With the strengthening of national health care awareness and the gradual popularization of medical checkups, many people are screened for thyroid nodules (ultrasonography positivity rate is about 20% to 60%). In the thyroid clinic of the Department of Nuclear Medicine, patients are often found to have nodules in the thyroid gland, some very small and some very large, and they are worried about whether the nodules are tumors or not. Are they malignant? Should they be removed surgically? As a doctor, you need to explain to the patient the types of thyroid nodules, how to examine them, their causes, whether they need to be treated, and how to treat and prevent them.
The patient’s biggest concern is whether the thyroid nodule is benign or malignant. There are several tricks to diagnose benign and malignant thyroid nodules: look, feel, test, scan, and cut.
Tactic one: look
For larger nodules, you can see a mass in the neck that moves up and down with the swallowing motion, and you can see it on your own in the mirror. Slightly smaller nodules need to be touched by an experienced physician to be able to feel them, and for very small nodules, most cannot be felt.
Tip 2: Ask
Learn more about the patient’s age, gender, past medical history, family history, history of local irradiation, diet, medication, physiological condition, and geographic area of residence. If the patient is young, male, has been irradiated in the neck, has a family history of thyroid cancer, or has a history of chronic thyroiditis or thyroid cancer, the possibility of malignant thyroid nodules is higher.
Trick 3: Touch
Touch the smooth or rough surface of the thyroid gland, the texture, the size, location, and number of nodules, whether they move with swallowing, and whether there is any pressure pain, etc.
Technique four: test
Intravenous blood tests, T3, T4, FT3, FT4, TSH can be used to understand how the thyroid gland functions, autoantibodies TPOAb, TGAb, TRAb, and tumor markers TG, CEA, and h-CT. We can also find out more about the past life and present life of thyroid nodules and see if there is any root cause of their development.
Tactic 5: Ultrasound
Ultrasound is the most conventional and effective means of examining thyroid nodules. It is sensitive and inexpensive, and can not only detect very small nodules, but can also show you all its details, shape, size, number, location; solid, cystic, reticular, lamellar; whether the edges are intact, whether the shape is regular, whether there is blood flow around or inside, etc. Ultrasound can also be graded to distinguish the benignity and malignancy of nodules, divided into grade 1, grade 2, grade 3, grade 4 and grade 5. Grades 1-3 belong to benign nodules, grade 4a, grade 4b and grade 5 have a high possibility of malignancy.
Trick 6: Sweep
Thyroid nuclear imaging, which is performed about 20 minutes after intravenous injection of a very small amount of drugs containing radioactivity, can show the function and blood flow and metabolism of thyroid nodules and surrounding tissues. The advantage of this test is that it is non-invasive and, more valuable, irreplaceable by other examination methods, a unique technique! The function of those solid nodules seen by ultrasound can all be seen at a glance, no matter how high or low! Hot and cold nodules are two schools of thought, and benign and malignant can be discussed and compared again – pro-tumor imaging without surgery!
The above tests are basically non-invasive tests, if these tests still can’t figure out the benignity and malignancy of the nodules, you have to use the following two types of invasive tests!
Trick 7: Wearing
Fine needle aspiration pathology section, the positive rate is high, but not 100%, with the sampling site accurate or not, the size of the nodule and other factors.
Tactic eight: excision
Pathological section after surgical excision of the nodule is the most accurate and reliable examination. However, if it is not malignant, it is too late to regret cutting the wrong one.
In conclusion, there are many examination methods and steps to diagnose benign and malignant thyroid nodules, and clinicians choose according to the specific needs of each patient.