Some patients with thyroid nodules have the idea that treatment is the same as “killing” the nodules. But the truth is that more than 95% of thyroid nodules are benign lesions and only 2% to 5% are malignant. However, although the number is small, if it is specific to the individual, it is 100% of the problem. Therefore, it is imperative to put away the “kill order” for thyroid nodules and to determine the “loyalty” of thyroid nodules through a series of tests. The word “nodules” always makes people feel uncomfortable, as it may be a local inflammation in the smallest case, or a malignant tumor in the largest. Therefore, when faced with the diagnosis of “thyroid nodules” on the medical report, people’s psychology can’t help but go to two extremes. One is that some people are very nervous when they hear the word “nodule”, afraid that they have an incurable disease, to immediately kill the “nodule” without amnesty; while others think that nodules are no big deal, neither painful nor itchy, let it go. In fact, for thyroid nodules, not only the patient’s mind is in a state of flux, but also the doctor’s headache. Even highly experienced specialists are unable to give a clear diagnosis without a comprehensive examination. Therefore, it is important not to go to extremes in thinking about thyroid nodules. Patients should be careful to identify and not panic, and a series of tests to determine the “faithfulness” of thyroid nodules is a priority. The first step in the process is to determine the “loyalty” of the nodules. The five big words “thyroid nodules” appear on the medical report. If you upgrade your physical exam and do an ultrasound of the thyroid gland, I believe more people will become “nodules”. The doctor will stand behind the subject and carefully touch the nodules with his or her index, middle, ring and little fingers. Usually, if multiple nodules are touched, it is more likely that the lesion is benign; if the nodule is only “one nodule”, and the texture is hard, the surface is uneven, and the activity is small when swallowing, it is highly suspected that it is a malignant lesion. The situation is even more suspicious if enlarged lymph nodes are also felt around the node. Although an experienced doctor can make a preliminary determination of the nature of the nodule by touch alone, the final diagnosis has to be made with the help of various modern testing instruments. Ultrasound is the imaging tool of choice because of the superficial location of the thyroid gland and the fact that it is a substantial organ that does not contain gas, so ultrasound can clearly visualize tiny nodules as small as 2 mm in diameter. If tiny calcifications are found in the nodules, local hypoechogenicity, and a richer blood supply between the nodules, these indicate that the nodules are growing faster, suggesting that the lesions are more likely to be malignant and should be further examined. Ultrasound is the first choice to determine the nature of thyroid nodules, but this does not mean that CT and MRI are meaningless. the higher spatial resolution of CT and MRI has a greater advantage in pinpointing the nodules and their relationship to adjacent tissues (e.g., important blood vessels, nerves, etc.) and is necessary for patients who require surgery. After identifying the good and bad thyroid nodules, what is the next step? Do we operate right away? Experts say that to be on the safe side, we can use the last resort – puncture cytology. If cancer cells are not detected in the punctured cells, it does not completely exclude the possibility of malignant nodules, and perhaps no malignant cells were punctured. Therefore, even negative patients should be followed up regularly, and ultrasound examinations should be done every six months to a year to see if the nodule has increased in size within a short period of time. If the size increases by more than 15% to 20%, surgery should be actively considered. Learn to live peacefully with nodules The correct attitude towards thyroid nodules is to live peacefully with them as they come. Firstly, maintain a good attitude, secondly, do the necessary tests and analysis of the condition, follow the advice of an experienced doctor, and if necessary, observe its dynamic changes appropriately, which is the necessary process and the best means for differential diagnosis. If necessary, surgical treatment is feasible, and after surgery, sometimes necessary isotope therapy and thyroid hormone replacement therapy should be performed, so that the quality of life and life expectancy of a normal person can be fully achieved. In conclusion, optimism, a healthy lifestyle and a good living environment are the best preventive and therapeutic tools to prevent various diseases, and the forthcoming implementation of a sub-regional selective iodization program is also a reasonable and effective public health initiative to prevent thyroid diseases. Isotope Imaging to Determine the Nature of Thyroid Nodules The “iodized salt fear” controversy not long ago was a big deal, although it ended with the authorities releasing an authoritative statement that “the iodine nutrition status of Chinese residents is appropriate. Although the incident ended with the issuance of an authoritative statement by the authorities that “the iodine nutrition status of Chinese residents is appropriate”, what is behind it is the fact that the incidence of thyroid disease is increasing. The reason why “iodized salt fear” is popular in society, instead of “calcium salt” or “iron salt” fear, is related to the unique physiological activity of the thyroid gland. The vast majority of iodine consumed by the body through food is enriched in the thyroid gland with blood circulation, thus providing sufficient raw material for thyroid hormone synthesis. What you may not know is that using this property can also facilitate the diagnosis of thyroid nodules. Although the accuracy of ultrasound diagnosis has been greatly improved compared to palpation, it is still an indirect diagnosis, and the doctor’s experience still plays a large part in making the diagnosis report. Is there a way to make malignant lesions “self-revealing”? The answer is yes, and that is isotope imaging. When an agent containing iodine isotopes is injected into the body, the isotopes are concentrated in the thyroid gland along with the blood circulation. Iodine isotopes have a “strange temper” – will continue to release gamma rays. With a gamma camera to image the thyroid gland, you can see a colorful, richly layered image. If the thyroid nodules are very eager to absorb iodine-containing substances, the image will show yellow, red. If, on the other hand, the nodule is not interested in iodine-containing substances, it will appear blue or purple. The former is called “hot nodules” or “warm nodules”, while the latter is called “cold nodules” or “cool nodules”. Of course, the cold, hot and warm nodules here are just a kind of substitution, but the essence is to reflect the absorption of iodine-containing substances by nodules. Usually, benign nodules absorb more iodine, while malignant nodules absorb less. In this way, the nature of the nodule can be basically determined.