Routine physical examination in the surgical examination always less neck palpation of this one, if the physical examination package of higher grade, will increase the neck ultrasound examination. However, this seems to be a simple “a touch”, “a super”, some people have encountered a problem – the medical report more than “thyroid nodules “Five big eye-catching words. Many people are very nervous when they hear the word “nodules”, fearing that they have an incurable disease, staring at the doctor to ask whether their nodules are benign or malignant. Others can not withstand the psychological pressure, that “a long pain is better than a short pain”, simply “eat a knife” to remove the nodules, but not long after the new nodules and so on, such as spring, etc., the incidence of thyroid disease is so high, the patient will often be subdivided into The incidence of thyroid diseases is so high that patients are often referred to various departments such as Endocrinology, General Surgery, Nuclear Medicine, etc., and the diagnosis of the disease has to be made by ultrasonography, pathology and other departments, which is very inconvenient. N possibilities behind thyroid nodules Nodules are a sign of many thyroid diseases, ranging from the most common nodular goiter, thyroid cyst, thyroid adenoma to the dangerous thyroid cancer. As you can see, it is not advisable to be nervous or to leave things as they are. Once a thyroid nodule is detected, it is only scientific to do further examination and evaluation to determine its nature at the first instance. The doctor should collect a complete medical history from the patient and do a detailed examination of the thyroid gland and nearby lymph nodes in the neck. Once the presence of localized enlarged lymph nodes is detected, the nature of the nodes should be highly suspected. In addition, if there are thyroid cancer patients in close relatives or the rapid growth of the mass causes pressure on the trachea and other neighboring organs, with a history of dyspnea, dysphagia, hoarseness, etc., it suggests that the nodule is more likely to be malignant. Ultrasound – non-invasive, fast, inexpensive to explore the nature of the nodule When it comes to determining the nature of the lump, many people first think of doing CT, MRI. In fact, for a superficial organ like the thyroid, ultrasound can provide a clear picture. Today’s ultrasound technology is so advanced that it can detect nodules as small as 2 mm in diameter. ultrasound can not only faithfully display the size, shape, border and location of the nodule, but also indicate whether the nodule is calcified and what the blood flow is like. If tiny calcifications are found in the nodules, localized hypoechoic, and the blood supply between the nodules is relatively rich, it suggests that there is a possibility of malignancy and further examination should be done. Ultrasound shear wave elastography uses the law of Young’s modulus of elasticity in physics to quantitatively describe the deformation of human tissues under stress, so that the elasticity of the lesion can be accurately known. When a doctor performs a thyroid ultrasound on a patient, in addition to understanding the shape, size, length, thickness and other morphological characteristics of the organ and lesion, the ultrasound probe will also release a shear wave that is imperceptible to the human body, and under the action of this special mechanical wave, the human body tissue will undergo a small deformation, which will be accurately captured by the ultrasound probe, and ultimately, through the complex calculations of the elasticity of the tissue of the lesion data. Generally speaking, benign thyroid nodules are soft because they are mostly gelatinous, while malignant nodules are hard because they are angularly branched and contain more fibers, blood vessels, and calcified vesicles. Using this technique to determine the nature of the nodule, the accuracy rate can be nearly 90%. Nuclear medicine – “temperature” to expose the nature of the nodule The thyroid gland has a characteristic, iodine has a special “hobby”, the human body intake of iodine are basically enriched in the thyroid gland, this feature This feature facilitates the examination of the thyroid gland by nuclear medicine. A small amount of radioactive iodine isotope is introduced into the human body and enriched in the thyroid gland through blood circulation. By means of a special gamma-ray camera, the thyroid gland can then be visualized. Depending on the concentration of iodine in the thyroid tissue, different colors are marked. Nodules that take up less iodine are darker in color and are called “cold nodules”; nodules that absorb the same amount of iodine as the surrounding tissue are called “warm nodules”; and if they absorb more iodine than the surrounding tissue, they are brighter in color and are called “hot nodules Hot nodules”. The “temperature” reveals the nature of the nodule. Under normal circumstances, malignant nodules are less likely to absorb iodine, so once the nuclear medicine examination found “cold nodules”, we should be highly vigilant. Pathology – fine needle minimally invasive puncture to determine the final outcome of some preoperative suspicion of thyroid cancer patients did not undergo rigorous examination, then hastily carry out surgery, the results of benign lesions, this is not uncommon. To determine whether a nodule is malignant or benign, and whether surgery is needed, the most reliable way of examination is to puncture the nodule with a fine needle or a coarse needle, and take a small amount of tissue for pathologic examination and diagnosis. When patients hear about the need for puncture, they are often resistant. “Fine-needle aspiration puncture is commonly performed with a 25-gauge needle, is safe and easy to perform, and is one of the most commonly used methods, with or without local anesthesia.” Fine-needle aspiration puncture is not very risky, and only a very small percentage of patients experience localized swelling and pain or bleeding or infection. In some patients with mixed nodules or located in the posterior lobes of the thyroid gland, ultrasound-guided puncture is needed to avoid misdiagnosis. Patients should also undergo ultrasound-guided fine-needle aspiration biopsy when they have a high-risk history of thyroid malignancy or when the ultrasound suggests signs of suspected malignancy, as long as the nodule is greater than five millimeters in diameter. A high-risk history of thyroid cancer includes a first-degree relative with thyroid cancer, a history of external irradiation therapy during childhood, a history of radiation exposure during childhood or adolescence, and thyroid cancer detected during a past partial thyroidectomy. However, there are four situations in which a puncture biopsy is not necessary. The first is a “hot nodule” confirmed by thyroid nuclear imaging, and the second is a purely cystic nodule suggested by ultrasound. If the nodule is highly suspected to be malignant according to the ultrasound image, it is not necessary to perform a biopsy. Fourth, the diameter of the nodule is less than one centimeter and there is no sign of malignancy on ultrasound. Nail and breast department – comprehensive evaluation to avoid blind surgery Malignant nodules should be surgically removed as soon as possible, and after surgery, they should be treated with thyroxine for life for suppression. The malignant nodule should be surgically removed as soon as possible, and after surgery, the patient should take thyroxine for a lifetime to suppress the disease. Some patients blindly remove benign nodules because of the “fear of cancer” and end up with hypothyroidism instead. Benign nodules with normal thyroid function only require regular observation and do not require surgery. However, if benign nodules are combined with hyperthyroidism, which is characterized by elevated levels of triiodothyronine and thyroxine and lowered levels of thyrotropin, medication or isotope 131I treatment is required. If hypothyroidism develops after nodule surgery, long-term replacement therapy with levothyroxine is required.