Thyroid nodules are a very common condition, especially among middle-aged women. Thyroid nodules are divided into two categories, benign and malignant, with benign nodules accounting for the majority and malignant nodules for less than 1%. A variety of clinical thyroid disorders, such as thyroid degeneration, inflammation, autoimmunity, and neoplasia, can manifest as nodules. Thyroid nodules can be solitary or multiple. Multiple nodules have a higher incidence than solitary nodules, but solitary nodules have a higher incidence of thyroid cancer.
1. Clinical manifestations
(1) Nodular goiter
It is more common in middle-aged women. In the absence of thyroid hormone in the body, the pituitary gland secretes more TSH, and under the long-term stimulation of this increased TSH, the thyroid gland is repeatedly or continuously proliferated, resulting in uneven enlargement and nodule-like changes. There may be bleeding, cystic changes and calcifications within the nodules. The size of the nodules can range from a few millimeters to several centimeters. The main clinical manifestation is an enlarged thyroid gland with multiple nodules of varying sizes on palpation. Patients have few clinical symptoms, usually only anterior neck discomfort, and thyroid function tests are mostly normal.
(2) Nodular toxic goiter
The disease starts slowly and often occurs in patients who have had nodular goiter for many years, mostly at the age of 40-50 years or older, and is more common in women. When the thyroid gland is palpated, a smooth round or oval nodule with clear borders and a hard texture can be found, which moves up and down with swallowing. Thyroid function tests may show elevated thyroid hormones in the blood. If the nodule is functionally autonomous, a nuclear scan may show a “hot nodule”.
(3) Inflammatory nodules
The former is mainly subacute thyroiditis caused by viral infection, while other infections are rare. The latter is mainly caused by autoimmune thyroiditis, mostly seen in middle-aged and young women, the patient’s conscious symptoms are less, the examination can find multiple or single nodules, hard and tough texture, less pressure pain, thyroid function tests show thyroglobulin antibodies and Thyroid function tests often show strong positivity for thyroglobulin and thyroid microsomal antibodies.
(4) Thyroid cysts
The majority of cysts are formed by degenerative changes in the nodules or adenomas of the thyroid gland, containing blood or slightly mixed fluid, with clear borders and a hard texture, usually without tenderness. In a few patients, the cyst is caused by a congenital thyroglossal cyst or a remnant of the fourth gill slit.
(5) Thyroid tumors
These include benign thyroid tumors, thyroid cancer and metastatic cancer.
2. Auxiliary examination
(1) Ultrasound examination of thyroid gland
A single solid nodule has a higher possibility of malignancy, while a mixed nodule also has the possibility of malignancy, while a simple cystic nodule has a lower chance of malignancy.
(2) Thyroid nuclide scan
The nodules are classified as “hot nodules” or “cold nodules” according to their ability to take up radionuclides. “Hot nodules are functionally autonomous thyroid nodules and are almost always benign. “Cold nodules may be cancerous, but multiple cold nodules are mostly benign adenomas or nodules, and if there is bleeding or cystic changes in the nodules, they may also appear as “cold nodules”.
(3) X-ray examination of the neck
Small or sand-like calcifications on the nodules may be the sand bodies of papillary carcinoma. Large, irregular calcifications can be seen in degenerative nodular goiter or thyroid cancer. If infiltration or deformation is seen in the tracheal image, it is suggestive of a malignant lesion.
(4) Thyroid fine needle aspiration cytology
This test is simple and safe and is very helpful in identifying benign and malignant nodules.
(5) Thyroid function measurement
The function of the thyroid gland can be normal, hyperactive or hypothyroid in chronic lymphocytic thyroiditis. Most of the thyroid nodules caused by the rest of the lesions are normal in function.
3.Treatment principles
Multiple nodules
(1) If the thyroid function is normal or hypothyroid, you can try small doses of thyroid hormone first. If the nodules are more obvious after treatment, surgery should be considered.
(2) Toxic thyroid nodules should be surgically removed after hyperthyroidism has been controlled.
Single nodule
(1) Hot nodules: Those with manifestations of hyperthyroidism may be considered for surgical treatment.
(2) Cold nodules: children or young men, especially those with a history of past neck radiation therapy or nodules that are hard and immobile, with palpable enlarged lymph nodes in the neck, should be treated directly with surgery; newly developed nodules with a faster growth rate should be considered for surgery.