Classification of thyroid tumors and postoperative follow-up and medication considerations

  Thyroid tumors are common tumors of the head and neck. Among them, thyroid adenoma (TA) is the most common benign thyroid tumor, and the pathology is divided into follicular thyroid adenoma (FTA) and papillary thyroid adenoma (PTA), The former is the most common, accounting for about 70%-80% of thyroid adenomas, while the latter is relatively uncommon and should be differentiated from papillary adenoma. The adenoma is often surrounded by an intact envelope. The cause is unknown and may be related to gender, genetic factors, radiation exposure (mainly external radiation), and chronic TSH overstimulation. Nodular goiter (NG) may be caused by a deficiency of iodine in the diet or a deficiency in the enzymes that synthesize thyroid hormones. Most of the nodules are multinodular, while a few are single nodules. Most of the nodules are gelatinous, with some forming cysts due to hemorrhage and necrosis; in long-standing cases, there may be more fibrosis or calcification in some areas, or even ossification. Thyroid bleeding often has a history of sudden pain and cyst-like masses within the gland; those with gelatinous nodules have a hard texture; those with calcification or ossification have a hard texture. Subacute thyroiditis is also known as De Quervain’s thyroiditis or giant cell thyroiditis. The size of the nodule depends on the extent of the lesion and is often hard in texture. It is often secondary to an upper respiratory infection and has a typical medical history, including an acute onset of fever, sore throat, and significant thyroid pain and tenderness, often spreading to the affected ear and temporo-occipital region. There is often an elevated temperature and increased blood sedimentation. In the acute phase, the thyroid gland has a reduced 131I uptake rate and is often “cold nodular”, but serum T3 and T4 are elevated and the basal metabolic rate is slightly increased, which helps in the diagnosis.  Thyroid carcinoma is the most common type of malignant tumor in the thyroid gland, and a very small number of malignant lymphomas and metastases can be present. Except for medullary carcinoma, most thyroid cancers originate from follicular epithelial cells. The incidence of thyroid cancer is related to region, race and gender. The incidence of thyroid cancer in the United States is higher. According to statistics, the annual incidence of thyroid cancer in the United States increased from 3.6 per 100,000 to 8.7 per 100,000 between 1973 and 2002, which is approximately a 2.4-fold increase (p<0.001), and the trend is still increasing year by year. The incidence of thyroid cancer in the country is low, of which about 0.8-0.9 per 100,000 in men and 2.0-2.2 per 100,000 in women, according to statistics.  The pathogenesis of thyroid malignancy is still unclear, but its related factors include many aspects, mainly the following categories: 1, oncogenes and growth factors: recent studies have shown that the occurrence of many animal and human tumors is related to the overexpression, mutation or deletion of the original oncogene sequence.  2.Ionizing radiation: It has been identified that external radiation to the head and neck is an important carcinogenic factor of the thyroid gland.  Genetic factors: Some medullary thyroid cancers are autosomal dominant; in some thyroid cancer patients, family history can be inquired.  4.Iodine deficiency: As early as in the early 20th century, the idea that iodine deficiency can lead to thyroid tumors was already proposed.  Estrogen: Studies in recent years suggest that estrogen can affect the growth of thyroid gland mainly by prompting the pituitary gland to release TSH, because when the plasma level of estrogen increases, the TSH level also increases. It is not clear whether estrogen acts directly on the thyroid gland.