The detection rate of thyroid nodules is increasing today, and the lack of adequate knowledge often causes a lot of psychological stress to patients. Some patients mistakenly equate thyroid nodules with thyroid cancer and are frightened by this. In fact, thyroid nodules are a generic term for lumps in the thyroid gland that are different from normal tissue. Only malignant nodules and a few benign nodules need to be treated.
The etiology of thyroid nodules is complex and is currently thought to be related to factors such as radioactive exposure, autoimmunity, genetics, and inadequate or excessive iodine intake. They can be classified as follows.
1. in terms of nature, they can be classified as benign and malignant.
2. morphologically, they can be classified as solid, cystic or cystic-solid
3. functionally, they can be high-functioning (hot nodules), normal-functioning (warm nodules), or low-functioning (cold nodules)
4. In terms of number, they can be single or multiple.
In the following, we describe several common clinical thyroid nodules.
I. Simple nodular goiter
Simple nodular goiter is a kind of uneven enlargement and nodule-like changes of the thyroid gland. It is mainly due to a decrease in the synthesis of thyroid hormone due to insufficient iodine intake and an increase in the compensatory secretion of thyroid stimulating hormone (TSH) by the pituitary gland, which leads to recurrent or continuous hyperplasia of the thyroid gland under the long-term stimulation of TSH. In addition, excessive iodine intake, certain goiter-causing substances and genetic defects can also lead to goiter.
1. Clinical manifestations
Most commonly seen in middle-aged women, the main manifestation is an enlarged thyroid gland accompanied by multiple nodules of varying sizes or, in rare cases, a single nodule. Patients usually have no obvious discomfort and are mostly detected by physical examination. However, if the nodules are large, they may also produce symptoms of pressure such as dysphagia and hoarseness.
2.Auxiliary examination
Thyroid function is often normal; thyroid ultrasound mostly shows normal echogenicity or hyperechogenicity with clear borders and regular morphology, nodules with no blood flow signal or less blood flow, and no local lymph node lesions.
3.Treatment
Generally, no special treatment is needed. If it is caused by iodine deficiency, iodine intake can be increased appropriately. Patients can follow up ultrasound and nail function once every six months to one year to monitor the changes of nodules. Smaller nodules usually do not require treatment. For those with significantly enlarged thyroid gland, obvious pressure symptoms or suspected malignant nodules, surgery may be considered.
Reminder: Treatment of thyroid nodules with thyroid hormone (levothyroxine sodium tablets) suppressive therapy requires controlling TSH at a low level (below 0.1 μIU/ml). The dosage of levothyroxine sodium tablets is higher than that of replacement therapy, which may lead to pharmacological hyperthyroidism, cause cardiovascular problems (atrial fibrillation, heart failure, etc.) and osteoporosis, and is not 100% effective; therefore, it is not Therefore, it is not routinely recommended.
Toxic nodular goiter
Toxic nodular goiter includes toxic adenoma and toxic multinodular goiter, the etiology of which is not well understood. Long-term presence of thyroid nodules or adenomas results in autonomic secretory dysfunction.
1. Clinical manifestations
In addition to nodules, patients also have hyperthyroidism.
(1) Clinical manifestations of thyroid nodules and goiter: e.g. neck discomfort, difficulty in swallowing, difficulty in breathing.
(2) Clinical manifestations of hyperthyroidism: such as hyperphagia, emaciation, fear of heat, excessive sweating, palpitations, hand tremors, increased frequency of stools, emotional irritability, anxiety and insomnia. Women may experience hypomenorrhea, and men generally experience decreased libido, erectile dysfunction and breast development.
2.Auxiliary tests
Thyroid function tests show a decrease in TSH and an increase in FT3 and FT4. Radionuclide scan shows increased concentration of nuclei in the nodular thyroid lesion and decreased nuclei in the extra-nodular thyroid tissue.
3.Treatment
Mostly treated with radioactive iodine or surgery.
Inflammatory thyroid nodules
Inflammatory thyroid nodules are divided into two categories: infectious and non-infectious, the former is mainly caused by viral infection “subacute thyroiditis”, the latter is mainly caused by autoimmune disorders chronic lymphocytic thyroiditis (also known as “Hashimoto’s thyroiditis”). The latter is a chronic lymphocytic thyroiditis (also known as Hashimoto’s thyroiditis) caused by autoimmune disorder.
1. Clinical manifestations
(1) Subacute thyroiditis: Patients have an acute onset, often with prodromal symptoms of upper respiratory tract infection, mainly manifesting as localized swelling and pain and fever in the thyroid gland, mainly in a single nodule, which is hard and painful to the touch, and may spread to the submandibular area and behind the ear.
The patient’s blood sedimentation is significantly increased (>50mm/hour), and the early stage may show mild hyperthyroidism while the iodine uptake rate of the thyroid gland is significantly reduced.
(2) Hashimoto’s thyroiditis: Mostly seen in young and middle-aged women, with slow onset and varying degrees of symmetrical enlargement of the thyroid gland, which may be accompanied by multiple nodules, but without obvious tenderness and without fever.
Thyroid function tests suggest that thyroglobulin and thyroid peroxidase antibodies are often strongly positive.
2. Treatment
The main treatment of subacute thyroiditis is anti-inflammatory and pain relief, symptomatic treatment, drugs can choose non-disastrous anti-inflammatory drugs or glucocorticoids. The treatment of Hashimoto’s thyroiditis is mainly to correct the abnormalities of thyroid function.
Four, thyroid cysts
The majority of thyroid cysts are formed by degenerative changes of nodules or adenomas of the thyroid gland, and the cysts contain blood or slightly mixed liquid.
1. Clinical features
Cysts are usually benign and occur mostly in women aged 20 to 40 years. Most of them are single, but they can also be multiple. The nodules have clear borders, smooth surface, no tenderness, and can move up and down with swallowing; patients usually have no discomfort.
2.Auxiliary examination
Ultrasound examination shows round or round-like nodules with clear borders and no echogenicity in the thyroid gland; radionuclide imaging shows “cold nodules”; thyroid function tests are normal.
3.Treatment
In the past, thyroid cysts were mostly treated by surgery, but nowadays, we advocate puncture and fluid extraction and injection of sclerosing agent. The sclerosing agent can cause aseptic necrosis of the cyst wall, causing adhesion of the cyst wall and occlusion of the cyst cavity to achieve the purpose of treating the cyst.
V. Suspected malignant thyroid nodules (cancerous nodules)
Malignant nodules of thyroid gland are closely related to large amount of exposure to radiation and genetic factors.
1. Clinical manifestations
Most commonly seen in the elderly and children, it is often a single isolated nodule. In the early stage, patients often do not have any clinical symptoms, but in the late stage, tumor compression or invasion of surrounding tissues may manifest as difficulty in breathing, difficulty in swallowing, hoarseness, etc.
2.Auxiliary examination
Ultrasonography indicates hypoechoic nodules with uneven internal echogenicity, unclear boundary, micro calcification, rich blood supply and blood flow disorder in the nodules. Lymph node lesions on one or both sides of the neck. For suspected malignant nodules, an aspiration cytology or biopsy of the thyroid nodule is required for a definitive diagnosis.
3.Treatment
Surgical excision. In conclusion, when thyroid nodules are detected by ultrasound, the patient’s medical history, symptoms and other relevant tests, such as thyroid function, thyroid autoantibodies, thyroid nuclear scan, thyroid aspiration cytology, etc., should be combined to further clarify the diagnosis and give scientific and reasonable treatment to thyroid nodules of different etiology and nature.