Nowadays, as people become more health conscious, medical checkups are becoming more and more common, which brings up a problem that many people, especially women, are nervous and overwhelmed by the discovery of “thyroid nodules” during neck ultrasound. Let me unravel the mystery of thyroid nodules for you.
First of all, what is a thyroid nodule?
The thyroid gland is an important endocrine organ in our body and is located in the front of the neck. It can be a benign tumor, focal thyroiditis, multinodular goiter, thyroid or parathyroid cyst, thyroglossal cyst, single lobe thyroid hypoplasia leading to hyperplasia of the opposite lobe, scarring and hyperplasia of the residual thyroid tissue after surgery or iodine 131 treatment, etc.
So why do you get thyroid nodules?
It has to do with the increased pressure of work and study, long-term anger and depression, and physical factors such as menstruation, pregnancy, childbirth, breastfeeding and other physiological characteristics of women. The detection rate of thyroid nodules in the general population is 3-7% by palpation (touch), while the detection rate can be as high as 20-67% by ultrasound, which means that as many as 7 out of 10 people have thyroid nodules, especially in women and elderly people.
What are the signs of a thyroid nodule?
Most people with thyroid nodules do not have any clinical symptoms. When combined with abnormal thyroid function, symptoms may appear (see my article on this subject). Of course, if a thyroid nodule is pressing on surrounding tissues, it can manifest as hoarseness, a feeling of pressure, and difficulty breathing/swallowing. (That’s why most patients with thyroid nodules are detected by an ultrasound of the thyroid gland during a health checkup)
Can a thyroid nodule be thyroid cancer?
This is the most important question for patients with thyroid nodules. The cancer rate of thyroid nodules is about 5-15%, and the trend is increasing in recent years. The clinical management of benign and malignant thyroid nodules varies significantly in terms of the impact on the patient’s quality of life and the cost of treatment. This is why it becomes necessary to evaluate how to assess the benignity or malignancy of your thyroid nodules.
Thyroid cancer is influenced by age, gender, history of radiation exposure, family history and several other factors, including
1. history of head and neck radiation exposure or radioactive fallout exposure during childhood (this is not expected for most people)
2, history of systemic radiation therapy.
3, someone in the family with thyroid cancer.
4, male.
5, rapid nodule growth.
6. persistent hoarseness and vocal difficulties (we have to exclude the possibility of laryngitis, etc.)
7. Difficulty in swallowing or breathing.
8, irregular shape of the nodule, adhesions with the surrounding tissue fixed.
9, with enlarged lymph nodes in the neck. So if you are one of the many patients with thyroid nodules, you can also refer to the above risk factors and self-assess to be aware of them. Of course, it is important to receive professional medical advice!
What further tests should be done after finding a thyroid nodule?
1. Ultrasound examination of the thyroid gland: Whether the nodule is suspected by palpation or suggested by X-ray, CT, MRI or PET, ultrasound examination of the neck should be performed. Ultrasound of the neck can confirm the existence of “thyroid nodules”, determine the size, number, location, texture, shape, border, envelope, calcification, blood supply and relationship with surrounding tissues, and assess the presence of lymph nodes and their size, shape and structural characteristics in the neck area. Therefore, ultrasound of the neck is a mandatory test for patients with thyroid nodules.
2. Thyroid function measurement (TSH): All patients with thyroid nodules should have their thyroid function, especially TSH level measured.
3.Fine needle aspiration cytology (FNAC) of thyroid gland: the sensitivity of diagnosing thyroid cancer is 83%, the specificity is 92%, the false negative rate is 5%, and the false positive rate is 5%. the results of FNAC can be divided into five categories: undiagnosable or unsatisfactory sampling, benign, uncertain, suspicious malignant and malignant. Simply put, puncture cannot absolutely determine the benignity or malignancy of a thyroid nodule. Therefore, any thyroid nodule >1 cm in diameter may be considered for FNAC examination. FNAC is not recommended routinely for nodules with a diameter of 1 cm (except in special cases).
4. Other tests such as serum Tg and Ct are not routinely recommended.
Treatment of benign thyroid nodules.
Most benign thyroid nodules require only regular follow-up and no specific treatment. In a few cases, surgery, radioiodine therapy or other treatments are available. Chinese medicine can effectively inhibit further enlargement of the nodules or reduce their size by draining the liver and Qi, removing phlegm and eliminating stasis, and achieving good results.
Patients with thyroid nodules should be followed up regularly.
Because of the uncertainty about the benignity and malignancy of thyroid nodules and their high potential for malignancy, regular follow-up is particularly important to keep track of the nodules and to detect the potential for malignancy and provide timely intervention. For most benign thyroid nodules, follow-up can be performed every 6 to 12 months. For suspected malignant or malignant nodules that have not been treated, the follow-up interval can be shortened.
Prognosis of differentiated thyroid cancer.
Ninety percent of malignant thyroid nodules are differentiated thyroid cancer (DTC), and while most patients with DTC have a good prognosis and a low mortality rate, about 30% of DTC patients will develop recurrence or metastasis after surgery, with 2/3 of them occurring within 10 years after surgery, and those with postoperative recurrence and distant metastases have a poor prognosis.