Thyroid nodules are very common in clinical practice. The prevalence of thyroid nodules found by palpation is 3% to 7% in the general population, and even more nodules are detected by ultrasound. The vast majority of patients with thyroid nodules have no clinical symptoms and are often detected by physical examination or by their own occasional touch.
Thyroid nodules are classified as benign or malignant, with benign nodules accounting for the majority and malignant nodules accounting for only about 1-5%. Depending on the cause of the nodules, they can be classified as: nodular goiter, inflammatory nodules, toxic nodular goiter, thyroid cyst, benign thyroid adenoma and thyroid cancer.
Patients are particularly concerned about whether thyroid nodules are malignant. Since benign and malignant thyroid nodules do not have characteristic clinical manifestations, a variety of indicators need to be considered in the differential diagnosis.
Clinical evidence suggesting a malignant thyroid nodule includes.
① Age less than 20 years or more than 70 years;
② Family history of thyroid cancer;
③ History of neck radiation exposure during childhood;
④ Male;
⑤ Rapidly growing nodule with a diameter of more than 50px;
(6) Persistent hoarseness, dysphonia, dysphagia and dyspnea;
⑦Nodules with hard texture, irregular surface or fixed nodules;
(viii) enlarged lymph nodes in the neck.
Suggestive of benign thyroid nodules, clinical evidence includes.
(i) clinical manifestations of hypo- or hyperthyroidism;
② Family history of benign thyroid disease;
(3) Pain or pressure in the thyroid nodule. Benign nodules are caused by nodular goiter, benign thyroid adenoma, cysts (degenerative adenoma and old hemorrhage with cystic changes, congenital thyroglossal cyst), acute suppurative thyroiditis, subacute thyroiditis, and Hashimoto’s thyroiditis.
Ancillary tests are important in identifying the benignity and malignancy of thyroid nodules. The main ones are as follows.
1, thyroid nuclear imaging can evaluate the function of the nodule and has important value in determining the nature of the nodule. The majority (85-90%) of thyroid nodules are non-functional cool nodules or cold nodules, of which about 10-20% are malignant, while 10-15% are functional warm nodules and hot nodules, of which only 1% are malignant.
2, ultrasonography suggests evidence of malignant nodules.
(1) Irregular thyroid nodules with poorly defined borders, solid or cystic
(2) microcalcifications within the nodule.
(3) abundant blood flow in the nodule. All three are highly specific for suggesting malignant lesions, but one feature alone is not sufficient to diagnose malignant lesions. Nodules with enlarged lymph nodes in the neck also suggest malignancy.
3. Laboratory tests: All patients with thyroid nodules should have their nail function checked. The majority of patients with malignant thyroid tumors have normal thyroid function; thyroid nodules caused by Hashimoto’s thyroiditis are detected with elevated serum thyroid peroxidase antibody (TPOAb) and thyroglobulin antibody (TgAb), and elevated TSH. Significantly elevated serum calcitonin suggests medullary carcinoma of the thyroid nodule.
4. Fine needle aspiration cytology is the most reliable and valuable diagnostic method to distinguish benign and malignant nodules.
Treatment of thyroid nodules
1.Surgery is preferred for malignant thyroid nodules.
The majority of patients with benign lesions do not require treatment, and follow-up is the main tool, with a review every 6 to 12 months. A few benign lesions require oral eugenol therapy, which can shrink the nodules. However, it should be noted that long-term use can lead to osteoporosis and atrial fibrillation.
3.Thyroid cysts or nodules combined with cystic changes can be considered for ultrasound-guided percutaneous alcohol injection treatment.
4. 131 iodine treatment is especially suitable for autonomic high-functioning adenoma and toxic nodular goiter.