(Disclaimer: This article is for scientific use only, and the information in the following content has been processed to protect patient privacy)
Abstract: Hashimoto’s thyroiditis, if not improved and treated, may lead to the development of thyroid nodules. The patient in this case came to the clinic with multiple masses in the neck and was diagnosed with Hashimoto’s thyroiditis combined with thyroid nodules after examination. After using multimodal 4-dimensional targeted microwave ablation treatment combined with AMI glandular immune reconstitution treatment, the patient felt that the neck pressure disappeared.
Basic information】Female, 60 years old
Disease Type】Hashimoto’s thyroiditis combined with thyroid nodules
Hospital】The First Hospital of China Medical University
Consultation date】May 20, 2021
Treatment plan】Multimodal 4-dimensional targeted microwave ablation + AIM glandular immune reconstitution
Treatment Period】1 day, 3-6 months outpatient follow up
Treatment effect】The condition was effectively controlled and all indicators were improving
I. Initial consultation
A few months ago, multiple lumps appeared on the patient’s neck, with obvious bumps, the largest of which was the size of an egg, and the neck was seriously deformed, no longer slender and beautiful, and looked like a strong man. The patient stated that he usually felt something stuck in his neck when he lowered his head, and often felt a hot, congested pain in his throat, a foreign body feeling in his throat, and a change in his voice, which became low and hoarse.
Ultrasound examination of the thyroid gland showed that the patient had an enlarged thyroid gland with uneven internal echogenicity and coarse dots, and scattered clusters of weak and strong echogenicity in the parenchyma of both lobes and isthmus. The right lobe and isthmus were 38.4×30.9mm, 17.2×14.4mm and 22.6×18.5mm in size, with clear borders and no clear envelope, and short streaks of blood flow were seen on CDFI. The left lobe was 74.3×36.1mm, 23.7×14.1mm, 18.1×11.1mm, 22.7×9.7mm, 18.1×11.1mm, 22.7×9.7mm, 24.8×15.7mm. The border was clear, with pericardial-like echogenicity around the larger ones and short streaks of blood flow signal within them. The thyroid parenchyma has slightly increased blood flow signal. The ultrasound suggests bilobar thyroid and isthmus nodules with TI-RADS classification of 3. The thyroid changes were suggested to be combined with thyroid function tests, and the thyroid function report showed a low free thyroxine (FT4) value, an anti-thyroid peroxidase antibody titer of 600 IU/ml and an anti-thyroglobulin antibody titer of 470 IU/ml, confirming the diagnosis of typical Hashimoto’s thyroiditis combined with thyroid nodules.
II. Treatment history
Since the patient and family were very anxious about the condition of the thyroid gland, we explained the condition in detail to the family based on the test results. The patient’s thyroid function test report showed that the anti-thyroid peroxidase antibody and anti-thyroglobulin antibody were elevated, while the FT4 index was decreased. This is a manifestation of Hashimoto’s hypothyroidism, indicating that he has been suffering from Hashimoto for some time. Hashimoto’s thyroiditis is a chronic inflammatory disease, and if the inflammation does not improve, the thyroid cells will become abnormally hyperplastic (nodules) and change in nature (from benign to malignant), so it is not uncommon for Hashimoto’s thyroiditis to be accompanied by thyroid nodules or even thyroid cancer.
During the communication with the patient, the patient suggested that he did not want to solve the thyroid nodules and Hashimoto’s thyroiditis by surgical means. Due to the complexity of the patient’s condition and her clear needs, we gave a systematic treatment plan – multimodal 4-dimensional targeted microwave ablation combined with AMI glandular immune reconstitution therapy. The first step is to eliminate the giant nodules in the neck by inducing necrosis in the body with the help of microwave ablation therapy. After that, the glandular cells are infiltrated with the repair factor to form a cell protective film, which repairs the thyroid cells damaged by Hashimoto’s thyroiditis to correct Hashimoto’s hypothyroidism and prevent the recurrence of thyroid nodules or even cancer.
III. Treatment effect
After receiving multimodal 4-dimensional targeted microwave ablation and 4 courses of AMI glandular immune reconstitution therapy, the patient’s thyroid nodules were well absorbed, the neck lumps disappeared, and the symptoms of esophageal, tracheal and laryngeal nerve compression disappeared. The symptoms of swollen limbs, coldness and depression due to Hashimoto’s hypothyroidism basically disappeared. The patient was discharged after 1 day of hospitalization. Before leaving the hospital, the patient’s antibody indexes decreased significantly, and the anti-thyroglobulin antibody basically disappeared, and the anti-thyroid peroxidase antibody decreased to 54.93 IU/ml, which is nearly 10 times lower. The patient was instructed to follow up in 3-6 months on an outpatient basis.
IV. Notes
We are glad that the patient’s condition has improved significantly after active treatment and the antibody index has decreased significantly. However, the patient is advised to still need to pay attention to the following matters after discharge from the hospital.
1. Within 7 days after receiving multimodal four-dimensional targeted microwave ablation treatment, patients should pay attention to avoiding water and beware of infection in the wound.
2, 1-2 days after surgery do not eat too hard, too hot, spicy stimulating food, you can moderate intake of protein to promote wound repair and enhance immunity. Take care not to eat too much high iodine food after receiving AMI glandular immune reconstitution therapy.
3. Regular review and close monitoring of antithyroid peroxidase antibodies and antithyroglobulin antibodies and thyroid stimulating hormone, as observation follow-up is the main treatment for benign thyroid nodules.
V. Personal insight
The early symptoms of thyroid nodules are not obvious, but once they appear, they can be very harmful. Untreated thyroid nodules may not only compress the patient’s trachea and esophagus, but may also become malignant, especially in patients with autoimmune thyroiditis such as Hashimoto’s thyroiditis and Graves’ disease. Clinical data prove that autoimmune thyroiditis increases the risk of thyroid nodules and thyroid cancer. As in this case, the patient with Hashimoto’s thyroiditis was not treated in time, which led to the development of thyroid nodules, but with aggressive treatment, the patient’s condition improved significantly. Therefore, it is recommended that patients with unidentified masses in the neck should be seen in a timely manner to improve the outcome of their condition.