Thyroid nodules are very common in the general population, and the incidence of nodules found in medical checkups is about 70%, and with the popularity of medical checkups, more and more people are being labeled as “thyroid nodule patients”. Treatment, and even more said to surgery, the patient more anxious. What to do?
In fact, there is no need to worry at all!
Benign thyroid nodules are a very serious disease that has been over-treated in recent years, and even among the thyroid patients operated in many tertiary hospitals, benign thyroid nodules account for 80% to 90%, and the percentage of thyroid cancer patients who really need surgery is very low, and the benefits that patients with benign thyroid nodules get after treatment are far less than the disadvantages.
I will briefly introduce the overview of thyroid nodules and my own clinical experience and opinions.
1. What is a thyroid nodule?
A thyroid nodule is a generic term for a growth in the thyroid gland, so it is important to first distinguish the nature of the nodule. This should be combined with the patient’s clinical symptoms and relevant tests.
2. What are the clinical symptoms?
Most nodules do not have any symptoms.
(1) Changes in the appearance of the neck, usually a swelling of more than 3 cm will affect the appearance, depending on the location of the swelling and the specific circumstances of the patient’s neck.
(2) Symptoms of invasion by the thyroid mass: compression of the trachea will cause displacement of the trachea and varying degrees of inspiratory difficulties; invasion of the trachea will cause coughing and hemoptysis; invasion or compression of the esophagus will cause difficulty in swallowing; invasion of the laryngeal nerve by the tumor will cause hoarseness.
(3) Patients with thyroiditis, especially subacute thyroiditis, have very obvious subjective symptoms: pain in the thyroid area is obvious, especially when swallowing saliva. It affects the patient’s sleep, daily life and work. There is also a low fever.
3. What routine tests are needed to confirm the nature of the thyroid nodule?
(1) Thyroid function test: To find out whether the thyroid function is normal, hyper or hypo. Generally, hyperactive nodules are rarely malignant, but high-functioning adenomas should be detected, which is an indication for surgery.
(2) Thyroid autoantibody test: to understand some specific inflammation-induced nodules.
(3) Ultrasonography: The accuracy of ultrasonography in determining the benignity and malignancy of thyroid nodules is 85% to 90%.
4.What benign nodules need surgery?
(1) The presence of local pressure symptoms clearly associated with the nodule.
(2) Those with combined hyperthyroidism and ineffective medical treatment.
(3) A mass located in the posterior sternum or mediastinum.
(4) Progressive growth of the nodule with clinical consideration of malignant tendency or combined with high risk factors for thyroid cancer.
(5) Those who strongly request surgery because of appearance or excessive ideological concerns affecting normal life can be considered as relative indications for surgery.
For the reference of size, the 2015 Global Thyroid Nodule Guidelines (guidelines developed by the American Thyroid Association) recommend surgery for 4 cm or more. Combining the national body size and our own clinical experience, it is recommended that surgery be considered for patients above 3 cm as it will affect their appearance or cause symptoms.
5. Non-surgical treatment of benign thyroid nodules
It should be said that non-inflammatory thyroid nodules that do not meet the indications for surgery can be treated without any treatment, and regular observation is all that is needed, with a review every six months to a year. Benign nodules do not affect the body in any way and some are even needed for the body to function. Treatment such as the impact on thyroid function, most notably hypothyroidism, requires lifelong medication to replenish thyroid function, which more than pays for itself.
(1) Medication: There is no single recommended effective medication that will eliminate all thyroid nodules.
TSH suppression therapy: Suppressing serum TSH levels to the low end of normal or even below the low end in an attempt to shrink thyroid nodules by inhibiting the pro-growth effect of TSH on thyroid cells. Some physicians use thyroxine to use TSH suppression therapy in patients with significant hyperthyroid side effects from high doses of thyroxine tablets, and more importantly, the treatment is very ineffective, so the 2015 Global Thyroid Nodule Guidelines (guidelines developed by the American Thyroid Association) strongly recommend that: TSH suppression therapy is not used to treat thyroid nodules because the potential harms clearly outweigh the benefits, and it is possible of stopping the nodules from increasing in size, not eliminating them.
Chinese medicine: a Chinese specialty, no country outside of China talks about this issue and there is no global opinion. Many people have a very difficult to understand view of Chinese medicine, which has indications for treatment and is not a miracle cure for all diseases. Many people seek Chinese medicine when there is no other effective solution, just like malignant tumor patients who must take some Chinese medicine after surgery and radiotherapy and chemotherapy. I don’t have much knowledge of Chinese medicine, but when I searched the domestic literature (Wanfang database), I didn’t find any important formula that could cure thyroid nodules, but as long as patients who go to see a Chinese medicine doctor can prescribe a bunch of drugs back and eat them for months or even years. My own opinion: don’t use herbs to treat benign nodules.
(2) Ablation therapy: It has been very hot in China in recent years, and is considered a feature of the Chinese medical community that it is much easier to carry out a technology than abroad. Until 2015, the U.S. FDA still does not allow radiofrequency treatment to be applied to thyroid masses, especially thyroid cancer. The FDA has not approved, for example, the use of radiofrequency to treat thyroid nodules and thyroid cancer within the United States, which is illegal. Radiofrequency treatment is not a new technology: the unit promoting radiofrequency describes radiofrequency treatment as a new technology, that is to confuse patients, radiofrequency technology is a mature technology more than 20 years ago, and it is a very mature and routine treatment in liver cancer treatment. Putting aside these issues, I personally think that the indications of RF for benign nodules should be strictly grasped: for single nodules with continuous enlargement, RF can be considered; multiple nodules should be weighed against whether all nodules can be eliminated, large nodules eliminated and small nodules left behind. Due to the reduction of normal thyroid tissue caused by RF and impaired thyroid function, small nodules will compensate and accelerate their enlargement, and will soon become obvious nodules. Excessive radiofrequency ranges can also cause hypothyroidism, requiring lifelong medication. Can the local fibrosis be absorbed after radiofrequency? No. If it is not absorbed, it is a lump, which is harder than the texture of the previous swelling. The cost of domestic radiofrequency treatment is very high, generally close to 20,000 yuan a time. Sadly, many patients who do not need treatment are those with multiple benign thyroid nodules and are scheduled for multiple radiofrequency treatments, which are very costly and require lifelong medication to supplement thyroid function after treatment.
(3) Intratumoral anhydrous alcohol injection: For some cystic solid masses, intratumoral anhydrous alcohol injection can be considered, which is also recommended by the 2015 global guidelines for thyroid nodules, but not many patients meet the indications and very few carry out this technique in China.