1. What is the value of thyroid ultrasound in the diagnosis of thyroid nodules?
First, thyroid ultrasound can confirm the presence or absence of thyroid nodules, which can usually be detected by ultrasound if the nodules cannot be reached by hand. Second, it can also determine the size, number, location in the thyroid, texture (solid or cystic), shape, borders, presence of calcification, blood supply and relationship to surrounding tissues of the nodule. Finally, it also reveals the presence of enlarged lymph nodes in the neck region and the size and shape of the lymph nodes. If the ultrasound reports: a purely cystic nodule, or a nodule with spongy changes consisting of multiple small vesicles occupying more than half of the nodule volume. This result almost confirms the diagnosis of benign. An ultrasound report may contain.
(1) An abundant and disturbed blood supply in the nodule.
(2) Irregular morphology and poorly defined borders of the nodule.
(3) microcalcifications, pinpoint diffuse or clustered calcifications within the nodule.
(4) Abnormal ultrasound images of lymph nodes in the neck, such as round lymph nodes, irregular or blurred borders, uneven internal echogenicity, internal calcifications, and poorly demarcated skin medulla, etc. In these cases, the chance of thyroid cancer increases a bit. A comprehensive judgment by an experienced doctor is needed.
2. What should I do after finding a thyroid nodule?
After finding a thyroid nodule, you should go to an endocrinologist. First, a detailed medical history will help determine the nature of the nodule. Most thyroid nodules can coexist peacefully with the thyroid gland and will not increase in size or will not increase in size significantly; nodules with symptoms of hyperthyroidism such as panic, fear of heat and excessive sweating may be high-functioning adenomas or early stages of Hashimoto’s thyroiditis or subacute thyroiditis; nodules with symptoms of hypothyroidism such as fear of cold, weakness and swelling are usually late stages of subacute thyroiditis and Hashimoto’s thyroiditis; nodules with a history of exposure to radiation in the neck in childhood have a high chance of malignancy; nodules with a history of exposure to radiation in the neck have a high chance of malignancy. If a nodule has been present for many years, the possibility of malignancy should be considered when the nodule increases painlessly and significantly in a short period of time. Secondly, some necessary laboratory tests should be done after the nodules are found, including thyroid function and thyroid autoantibody measurement to clarify the function of thyroid nodules. In addition, for thyroid nodules that are suspected to be malignant, fine needle aspiration should be performed to obtain pathological examination. Finally, regular follow-up is very important. Ultrasound of the thyroid gland every six months can compare the size and changes of the nodules and is very valuable in determining the benignity and malignancy of the thyroid nodules.
3. In what cases should fine needle aspiration cytology be performed?
The best way to distinguish between benign and malignant thyroid nodules is ultrasound-guided fine-needle aspiration cytology (FNA). However, so many patients with thyroid nodules cannot all be examined by FNA. FNA is performed mainly on nodules ≥1 cm in diameter and on nodules that are not very large but have
(1) have had radiation therapy to the head and neck.
(2) A family history of medullary thyroid cancer.
(3) Age <20 years or >70 years.
(4) Rapidly growing nodules.
(5) hard nodules with indistinct margins.
(6) immobilization of the nodule.
(7) Enlarged cervical lymph nodes.
(8) Hoarseness, cough, dysphagia, dyspnea, etc.
A very fine needle is used to aspirate the thyroid tissue for cytological examination. It is the gold standard for preoperative differentiation of benign and malignant thyroid nodules and is an effective method for the diagnosis and differential diagnosis of many thyroid diseases. Fine needle aspiration is performed by aspiration, and the aspirated tissue is hidden in the needle core due to negative suction, so that it will not leak out and contaminate other levels of tissue. So far, no tumor implantation in the needle tract has been reported in the use of fine needle aspiration for thyroid nodules, so there is no need to worry about the spread of tumor caused by aspiration. Our ultrasound department mainly uses ultrasound-guided puncture of thyroid nodules for examination, which is safer and more accurate in diagnosis.
4. What are the treatments for benign thyroid nodules?
Not all thyroid nodules need to be treated. The tests mentioned earlier can help doctors distinguish which nodules need to be treated and which do not require interventional treatment and can only be followed up and observed. There are several treatment options: medications, surgery, isotopes, and anhydrous alcohol injections. Of course, the choice of treatment depends on the specific situation and is sometimes adjusted, for example, patients who are initially followed only periodically may require surgery because of rapid nodule growth or calcification. Recommended surgical treatment includes the following conditions.
1, for rapid growth, high suspicion of malignancy, and puncture confirmed malignancy.
2, for large nodules and the presence of local pressure symptoms clearly associated with the nodules, and where non-surgical treatment is ineffective.
3, nodules with combined hyperthyroidism. In conclusion, the final treatment plan is developed after weighing the pros and cons and after full communication with the patient.