Anatomy and physiological functions.
The thyroid gland is located in the anterior middle of the neck and consists of two conical lateral lobes, with fibrous tissue anchored above the trachea and on either side of the thyroid cartilage, so that it moves up and down with the trachea when swallowing. The thyroid gland is surrounded by many important nerves and blood vessels, among which the laryngeal nerve, which governs the movement of the vocal cords, if destroyed, will lead to hoarseness. The thyroid gland has many important physiological functions, and its secretion of thyroid gland can promote the body’s metabolism.
Symptoms.
Thyroid tumor is a common tumor of the head and neck, and is more common in women. The symptoms are a lump in the middle of the front of the neck, which moves with swallowing. Some patients also have hoarseness and difficulty in swallowing and breathing. There are many types of thyroid tumors, benign and malignant. Generally speaking, a single mass with faster growth has a higher possibility of malignancy, and the younger the age, the more likely the thyroid mass is to be malignant. Due to the obvious symptoms, patients can usually be diagnosed in time.
Classification of benign thyroid tumors.
1, thyroid hyoid bone cyst: not congenital thyroid hyoid bone degeneration incomplete, tissue residue, forming a cyst, located between the thyroid gland and hyoid bone, easy to combine infection, rarely malignant, surgery must be removed at the same time part of the hyoid bone, complete removal will not recur.
2, nodular goiter: related to iodine deficiency, manifested as a diffuse enlargement of the thyroid gland, a few can become malignant. Generally, the enlarged thyroid gland produces symptoms of pressure, malignancy, or hyperfunction and requires surgery, but is generally treated conservatively.
3.Thyroid adenoma: common, tumor with envelope, slow growth. Most of them are not pre-cervical masses, but they can swell rapidly when combined with bleeding, so surgery is effective.
4.Subacute thyroiditis: It is easily misdiagnosed as thyroid cancer, usually caused by viral infection, with a history of cold before the onset of the disease and painful lump.
Classification of thyroid cancer.
Thyroid cancer is a malignant tumor of the thyroid gland and is divided into 4 categories, the symptoms and treatment of which differ from one category to another.
Papillary thyroid cancer: It is the most common type of thyroid cancer, accounting for about 60% to 89% of the cases. Due to slow growth, it is easy to be ignored clinically. Most of them are found within 2 years and come to the clinic with a neck lump, and the diagnosis can be confirmed by fine needle aspiration for biopsy or rapid sectioning during surgery. This includes removal of the thyroid gland and clearance of the neck tumor. The prognosis of this disease is good, 20% of recurrence cases are more than 10 years, therefore, postoperative follow-up should be more than 10 years.
Follicular carcinoma of thyroid: It accounts for 10.6%-15% of thyroid cancer. Compared with papillary carcinoma, it is more common in men and has a longer course, manifesting as multiple lumps in the thyroid gland and neck.
Medullary thyroid carcinoma: It accounts for 3-10% of thyroid carcinoma and is clinically divided into disseminated type and hereditary type, with hereditary type accounting for 10-20%.
Due to the secretion of endocrine hormones by the tumor, it can produce lower blood calcium, intractable diarrhea, facial flushing and palpitations. Treatment is mainly surgical, most of the thyroid gland is excised or total excision, and distant metastatic lesions can be treated with radionuclide.
4.Undifferentiated thyroid cancer: It is less common, but with high malignancy and rapid development. Patients are mainly of advanced age and often come to the clinic with hoarseness and dyspnea, for which there is no satisfactory treatment.
Treatment.
The treatment of thyroid tumor is mainly surgery. Due to the different classification, its treatment method and treatment effect are also different, meanwhile the preoperative examination will help the diagnosis and treatment. Generally, doctors will arrange the following tests for patients.
1.Blood test: to determine whether the patient has combined hyperthyroidism
2. Ultrasound of the thyroid gland: to determine the nature of the mass (solid or cystic)
3.Thyroid nuclear scan: The scan uses the thyroid gland to specifically take in certain elements to understand their distribution in the thyroid gland, which is normally evenly distributed. If there is a thyroid tumor, there will be a dense or sparse distribution to help the clinician make a diagnosis
4.Thyroid CT is sometimes also important because it can clearly show the location of the tumor and its relationship with important organs, and also help to judge the benign and malignant
5.Thyroid biopsy: with it, thyroid tumor can be characterized and treatment can be started.
The treatment is mainly surgery. It includes partial or total thyroidectomy, cervical lymph node dissection. Nuclear therapy, radiation therapy, and medication are also available. The results of surgery vary depending on the pathological classification, but the overall results are good and the patient has a high quality of life.
Choice of ENT DD head and neck consultation.
Traditionally, thyroid is considered to be treated in surgery, but due to the rapid development of otorhinolaryngology – head and neck surgery in recent years, patients have an additional choice in treatment. ENT is a boon for thyroid patients and a trend for future development due to its advantage of familiarity with head and neck anatomy and intraoperative protection of the recurrent laryngeal nerve.