1. The patient has a long history of simple goiter. The age of onset is usually greater than 30 years. There are more females than males. The degree of goiter varies and is often asymmetric. The number and size of nodules vary, usually multiple nodules, or only one nodule in the early stage. The nodules are soft or slightly hard, smooth and non-tender. Sometimes, the boundary of the nodules is not clear, and the surface of the thyroid gland only feels irregular or lobulated when touched. The disease progresses slowly and most patients are asymptomatic. Larger nodular goiter may cause compression symptoms, such as dyspnea, dysphagia and hoarseness. Acute hemorrhage within the nodule can lead to sudden enlargement of the mass and pain. Symptoms may subside within a few days, and an enlarged mass may decrease in size within a few weeks or more.
2. When hyperthyroidism (Plummer's disease) occurs in nodular goiter, the patient has symptoms such as fatigue, weight loss, palpitations, arrhythmia, fear of heat, excessive sweating, and agitation, but there is no localized vascular murmur or tremor in the thyroid gland, and protruding eyes are rare, as is finger tremor. Elderly patients often have atypical symptoms.
3. Whether the patient has a history of radiation, oral medications, family history, and whether the patient is from an endemic goiter area. In general, nodular goiter has a long history, no pressure symptoms, no symptoms of hyperthyroidism, the patient is not concerned about, inadvertently found a thyroid nodule to come to the clinic for examination.
4. In the case of hot nodules or toxic nodules, the patient's age is more than 40-50 years old, and the nodules are of medium hardness, with symptoms of hyperthyroidism, even atrial fibrillation and other arrhythmic manifestations, and there may be pain and even fever if there is hemorrhage. When the nodule is large, compression symptoms may occur, such as dysphonia, dyspnea, chest tightness, shortness of breath and irritating cough.
5. If patients with nodular goiter come from iodine-deficient areas, their thyroid function can be hypothyroid, and heart rate slowing, edema and skin roughness, and anemia can also occur. A small number of patients may also become cancerous. Warm nodules are more common and can be treated with thyroid preparations, and the enlarged gland may shrink. Cold nodules are rare, and those with clinical hypothyroidism can be treated with thyroid preparations, but often require surgery.