There are more and more people around who have thyroid nodules. With the increasing technology of screening devices, 60-70% of Chinese people can detect thyroid nodules when the resolution of ultrasound reaches 1mm. This means that 2 out of 3 Chinese people have nodules. This makes it appear that thyroid nodules don’t even look like a disease anymore.
We often hear about people who go for medical checkups and find out that they have thyroid nodules, or that they have multiple nodules. Whoever has a nodule in the thyroid gland that was detected during a physical examination at work has to undergo surgery. Yes, thyroid nodules are so painless and insidious. More and more people are suffering from thyroid nodules, does it matter or not?
Of thyroid nodules, 85-95% are benign nodules. Of the malignant thyroid nodules, more than 90% are again low-grade malignant.
1. Is ultrasound or CT or MRI better to check the thyroid?
Ultrasound is the most accurate imaging test for the thyroid, but CT and MRI are not as good. Unless you want to see the details of the surrounding tissues, you can have another MRI.
2. How do I look at thyroid ultrasound results?
Ultrasound looks at 3 points: in order of weight: border – calcification – blood flow.
The following are some of the common descriptions on the report.
1. “Poorly defined borders”.
Benign nodules generally have clear borders, and malignant ones because there is invasion of surrounding tissues. The borders can be unclear. However, inflammatory lesions, which are not malignant because they can be exudative, also have unclear borders.
2. “Dotted strong echogenicity”.
It can be seen in two cases: one is colloid, which is a sign of benign. One is calcification, malignant generally have calcification, and mostly microcalcifications; but, calcification is not necessarily malignant.
3. “Internal blood flow disturbance”.
Blood flow is divided into internal blood flow and external blood flow. Malignant ones have more internal blood flow disturbances.
(1) unclear boundary.
(2) Microcalcifications.
(4) Internal blood flow disorder.
These 3 points, if there is no point, do not worry, the possibility of benign is large. If you have 1-2 points, do a puncture if you are not sure, and if you have all 3 points, there is a high possibility of malignancy.
To identify benign and malignant nodules, in addition to the above three points, we can also look at: whether there are adhesions with surrounding tissues, whether there are lymph node metastases, whether there is rapid growth in a short period of time, the growth pattern (malignant nodules with longitudinal growth are more likely), the size of the nodule (surgery is also recommended for nodules >50px), and so on.
It is worth noting that the experience of the ultrasound doctor and the resolution of the machine may have a great impact on the judgment of the ultrasound results, and the ultrasound results are a particularly important reference for determining the nature of the nodule, so it is recommended that those who need to clearly identify the nature of the nodule can go to a large hospital to find an experienced ultrasound doctor to do the examination.
3. What about benign nodules?
High TSH can cause thyroid nodules to grow, so people with nodules require low TSH, between 0.5 and 1.0.
TSH has a feedback relationship with T3 and T4. High TSH can promote higher T3 and T4 levels; and higher T3 and T4 will in turn feed back to make TSH levels lower.
People with nodules should lower their TSH levels appropriately. What are the methods? The first choice is dietary therapy.
What foods shrink nodules?
Seafood. Yes, you read that right, seafood. People with benign thyroid nodules eat more seafood, not seafood as people think they can’t eat if they have nodules, and if TSH is >2.5, they need to take Eugenol to control the nodules.
What foods will grow nodules?
Cruciferous foods: cabbage, white radish, etc., because it can make T3, T4 synthesis is blocked, thus raising TSH, so it is long nodules, eat less, but is not contraindicated, after all, you can not eat too much a day.
In addition, it is worth noting that patients with thyroid nodules, as long as TpoAb, TgAb, TRAb these antibodies are negative, no need to avoid iodine; if TpoAb, TgAb, TRAb positive, it is necessary to eat less kelp, nori type high iodine food.
Benign nodules can be reviewed regularly by ultrasound. It is normal for the size of the nodule described on the result report to deviate by a few millimeters due to the difference in the ultrasound probe section each time. Although benign nodules can be treated with dietary therapy, there are no measures that can significantly reduce the size of nodules. There is no need to be demanding, as benign nodules need not be too concerned at all, as long as they are not significantly larger, do not hurt, and do not affect thyroid function.
4. Talking about iodine in food
If the iodine in table salt is counted 1 times, then
(1) seafood such as kelp, nori and seaweed is 1,000 times.
(2) Shellfish and crabs are 100 times more.
(3) fish, shrimp, squid and squid are 10 times more.
(4) Chicken essence is 700 times more.
5. Thyroid cancer.
Malignant tumors of thyroid gland are classified into papillary carcinoma, follicular carcinoma, medullary carcinoma, undifferentiated carcinoma, lymphoma and metastatic carcinoma according to pathological types. Among them, low-grade malignant ones, including papillary carcinoma and follicular carcinoma, account for about 92%. The three-year survival rate is over 90%. This type of low-grade malignant tumor tissue can take in iodine and even if there is metastasis, it can be killed with isotopes (radioactive iodine) regardless of the part of the body to which it has metastasized.
Follicular tumor and follicular carcinoma cannot be distinguished by fine needle aspiration method, and only by biopsy can we observe whether they break through the envelope and thus distinguish them. Moreover, even in the case of follicular tumors, there is no way to predict when they will break through the envelope. Therefore, as long as it is a follicular tumor, surgery is recommended regardless of whether it is a tumor or a cancer.
There has been controversy about the need for surgery for papillary carcinoma. One side believes that knowing the pathological result is malignant, it is easy to have long-term psychological burden if not operated; and if metastasis occurs, it needs to be treated with isotope, and surgery is still necessary before treatment. So they believe that as long as it is determined to be malignant, surgery must be performed. On the other hand, the other side believes that it is over-medication to operate one thyroid cancer when one is found. Because according to a Japanese study, papillary thyroid cancer has a 5-year metastasis rate of 1% and a 10-year metastasis rate of 5%, and no post-operative re-metastasis has been observed to occur when you go for surgery after metastasis is found. So surgery does not need to be so aggressive and cause over-medication. And there is a controversy about whether the surgery should be total or partial resection.
The standard treatment process for differentiated thyroid cancer: total or near-total surgical excision – radioactive iodine therapy for residual lesion removal – levothyroxine T4 drug for TSH suppression therapy for more than 10 years – whole body scan and Tg examination within 1 year. Postoperative TSH suppression therapy: for those with metastasis, TSH should be controlled at 0.1-0.5. For those without metastasis, TSH should be controlled at 0.5-1.0. After surgery, in addition to checking thyroid function, CEA and other tumor markers should be followed up, and blood calcium and parathyroid hormone (PTH) levels should be checked at least once to clarify whether the parathyroid glands, which are easily damaged during surgery, have been affected. The parathyroid glands are involved in the regulation of blood calcium and phosphorus levels.