In recent years, the incidence of thyroid cancer in China has been increasing significantly, and the incidence of thyroid cancer in China has increased nearly 5 times in 10 years. Ultrasound examination of the thyroid gland has become a mandatory part of routine medical checkups.
Question 1: What is a thyroid nodule?
A: Thyroid nodules are scattered lesions caused by abnormal local growth of thyroid cells. These include: thyroid lumps that we can usually palpate (confirmed by thyroid ultrasound). Nodules that are not found on physical examination and are detected by thyroid ultrasound.
Question 2: What is the incidence of thyroid nodules?
A: Thyroid nodules are very common. The detection rate by palpation (clinical examination) in the general population is 3% to 7%, and with the help of high-resolution ultrasound (thyroid ultrasound) the detection rate can be as high as 20% to 76%.
Question 3: What should I do if I find a thyroid nodule?
A: When a thyroid nodule is found, the key question is to clarify the nature of the nodule, that is, whether it is “thyroid cancer” or not, and whether it should be treated surgically. 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 medical costs involved. Therefore, the benignity or malignancy of thyroid nodules needs to be evaluated after they are detected.
Question 4: What are the general clinical manifestations of thyroid nodules?
A: Most patients with thyroid nodules do not show clinical discomfort. When combined with abnormal thyroid function, corresponding clinical manifestations may occur. Some patients have symptoms of pressure such as hoarseness, neck pressure, breathlessness, and difficulty swallowing due to nodule compression of surrounding tissues.
The following medical history and clinical examination findings are risk factors for thyroid cancer: history of childhood head and neck radiation exposure or radioactive dust exposure; history of systemic radiation therapy; presence of DTC, medullary thyroid carcinoma (MTC) or multiple endocrine adenomatosis type 2 (MEN2), familial polyposis, certain thyroid cancer syndromes (such as Cowden syndrome, Carney syndrome, Werner syndrome, and Garder syndrome). The nodules are rapidly growing, with persistent hoarseness, dysphonia, and exclusion of vocal cord lesions (inflammation, polyps, etc.), with dysphagia or dyspnea, irregularly shaped nodules, fixed adhesions to surrounding tissues, and pathologically enlarged lymph nodes in the neck.
Question 5: What blood tests are required after the discovery of thyroid nodules?
A: When thyroid nodules are found, a full set of thyroid function tests are routinely performed, with emphasis on TSH. Studies have shown that patients with thyroid nodules with lower than normal TSH levels have a lower percentage of malignant nodules than those with normal or elevated TSH levels. The use of serum Tg to assess the benignity or malignancy of thyroid nodules is not recommended. The use of serum CT testing in the evaluation of benign and malignant thyroid nodules is not recommended nor is it opposed.
Question 6: For the evaluation of thyroid nodules, which imaging test is best?
A: High-resolution ultrasonography is the preferred method of evaluating thyroid nodules. Most thyroid nodules can be initially evaluated for benignity or malignancy by thyroid ultrasonography. CT and MRI are not superior to ultrasonography in assessing the benignity or malignancy of thyroid nodules.
Question 7: What is the role of FNAB (fine needle aspiration biopsy) in the evaluation of thyroid nodules?
A: FNAB (fine-needle aspiration biopsy) of thyroid nodules can exclude a proportion of patients who do not require surgery, and these patients only need regular outpatient follow-up. The sensitivity of diagnosing thyroid cancer by FNAB is 83% (65%-98%) and the specificity is 92% (72%-100%).
Question 8: What is the procedure of FNAB test in your hospital?
A: You can contact me through the specialist clinic after consultation, or you can contact me by contacting me, or you can scan and add my personal WeChat or public WeChat to contact me. I will determine the time of your puncture depending on my work schedule. Routine blood tests and coagulation are usually required prior to thyroid nodule puncture, and results are usually available within 1 to 3 business days after the puncture. A thyroid nodule puncture does not require hospitalization.
Question 9: What if the clinical examination is considered malignant, or if it is clear that the thyroid nodule is malignant?
A: For thyroid nodules that are considered malignant on clinical examination, FNAB is recommended to clarify the diagnosis. If the nodule is clearly malignant, then it is diagnosed as thyroid cancer and requires surgery.
Question 10: What should I do if I consider benign thyroid nodules?
A: The follow-up interval for most benign thyroid nodules is 6 to 12 months. Suspected malignant nodules that have not received treatment for the time being need a shorter follow-up interval. If a nodule is found to be significantly larger during follow-up, pay special attention to whether it is accompanied by symptoms, signs (such as hoarseness, difficulty in breathing/swallowing, nodule fixation, enlarged lymph nodes in the neck, etc.) and ultrasound signs suggestive of nodule malignancy, at which time it is necessary to promptly consult a doctor and re-evaluate the benignity or malignancy of the thyroid nodule.
Question 11: How long does a hospital stay usually take for surgery with you, Dr. Tao?
A: Our hospital has a virtual bed system for surgical patients. The so-called virtual bed means that all the tests are completed before the patient is admitted to the hospital, and the cost is included in the reimbursement. For benign patients or patients who only undergo “lobe (including bilateral) + central lymph node dissection”, they can be discharged 2 to 3 days after surgery. For patients who undergo “lateral lymph node dissection”, the hospital stay is extended as appropriate.