Thyroid nodules are the most common clinical condition of the thyroid gland, and are more common in middle-aged women. The incidence of thyroid nodules ranges from 5% to 50%, with the majority being benign nodules and less than 5% malignant.
Thyroid nodules are the most common clinical condition of the thyroid gland. Thyroid nodules are more common in middle-aged women and are broadly defined to include hyperplastic lesions, cysts, inflammation and tumors. The incidence of thyroid nodules ranges from 5% to 50%, with the majority being benign nodules and less than 5% malignant.
The determination of benign and malignant thyroid nodules can be made from the following aspects.
I. Clinical assessment of the risk of malignancy of thyroid nodules.
1. Age and sex: Thyroid nodules are less common in children and adolescents compared to adults. The prevalence of thyroid nodules in children is 1.5% on palpation, yet thyroid cancer accounts for 26% of thyroid nodules in children, which is twice as high as in adults. Thyroid nodules are more common in women than in men, but the malignancy rate of thyroid nodules in men is twice as high as that of women.
2. Symptoms and signs.
Most patients with thyroid nodules have no obvious complaint symptoms at the time of consultation. Most of them are found by accidental discovery of a lump in front of the neck or by palpation or ultrasound during a health checkup.
Thyroid nodules with symptoms of pressure such as dysphagia, hoarseness, and dyspnea should also be considered as malignant. In the case of thyroid lymphoma, undifferentiated carcinoma and malignant metastases to the thyroid gland, the nodules grow rapidly, mostly reaching 75px or more within 2 months.
Careful physical examination is often helpful in determining the nature of thyroid nodules. When palpating a thyroid mass. If the nodule is smooth, elastic and moves with swallowing, it is a benign tumor; if the nodule is hard, not smooth and irregular in shape, it should be alerted to the possibility of malignancy; if the nodule is poorly moved and fixed when swallowing, it is most likely to be a thyroid cancer and has infiltrated the surrounding tissues; if the thyroid lump is accompanied by obviously enlarged and hard cervical lymph nodes, it should be alerted to thyroid cancer.
Auxiliary examination
1.Fine needle aspiration biopsy (FNAB): FNAB is a safe and inexpensive diagnostic method to identify benign and malignant thyroid diseases, which can provide the most direct, specific and valuable pathological information. Currently, FNAB is considered the most valuable method to identify benign and malignant nodules. Any suspicious nodule >25px in a single or multiple nodules should be subjected to FNAB.
2.Ultrasound examination: Ultrasound can clearly show the location, number, size, morphology, structure, characteristics and invasion of surrounding tissues of thyroid nodules. Ultrasound imaging features of thyroid cancer include: tiny calcifications in nodules; irregular nodule edges and unclear borders; rich blood supply and disorganized blood flow in nodules.
3.Nuclear imaging: Since most benign and malignant thyroid nodules are cold nodules, nuclear imaging is of little value in differentiating benign and malignant thyroid nodules.
Treatment of thyroid nodules
I. Malignant or suspected malignant thyroid nodules
A definite diagnosis of thyroid cancer must be treated surgically, and complete removal of the tumor lesion is the most critical factor affecting the prognosis.
Suspected cases should be regularly observed and followed up, or pathological diagnosis should be made after surgery.
Benign thyroid nodules
1. Enlarged benign nodules need surgery if they cause pressure symptoms.
L-T4 suppression therapy: In view of the limited efficacy of L-T4 and concerns about the safety of its long-term use, the routine use of L-T4 for benign thyroid nodules is not recommended.
3.Chinese medicine treatment:The effect of Chinese medicine in treating benign thyroid nodules is good. As far as single Chinese medicine is concerned, the node-dispersing effect of Xia Ku Cao, Zhe Bei and Oyster is indisputable, and the node-dispersing effect of proprietary Chinese medicine is also affirmed, such as our Node-dispersing Tablets and Gall Dissipating Tablets, which have been well received by patients. Xia Ku Cao preparations (capsules and oral liquid) are also widely used. Of course, I advocate the use of Chinese medicine to treat both the symptoms and the root cause of the disease, taking into account the clinical manifestations of the whole body and the nail function.