A thyroid nodule is a mass with one or more abnormal tissue structures in the thyroid gland due to various causes. Most commonly seen in women, the prevalence of thyroid nodules obtained by palpation is 3% to 7%; the detection rate of ultrasound examination is about 20% to 76%; the prevalence of thyroid cancer among thyroid nodules is 5% to 15%. However, with the gradual increase of people’s health awareness, the demand for treatment of some benign thyroid nodules (e.g. those with related symptoms, clinically considered to have malignant tendency, combined with high risk factors for thyroid cancer, and those whose normal life is affected by excessive appearance or anxiety in mind) has also increased.
Do thyroid nodules go away on their own?
Most benign non-functional nodules continue to grow, especially solid nodules; the fate of most nodules is not known, but some may become malignant.
What tests do I need to have for a thyroid nodule?
Blood test for thyroid function to understand the functional status of the thyroid gland; urine iodine test to understand the iodine intake of the patient; thyroid ultrasound to understand the number, location and size of the nodules and to identify the benignity and malignancy of the nodules; nuclear examination and fine needle aspiration biopsy to identify the benignity and malignancy of the thyroid nodules if necessary.
What are the treatment options for thyroid nodules and their advantages and disadvantages?
1. Follow-up observation: The advantage is that there is no risk and cost associated with the treatment; the disadvantage is that thyroid nodules do not disappear on their own, most nodules continue to increase in size and a few nodules have the risk of malignancy, which affects the patient’s aesthetics and causes anxiety.
2.Thyroid hormone suppression therapy (levothyroxine): The advantage is that it is economical and does not involve the risks associated with invasive treatment; the disadvantage is that the efficiency is low and the nodules that have shrunk can re-grow in some patients after stopping the medication.
3.Surgery: The advantage is that radical resection of malignant nodules is feasible; the disadvantage is the high risk of postoperative bleeding, hematoma and nerve damage, and the large surgical scar affects the aesthetics.
4.Radioactive iodine treatment: The advantage is that there is no risk associated with invasive treatment; the disadvantage is the risk of radiation damage and hypothyroidism.
5.Minimally invasive treatment.
①Alcohol interventional therapy: the advantages are economical, less invasive and faster recovery; the disadvantage is that it is only applicable to cystic nodules, which are prone to recurrence and require multiple treatments.
②Thermal ablation coagulation therapy: the advantages are small trauma, no scar, fast recovery, and precise efficacy; the disadvantage is that it is not applicable to grade III nodular goiter.
How does microwave thermal ablation coagulation therapy work?
The microwave ablation needle is punctured into the lesion under ultrasound guidance, causing coagulative necrosis of the lesion tissue through high temperature heating, and finally the necrotic tissue is absorbed by the body, thus achieving the purpose of minimally invasive local inactivation of the lesion.
Suitable for microwave thermal ablation coagulation treatment of thyroid nodules are.
① benign thyroid nodules larger than 1cm in diameter.
(ii) Significant nodule growth (more than 50% increase in volume within 1 year, or at least 2 diameter lines increase by more than 20% and by more than 2 mm).
(iii) The patient has symptoms significantly associated with the nodule (e.g., foreign body sensation, neck discomfort or pain).
④ the nodule is significantly convex and affects the aesthetic appearance and requires treatment
⑤ Patients with excessive ideological concerns affecting normal life and refusing clinical observation.
⑥Autonomous functional nodules causing hyperthyroidism symptoms.
Relative contraindications: nodules with solid components larger than 3 cm (requiring fractional ablation).
Contraindications include: abnormal vocal cord function on the opposite side of the lesion, severe coagulation mechanism disorder, and severe cardiopulmonary disease.
What are the complications of microwave thermal ablation coagulation therapy for thyroid nodules and their management?
1. Burning sensation and pain in the neck: a more common complication, sometimes radiating to the head, teeth, both shoulders and chest, usually appearing intraoperatively and relieved immediately by reducing the power or discontinuing treatment, without painkillers.
2, fever: rare, mainly due to the body’s reaction to the high temperature of the microwave fever and the absorption of heat on necrotic tissue, symptomatic treatment can subside.
3, extra-thyroidal hematoma: the incidence of about 2.1%, mostly disappeared within 1 month.
4.Returning laryngeal nerve injury: a more serious complication with an incidence of about 1.3% to 3.3%, which can be avoided by intraoperative conversation with the patient and fractionated ablation.
5.Thyroid function abnormalities: rare and mild, no need for medication, usually found in a week, and normalized after a month.
6, other complications: rare, such as infection, important structural damage (including the skin of the larynx, trachea, esophagus, blood vessels, etc.)
What is the effect of microwave thermal ablation coagulation treatment for thyroid nodules? How many days of hospitalization is required?
Ultrasound-guided microwave ablation for thyroid nodules is a safe and effective method with a final lesion absorption rate of 84.11±14.93%. The hospital stay is usually 3 to 5 days.