A. Diagnosed thyroid adenoma must be treated, surgery is the first choice Zhang Yan, Department of Thyroid Neck Tumor, Tianjin Cancer Hospital
1. Do all thyroid adenomas detected need treatment? What are the treatment methods?
A: Not all thyroid adenomas need treatment. Those with small tumors and no pressure symptoms can check ultrasound regularly to understand the changes of tumors; those with large tumors but no pressure symptoms can try Chinese medicine, but Chinese medicine cannot make tumors disappear, and the effect varies from person to person; those with large tumors and pressure symptoms can consider surgery, but they may take medicine for a long time after surgery, and those with multiple tumors may have recurrence after surgery.
2. Can medicine alone stop the growth of adenoma and avoid surgery? Can it be cured?
A: It is impossible to make the tumor disappear by taking medicine alone. Some patients can shrink the tumor, some patients can control the growth of tumor and avoid surgery, while some patients have poor tumor control effect and may still have surgery.
3. What kind of thyroid adenoma needs surgery?
A: Thyroid adenoma with pressure symptoms.
4. How effective is the treatment by traditional surgery? Can removal of the adenoma cure it?
A: Traditional surgery can remove the tumor, but it is possible to take medication for a long time after surgery, and there is a possibility of recurrence after surgery for multiple tumors and recurrence for single tumors.
5. What is minimally invasive thyroid surgery? How is the treatment effect?
Answer:Minimally invasive thyroid surgery generally refers to lumpectomy, and the treatment effect is similar to traditional surgery (must be operated by experienced physicians), now some hospitals also call radiofrequency ablation as minimally invasive surgery.
6. What are the advantages and disadvantages of minimally invasive surgery compared to traditional surgery? What kind of patients are they suitable for? Which patients are not suitable?
A: The advantage of lumpectomy is that the incision is concealed or small, which is suitable for patients with high cosmetic requirements, but the surgery is not less invasive. Traditional surgery has the advantage of adequate exposure and is suitable for patients with large tumors and close relationship with surrounding tissues, but it leaves scars after surgery, especially for patients with keloid scars.
7. Is radiofrequency ablation feasible for treating thyroid adenoma? How is the treatment effect?
A: Radiofrequency ablation is feasible for the treatment of thyroid adenoma, and it is effective for patients with single tumor and moderate size.
8. Is iodine 131 treatment for thyroid adenoma feasible? What kind of patients are suitable for iodine 131 treatment? How effective is it? What are the contraindications?
A: Iodine 131 therapy is not suitable for thyroid adenoma. Iodine 131 therapy is suitable after total thyroidectomy for hyperthyroidism or advanced thyroid cancer.
9. How should scar patients choose their treatment modality?
A: There is no big difference with general patients, and treatment should be chosen according to the condition.
10. Is it necessary to treat thyroid adenoma detected in pregnant women? How to choose the treatment? At which stage of pregnancy is treatment usually chosen?
A: Generally, treatment is not needed. You can review ultrasound during pregnancy to observe the change of tumor, and then visit the doctor after delivery to decide whether to treat it.
There is a difference between pre- and post-operative medication for thyroid adenoma
1. Do patients with thyroid adenoma need to take medication before surgery? If so, which medications should be taken? What is the purpose?
A: Patients with thyroid adenoma generally do not need to take medication before surgery, but they need to take medication for other diseases (especially medical diseases that affect surgery) as appropriate.
2. If iodine is taken before surgery, how is the dose calculated? What are the precautions?
A: Pre-operative iodine may be required for hyperthyroidism, and the dose should be taken according to the endocrinologist’s prescription.
3. If you need to take antithyroid drugs before surgery, how should you choose thioureas and imidazoles? How is the dose calculated? What are the precautions?
A: Take them according to the endocrinologist’s prescription.
4. What medications should be taken after surgery? How to determine the medication plan?
A: It is possible to take levothyroxine for a long time after surgery, depending on the condition and scope of surgery.
5. What are the precautions when taking the medication? Do I have to take the medication for life? When can I stop taking it?
A: Levothyroxine should be taken daily in the morning on an empty stomach. It is possible to take the medication for life.
6 What are the side effects of taking thyroxine preparations? Does it have any effect on the body when taken for a long time?
A: The most important side effects are cardiovascular side effects and osteoporosis.
7. In addition to thyroxine preparations, do I need to take other drugs for a long time after surgery?
A: Generally, there is no need to take other drugs for a long time.
3. Things that should be noted before and after thyroid tumor surgery
1. Why do I need laryngoscopy before surgery? What other things should I pay attention to before surgery?
A: Laryngoscopy is done before surgery to understand the activity of vocal cords and whether the recurrent laryngeal nerve is invaded or not; if the tumor invasion is serious, it may also invade the trachea and so on. Before surgery, general examination should be performed to understand the patient’s physical condition, and ultrasound and CT examination should be performed to understand the scope of tumor.
2. How long can I drink and eat after surgery? How should I deal with the cough?
A: Generally, patients can drink and eat on the next day after surgery, and coughing can be treated with cough suppressant and phlegm-relieving drugs.
3. Patients reflect that they speak normally after surgery, but they feel more strained, why?
A: This is because the postoperative wound edema scar and other factors caused by the laryngeal nerve function is weakened, will slowly improve, but need time, do not be anxious.
4. Why do some patients have hoarseness after surgery? What should I do after that?
One is that some patients have a thin laryngeal nerve or heavy tumor invasion, and the laryngeal nerve function is weakened due to postoperative wound edema and scarring, which can be recovered slowly by physical therapy and appropriate use of neurological nutrients.
5. Although there is no hoarseness after thyroid surgery, why is there a change in the tone of pronunciation and difficulty in producing high notes?
A: The laryngeal nerve function is weakened due to postoperative wound scar and other factors, which will slowly improve, but it takes time.
6. What is thyroid crisis? How to avoid thyroid crisis?
A: Thyroid crisis is a very serious condition that occurs when thyroid tumor is combined with hyperthyroidism and the hyperthyroidism is not well controlled.
7. How long do I have to stay in the hospital? How long does it take to return to normal?
A: The length of hospital stay depends on the condition, patient’s physical condition, the scope of surgery and post-operative recovery. Generally, it takes 7-10 days for central zone debridement and about 15 days for radical thyroid cancer surgery. After the operation, the patient will gradually recover and the scar reaction around the wound will take about six months to gradually reduce, but it is impossible for the operated area to completely return to normal after the operation.
8. Besides medication, what do I need to pay attention to after surgery? For example, diet, etc.
Some patients need to restrict high-fat and high-protein diet. At the same time, attention should be paid to the wound pressure dressing.
4. Guidelines for patients with thyroid adenoma
1. Which department should patients with suspected thyroid adenoma visit first? What information do I need to prepare?
A: Generally, patients should go to the head and neck department of cancer hospital, while general hospitals can go to the thyroid breast surgery or general surgery department, and they need to bring physical examination report or previous ultrasound and other examination information.
2. What tests are usually done at the first consultation? Are they done on the same day of the visit? Can the results be obtained on the same day? Can the diagnosis be confirmed on the same day of consultation?
A: In general, ultrasound examination of the neck is required for the first consultation. As there are more patients in our hospital, it may be done on the same day, or it may be necessary to make an appointment for the examination.
3. If I need surgery, how do I determine the date of admission to the hospital? How long is the hospital stay? What is the approximate cost?
A: If surgery is needed, the patient needs to choose the treating doctor and the exact time depends on the patient’s condition of different doctors, because there are more patients, it is usually necessary to wait for a period of time; the hospitalization time depends on the condition, the patient’s physical condition and the scope of surgery and post-operative recovery, usually it takes 7-10 days for the central zone clearance and about 15 days for the radical thyroid cancer surgery, the cost is usually about 30,000 RMB (different conditions may vary). The cost is usually around 30,000 RMB (it varies with different conditions).
How do I get your number? What is the flow of your clinic?
A: My clinic hours are every Thursday afternoon and Friday morning. It is best to make an appointment online and by phone in advance (because there are fewer places available on site), and it is best to have an ultrasound of the neck done at our hospital before your visit, so that you will not be able to see the results at the time of the examination.
5. What should I describe during the online consultation? What information should I upload?
A: When consulting online, you should describe clearly the time of onset, tumor condition (size, texture, mobility, etc.), consultation, tumor changes and previous examination results. You need to upload ultrasound, laboratory tests and other examination reports.