Putting away the “kill order” for thyroid nodules Some patients with thyroid nodules have the idea that treatment is the same as “killing the nodules”. But in fact, more than 95% of thyroid nodules are benign lesions, and only 2%-5% are malignant lesions. However, although the number is small, if it is specific to the individual, it is 100% of the problem. Therefore, it is imperative to put away the “kill order” for thyroid nodules and to determine the “loyalty” of thyroid nodules through a series of tests. The word “nodules” always makes people feel uncomfortable, as it may be a local inflammation in the smallest case, or a malignant tumor in the largest. Therefore, when faced with the diagnosis of “thyroid nodules” on the medical report, people’s psychology can’t help but go to two extremes. One is that some people are very nervous when they hear the word “nodule”, afraid that they have an incurable disease, to immediately kill the “nodule” without amnesty; while others think that nodules are no big deal, neither painful nor itchy, let it go. In fact, for thyroid nodules, not only the patient’s mind is in a state of flux, but also the doctor’s headache. Even highly experienced specialists are unable to give a clear diagnosis without a comprehensive examination. Behind thyroid nodules may be hyperplastic goiter (diffuse and nodular), toxic nodular goiter, thyroid adenoma, thyroid cyst, focal thyroiditis, differentiated thyroid cancer (papillary thyroid cancer, follicular thyroid cancer), undifferentiated thyroid cancer, and medullary carcinoma. The list of disease names is so long that it makes the public more nervous if they lack medical knowledge. The good thing is that clinical statistics give people great comfort – more than 95% of thyroid nodules are benign lesions and only 2-5% are malignant lesions. Most patients’ worries are superfluous. However, although the number of 2%-5% is small, if it is specific to individuals, it is 100% of the problem, and with the increasing prevalence of routine medical checkups and ultrasound, the detection of thyroid nodules is increasing. Even for malignant lesions, the prognosis of thyroid cancer is far better than other tumors. Therefore, it is important for patients and doctors to have the right attitude on how to treat thyroid nodules. Therefore, Prof. Qu Shen reminds patients that they should not go to extremes in their thinking about thyroid nodules. Patients should carefully identify and not panic, and it is imperative to determine the “loyalty” of thyroid nodules through a series of tests. The neck palpation is a routine checkup, but this seems to be a simple “touch”, but some people feel the problem – the physical examination report has more “thyroid nodules” five The report has five big words “thyroid nodules”. If you upgrade your physical examination program and do an additional thyroid ultrasound, I believe more people will become a “nodule family”. The first thing you need to do is to get a good idea of what you’re doing. Therefore, patients with nodules should carefully recall information such as whether anyone in their family has ever had a malignant thyroid tumor, in order to provide comprehensive information to their doctors. Of course, these are just background information, and the next step will depend on the doctor’s hand and clinical experience. The doctor will stand behind the patient and carefully touch the nodule with the index, middle, ring and little fingers of both hands. Usually, if multiple nodules are touched, it is more likely that the lesion is benign; if there is only one nodule with a hard texture, uneven surface, and less activity when swallowing, it is highly suspected that it is a malignant lesion. The situation is even more suspicious if enlarged lymph nodes are also felt around the node. Although an experienced doctor can make a preliminary determination of the nature of the nodule by touch alone, the final diagnosis has to be made with the help of various modern testing instruments. Ultrasound is the imaging tool of choice because of the superficial location of the thyroid gland and the fact that it is a substantial organ that does not contain gas, so ultrasound can clearly visualize tiny nodules as small as 2 mm in diameter. If tiny calcifications are found in the nodules, local hypoechogenicity, and a richer blood supply between the nodules, these indicate that the nodules are growing faster, suggesting that the lesions are more likely to be malignant and further examination should be done. Professor Qu tells us that ultrasound is the first choice to determine the nature of thyroid nodules, but this does not mean that CT and MRI are meaningless. the higher spatial resolution of CT and MRI has a greater advantage in pinpointing the nodules and their relationship to adjacent tissues (such as important blood vessels, nerves, etc.) and is necessary for patients who need surgery. After the initial identification of good and bad thyroid nodules, what should be the next step? Do you want to operate immediately? Prof. Qu Shen points out that to be on the safe side, we can use the last resort – puncture cytology. The fine needle aspiration cytology biopsy of thyroid nodules has become a routine in the treatment of thyroid nodules at home and abroad and is widely carried out in large hospitals at home and abroad, it can detect more than 90% of malignant cells and is more accurate, but this technology needs to be further standardized, puncture and cytology testing need to be carried out by experienced specialists, if necessary, under the guidance of B ultrasound, now many large hospitals in Shanghai have the ability and technology to do this Now many large hospitals in Shanghai have the ability and technology to do this, which allows most patients to exchange one bite from a mosquito (puncture) for one bite from a tiger (surgery). The Shanghai Endocrinology Group is developing specifications for fine needle puncture of thyroid nodules, which I believe will be a boon to most patients. Learn to make peace with nodules If cancer cells are not detected in the punctured cells, it does not completely exclude the possibility of malignant nodules, and perhaps no malignant cells have been punctured. Therefore, even negative patients should be followed up regularly, with ultrasound examinations every six months to a year, to see if the nodules have increased in size or changed in nature within a short period of time, and if there are accompanying symptoms. If the size increases by more than 15-20%, local discomfort, pain or hoarseness, or enlarged lymph nodes occur, surgery should be actively considered. Even if the nodule is confirmed to be malignant, there is no need to talk about cancer. The common papillary carcinoma has a cure rate of 90% after surgery, and it does not affect the quality of life and life expectancy too much. Even for benign nodules, some patients may have psychological stress, sleepless at night and live in fear. In this case, surgery can also be performed to relieve the patient’s worries. The current thyroid nodule surgery is very mature and advanced, and will not cause adverse consequences. We caution that the correct attitude towards thyroid nodules is to try to live peacefully with them as they come, firstly to maintain a good state of mind, secondly to do the necessary examinations and analysis of the condition, to follow the advice of an experienced doctor and, if necessary, to observe their dynamic changes as a necessary process and the best means of differential diagnosis. If necessary, surgical treatment is feasible, and after surgery, sometimes necessary isotope therapy and thyroid hormone replacement therapy should be performed, so that the quality of life and life expectancy of a normal person can be fully achieved. In conclusion, optimism, a healthy lifestyle and a good living environment are the best preventive and therapeutic tools to prevent various diseases, and the forthcoming implementation of a sub-regional selective iodization program is also a reasonable and effective public health initiative to prevent thyroid diseases.