1, thyroid nodules are a very common condition, especially in middle-aged women.
2, thyroid nodules are divided into two categories, benign and malignant, benign nodules account for the vast majority, less than 1% of malignant nodules.
3, there are a variety of clinical thyroid diseases, such as thyroid degeneration, inflammation, autoimmune and neoplastic, etc. can be manifested as nodules. Li Jianhua, Department of General Surgery, First Affiliated Hospital of Zhengzhou University
4. Thyroid nodules can be solitary or multiple. Multiple nodules have a higher incidence than single nodules, but the incidence of thyroid cancer in single nodules is higher.
Clinical manifestations of thyroid nodules
1.Nodular goiter
It is more common in middle-aged women. There may be bleeding, cystic changes and calcification in the nodules. The size of the nodule can range from a few millimeters to several centimeters. The main clinical manifestation is enlargement of the thyroid gland and multiple nodules of different sizes can be found on palpation, the texture of the nodules is mostly moderately hard.
2. Nodular toxic goiter
The disease starts slowly and often occurs in patients who have had nodular goiter for many years, mostly at the age of 40 to 50 years or older, and is more common in women. When the thyroid gland is palpated, a smooth round or oval nodule with clear borders and a hard texture can be found, which moves up and down with swallowing. Thyroid function tests may show elevated thyroid hormones in the blood, and if the nodule is functionally autonomous, a nuclear scan may show a “hot nodule”.
3. Inflammatory nodules
Infectious and non-infectious nodules are two types of nodules, the former is mainly subacute thyroiditis caused by viral infection, other infections are rare. The latter is mainly caused by autoimmune thyroiditis, mostly seen in middle-aged and young women, the patient’s conscious symptoms are less, the examination can find multiple or single nodules, hard and tough texture, less pressure pain, thyroid function tests show thyroglobulin antibodies and Thyroid function tests often show strong positivity for thyroglobulin and thyroid microsomal antibodies.
4. Thyroid cysts
Most of them are formed by degenerative changes of goiter nodules or adenomas, containing blood or slightly mixed liquid, with clear borders and hard texture. In a small number of patients, the cyst is caused by a congenital thyroglossal cyst or a remnant of the fourth gill slit.
Disease characteristics and clinical manifestations of hyperthyroidism
I. Disease characteristics
Hyperthyroidism, referred to as hyperthyroidism, is an endocrine disease characterized by systemic hypermetabolism due to excessive secretion of thyroxine for various reasons, with a male to female incidence ratio of about 1:4.
Clinical manifestations
1. Enlarged thyroid gland
Mostly no local pressure symptoms. Due to the dilated blood vessels and accelerated blood flow in the gland, there is tremor on palpation and murmurs on auscultation, especially at the upper pole of the superior thyroid artery.
2. Sympathetic hyperfunction
The patient is often talkative, impatient, easily agitated, insomniac, with fine and rapid trembling of the hands, fear of heat, sweating, and warm skin.
3.Protruding eyes sign
In typical cases, the eyeballs protrude bilaterally and the eye fissures widen; in some severe proptosis, the upper and lower eyelids are difficult to close and cannot even cover the cornea; the transient gaze decreases when gazing, the upper eyelids cannot close with the eyeballs when looking down, and both eyes have poor cohesive ability.
4. Changes in cardiovascular function
Most complaints of palpitations, chest tightness and discomfort; fast and strong pulse, pulse rate is often above 100 times/minute, still fast at rest and during sleep, systolic blood pressure is elevated, diastolic blood pressure is reduced, and thus pulse pressure is increased. Increased pulse rate and increased pulse pressure is often used as an important sign to determine the extent of the disease and the effectiveness of treatment, if the left heart gradually dilated, hypertrophy can have a systolic murmur, serious cases of arrhythmia, heart failure.
5. Increased basal metabolic rate
The degree of the increase is parallel to the clinical symptoms, with hyperphagia but emaciation, weight loss, easy fatigue and reduced work efficiency.
Some patients may experience endocrine dysfunction such as menopause, impotence or hyperactive bowel movement, diarrhea, etc. Very few patients have limited anterior tibial mucinous edema, which often occurs simultaneously or sequentially with severe proptosis.