I. Patient.
Description of disease.
Ultrasound description of thyroid gland: left lobe of thyroid gland 2.4*1.9*4CM, right lobe of thyroid gland 1.5*1.3*3.7CM,, isthmus thickness 0.2CM. The morphology of the thyroid gland is abnormal in cross-section, the left lobe is obviously enlarged, irregular in outline, surface is still smooth, internal echogenicity is not uniform, multiple nodules of different sizes are seen within it, the boundary is still clear, the largest nodule in the left lobe is about 3.4*1.7 CDFI showed that a little blood flow signal could be detected around the nodules.
Results and reference values of the five thyroid tests
T3(T3):2.07 0.92-2.79
T4(T4):95.99 58.1-165.2
T3(FT3):5.01 3.5-6.5
T4(FT4):13.61 10-23
TSH:2.98 0.2-8.2
aTg:21.87 0-60
aTPO:38.39 0-60
Q.
1. Do I need surgery in my case?
2. What would be the surgical removal of the thyroid gland due to the large nodule on the left side?
3. Will it cause post-surgical hypothyroidism?
4. Will the surgery damage the nerves causing difficulty in vocalization?
5. What kind of suture should be used to minimize the scar after surgery?
Second, the diagnosis is nodular goiter.
1. Some doctors recommend you to have surgery on the grounds that the nodule has exceeded 2CM.
2. Some doctors recommend you to continue observation on the grounds that there is no malignant tendency and no symptoms of pressure on the surrounding organs.
Generally speaking, in developed countries, such as the United States, the indications for surgery for nodular goiter are more strict, and surgery is only done when malignancy is suspected or when there is pressure on the surrounding organs, because they have better medical conditions and can do ultrasound observation and blood tests for the five A-factors on a regular basis.
In developing countries, such as China, the indications for surgery for nodular goiter are more relaxed. If the nodule exceeds 2CM, surgery will be performed.
Whether to operate in your case, please decide for yourself according to your medical resources.
If surgery, in developed countries, such as the United States, most do complete bilateral thyroidectomy, the reason is to avoid recurrence and then surgery, but the incidence of low thyroid is high, they are not afraid of low thyroid, due to low thyroid, oral thyroxine tablets can be taken, thyroxine tablets are cheap. In developing countries, such as China, most of them do nodule removal for the reason of avoiding hypothyroidism and avoiding damage to the supraglottis and the recurrent laryngeal nerve, but the recurrence rate is high, and after recurrence, surgery is done again, because the cost of surgery is low.
Open surgery cannot avoid scars, but most modern surgeons have applied cosmetic surgery techniques to thyroid surgery to make the scars as small as possible.
There is also lumpectomy thyroidectomy, which can completely avoid open scars, but it requires three small holes in the armpit and hidden areas, which is equal to transferring the scars to hidden areas, but it is more traumatic, and thyroid surgery cannot be complicated, and the surgeon should have special training in this way.