

There may be various complications in thyroid removal. On the one hand, due to grossly negligent behavior, the larynx or trachea may be damaged, but this should not happen to experienced surgeons.

On the back of the thyroid are four so-called epithelial bodies, the so-called parathyroid glands, which must be preserved in any case.
Because in them, the parathyroid hormone is produced, which plays an important role in the calcium balance of the body.
Due to the small size of the parathyroid glands, care must be taken.

If sufficient surrounding tissue can not be obtained on the spot, it is possible to transplant the epithelial bodies into the arm. There they are connected to the blood supply and can continue to fulfill their duties.

Attention should also be paid to the recurrent laryngeal nerve . This runs along the way to the larynx very close to the trachea and thus also passes through the area of ​​the thyroid gland.
In the larynx, he controls almost all existing muscles.

Damage causes various restrictions such as permanent hoarseness or shortness of breath.


If cold knots present in the thyroid gland have no devastating cause or if there is no serious hypothyroidism, alternative remedies can also be used.

Homeopathy is also understood as a supportive form of treatment that can be used in addition to conventional medical measures in order to achieve the greatest possible success.

For example, mild hypothyroidism caused by cold knots can be controlled by homeopathic remedies.
Metabolism has a slowing effect on graphites and pulsatilla, which also help to boost digestion, cleanse the skin, or help regulate the cycle.

Barium carbonicum and alumina can be administered in cases of nervousness and mental decline, whereas potassium carbonicum and silicea have a positive effect on people prone to increased fatigue or edema.

Some naturopaths are of the opinion that nodules in the thyroid are expressions of mental conflicts and indicate special character traits. At the same time, they are regarded as a phenomenon of psychosomatics and as a result of unwanted stimuli. In the knot, the soul of the patient is relieved. If the node is harmless, this concept advises against surgery because it removes the patient's self-regulation.

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