With the changes in lifestyle, the improvement of people's health awareness, and the refinement of examination methods, the detection rate of thyroid nodules has increased significantly. So what exactly are these nodules? Do they need surgical removal? Xu Jiongyuan, director of the third medical department of Guangzhou Fuda Cancer Hospital, shared with everyone about the diagnosis and treatment of thyroid nodules.
01Where is the thyroid gland and what functions does it have?
The thyroid gland is located below the laryngeal prominence and looks like a butterfly. It is divided into two lateral lobes, connected by an isthmus in the middle. It is the largest endocrine gland in the human body. The thyroid hormone it’s secretes plays a role in regulating the body's growth and development, promoting the body's metabolism, and improving the central nervous system. It plays an important role in increasing the excitability and maintaining the functions of various organs in the body. Too high or too low of thyroid hormone can cause harm to the human body.
02What are thyroid nodules?
Thyroid nodules are a general term for tumors in the thyroid gland. They are masses formed by abnormal proliferation of thyroid cells. They are more common in women than men (4:1), and more common in middle-aged and elderly people than in adolescents. They can be single or multiple. Clinically divided into Cystic nodules, hyperplastic nodules, inflammatory nodules and neoplastic nodules.
Clinically, the vast majority of thyroid nodules are benign, with only a small proportion (5%) of malignant nodules, and most of them belong to the less malignant differentiated thyroid cancer (DTC), which is mostly less aggressive than other malignant tumors. The tumors are much smaller, patient survival rates are high, and the overall prognosis is good. Therefore, although we must pay attention to thyroid nodules, we do not need to be afraid.
03Why do thyroid nodules develop?
The cause of thyroid nodules is relatively complex and is generally believed to be related to the following factors:
Exposure to radiation (especially to the head and neck during childhood);
Inadequate or excessive iodine intake;
Autoimmune disorders (such as Hashimoto's thyroiditis, etc.);
Family inheritance (except for familial medullary cancer, there is currently no evidence that other thyroid cancers are hereditary, and only about 7% of patients with papillary thyroid cancer may have a family hereditary tendency.);
Inflammatory lesions caused by viral or bacterial infection (such as subacute thyroiditis, etc.);
Anxiety, depression or excessive mental stress.
All of the above factors may affect the occurrence and development of thyroid nodules.
04What are the dangers of thyroid nodules?
Most thyroid nodules have no symptoms. Whether they affect health depends on the pathological nature, size, growth pattern and functional status of the nodules.
The so-called pathological properties are what people often call benign or malignant. Malignant will harm our health, while benign will at most cause some uncomfortable symptoms, such as inflammatory nodules - subacute thyroiditis will cause fever and neck pain.
If the nodule is too large or grows invasively, it may compress the esophagus, trachea, and nerves, causing corresponding symptoms such as difficulty swallowing, choking, difficulty breathing, and hoarseness.
If the nodule can secrete thyroid hormone autonomously, it will cause symptoms of hyperthyroidism such as palpitation, heat intolerance, sweating, hunger, and weight loss; if it is combined with hypothyroidism, it may cause chills, edema, memory loss, etc. Performance: If the thyroid nodule undergoes necrosis and bleeding, the neck mass will suddenly increase in size and may cause pain. Of course, the vast majority of benign nodules do not cause any subjective discomfort and can coexist with you peacefully.
Related inspections——
✅Palpation is one of the easiest and most convenient methods for thyroid nodules. However, palpation can only detect larger or superficial nodules, which has certain limitations;
✅Ultrasound examination can not only provide important information such as the size, texture, boundary, calcification and blood flow signal of nodules, but is also non-invasive, fast and inexpensive. Therefore, it can be used as a basis for diagnosis of nodules and for follow-up of nodules. The growth of nodes;
✅For suspected malignant nodules, fine-needle aspiration (FNA) is also required. FNA is the standard for confirming the nature of thyroid nodules. So far, fine-needle aspiration of thyroid nodules has been used, and there have been no reports of tumors growing in the needle tract. Therefore, there is no need to worry that the puncture will cause tumor spread.
In addition, some necessary biochemical tests should be done after nodules are discovered, including measurement of thyroid function, autoantibodies and tumor markers.
05Which nodules are considered malignant?
The age at onset of disease is younger;
male patient;
solitary nodule;
The nuclide scan showed "cold nodules";
In infancy and early childhood, there has been a history of radiation to the head, neck or upper chest (such as CT, X-ray examination or radiation therapy);
The nodule has recently increased significantly;
The texture of the nodules is as hard as stone;
X-ray films show fine sand-like or punctate calcifications (suggesting papillary carcinoma), or flake-like homogeneous calcifications (suggesting medullary carcinoma).
Sonographers stratify the malignant risk of thyroid nodules according to the TI-RADS grading standards. The higher the grade, the greater the possibility of malignancy of the nodules.
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How are thyroid nodules treated?
Not all thyroid nodules require treatment, and some benign nodules only need follow-up observation. The current treatment methods mainly include the following: drugs, ablation, surgery, and absolute alcohol injection. Of course, the selection of treatment plan should be adjusted according to the specific situation and formulated after full communication with the patient.
✅Thyroxine suppression therapy
Nodules that are between surgery and follow-up, such as nodules that are small in size and less than 2cm in diameter;
For nodules that are originally small but tend to increase during follow-up.
It is worth noting that patients with existing tachycardia, tachyarrhythmia, coronary heart disease, hypertension, severe diabetes, osteoporosis, insomnia, menopausal women, elderly patients, and low TSH levels are not suitable for thyroxine suppression therapy.
✅Ablation treatment
Ultrasound examination showed benign, and fine-needle aspiration biopsy cytology and pathology or preoperative histology and biopsy pathology confirmed it to be a benign nodule;
No history of childhood radiation therapy;
Be fully informed and request minimally invasive treatment, or refuse surgery and clinical observation;
Autonomous functional nodules cause symptoms of hyperthyroidism;
The patient has subjective symptoms that are obviously related to the nodule, or affects the appearance, and requires treatment;
Recurrent nodules remain after surgery, or the nodule size increases significantly.
✅Surgical treatment
Not all benign nodules do not require surgery. A few patients have larger nodules. Surgery should be considered if the following conditions occur: ① Compressing the trachea and affecting breathing; ② Affecting the appearance of the neck; ③ Falling into the chest cavity and developing into retrosternal goiter, etc.