[Health Introduction] Yes, you read that right! When Chinese people have a medical checkup, 60-70% of them can detect thyroid nodules! Faced with such a high incidence of thyroid nodules, should we treat them or not? Let’s not be afraid, let’s face the reality and talk about the following topic: What should we do when thyroid nodules are found during medical checkups? We know that the thyroid gland is the largest endocrine gland in the body, which synthesizes thyroid hormones, promotes metabolism, and is essential for the development of the brain, bones, and nervous system. As the saying goes, “if you work too much, you’re prone to problems”, especially since most of us can’t work without computers and cell phones, and these radiations play a role in the formation of thyroid nodules. The bad news is that as people pay more attention to health checkups and the development and improvement of ultrasound diagnostic technology, the detection rate of thyroid nodules is indeed getting higher and higher. In our daily work, we often hear things like “more than half of our units have thyroid nodules in their physical exams” or “whoever is normally fine, found thyroid nodules as soon as they had a physical exam, or malignant ones, and had them all cut out”. These words inevitably make people who do not understand the medical knowledge of thyroid nodules to talk about it. However, the not-so-bad news is that although thyroid nodules are found at such a high rate, 85-95% of these nodules are benign nodules, and of the remaining 5-15% of malignant thyroid nodules, more than 90% are highly treatable, low-grade malignant papillary carcinomas, which have a 10-year survival rate of more than 90%. Therefore, it is not terrible to find thyroid nodules, so what should we do? [Learn knowledge, scientific response] 1. If thyroid nodules are found in physical examination, what tests should be done? Among all the imaging means of thyroid examination, ultrasound is the best. Because of its simplicity, low cost, reproducibility and non-invasiveness, it has become the imaging method of choice for thyroid disease. However, ultrasonography also has a shortcoming in that it is somewhat subjective and is greatly influenced by the operating experience of the examining physician and the resolution of the ultrasound instrument. Therefore, we recommend that if you want to have an ultrasound examination of the thyroid gland, it is best to go to a large hospital and find an experienced ultrasonographer. 2. How to identify the “good guys” and “bad guys” from ultrasound images? I often hear people say, “My nodule is rich in blood flow, is it malignant”, “My nodule has calcification, some people say it is bad if it has calcification”, or “My nodule is solid, is it bad? ” and so on. In fact, the ultrasound assessment of a thyroid nodule is based on a comprehensive assessment of several ultrasound features of the nodule, and one cannot rely on one feature alone to make it a “bad” or “good” nodule. The main points to look for in an ultrasound are: the presence of diffuse lesions in the thyroid gland, the morphology, borders, margins, internal echogenicity, calcification, blood flow, elasticity, and metastasis of lymph nodes in the neck. The key information to remember is that the more recognized signs of malignancy on ultrasound are: aspect ratio ≥ 1, irregular morphology, very low echogenicity, microcalcifications (note that they are distinguished from adhesive paper clusters), disturbed blood flow distribution, and cervical lymph node metastases. If the nodule found in your physical examination does not have any of the above points, then there is no need to worry, regular review can be done; if there are 1 or 2 points in the above characteristics, then this nodule should be taken seriously, do a biopsy puncture if you are not sure, one of the puncture specimens can be sent to the pathology department to see the cytology results, and the other one can be sent to the molecular pathology laboratory for genetic testing, if the cytology results are benign. If the cytology result is benign and the genetic test shows positive for B-Raf V600E gene, then the nodule will be treated as malignant nodule, which can prevent the underdiagnosis of malignant nodules caused by unreliable puncture results; if unfortunately, the nodule has 3 or more of the above characteristics, then the nodule has a high possibility of malignancy and needs to be hospitalized for further treatment. 3.After the ultrasound examination, what kind of examination will be done? Of course, it is to check the thyroid function, especially for those patients with diffuse thyroid lesions, such as Hashimoto’s thyroiditis, nodular goiter, etc. We have to clarify whether our thyroid function is normal or not, and whether it is normal or not has a lot to do with our emotions, the function of several organs and treatment measures. 4. How to treat benign thyroid nodules? Benign nodules can be reviewed regularly with ultrasound, save the results of each review for subsequent review and control, and don’t be too concerned if they don’t grow fast. If the nodules grow faster, you can choose minimally invasive thyroid surgery to avoid pressure symptoms caused by overly large nodules; for those with positive antibodies (TpoAb, TgAb, TRAb), it is time to limit the intake of iodized salt and seafood. 5. How to treat malignant thyroid nodules? The pathological types of malignant nodules in the thyroid gland are papillary carcinoma, follicular carcinoma, medullary carcinoma and undifferentiated carcinoma. For papillary carcinoma, if lymph node metastasis occurs, surgery is still recommended. If the nodule is below 1 cm and the lymph nodes are fine, then there is room for observation because its biological behavior is inert, and it is not too late to have surgery even after lymph node metastasis occurs; if the ultrasound report indicates that it is a follicular tumor, then surgery is still recommended. Medullary carcinoma and undifferentiated carcinoma have high risk of malignancy, so it is better to operate as soon as possible.