The thyroid gland is the largest endocrine gland in the body and is also one of the most susceptible to disease. From a surgical point of view, thyroid disorders are classified as thyroid adenoma, nodular goiter, hyperthyroidism, chronic lymphatic thyroiditis and thyroid cancer.
The high incidence of thyroid disease is concentrated in the age group of 30-50 years old, with a predominance of women, roughly seven times that of men. Although the incidence of thyroid disease is high, its prognosis is very good. With early detection and standardized treatment, the cure rate of thyroid cancer is very high, with a ten-year survival rate of about 95.2%.
I. Which thyroid nodules should be alerted to cancer
The incidence rate of thyroid nodules is 7%, which is a very high incidence rate (for example, the incidence rate of stomach cancer is 50/100,000). This nodule may be benign or cancerous, and it is thought that one quarter of solid, solitary thyroid nodules are thyroid cancer.
A thyroid nodule is a nodular growth on the thyroid gland. It may be a nodular goiter, a sarcoidosis, thyroiditis, thyroid adenoma or thyroid cancer, all of which are collectively called thyroid nodules until they are characterized.
Size is not the only indicator of whether a thyroid nodule requires surgery. Some nodules may be as small as 0.8 cm in diameter, but if they have a malignant tendency, they need to be cut out as soon as possible. If the nodule appears benign on ultrasound, then we will consider removing it only when it is 3 to 4 cm in diameter. If the ultrasound indicates a thyroid adenoma, it is also best to remove it surgically because 10% of thyroid adenomas become cancerous as they grow.
How do I know that a nodule is malignant? There are several conditions that need to be alerted for thyroid nodules.
1. A single nodule is more dangerous than multiple nodules;
2. A single nodule is hard, fixed and painless;
3, fast growing;
4. Ultrasound indicates that the nodule has tiny calcification points;
5, ultrasound suggests hypoechoic nodules, hypoechoic nodules are more likely to be malignant than medium or high echogenic nodules;
6. Solid nodes are more dangerous than cystic or cystic nodes;
7. The adjacent cervical lymph nodes are enlarged;
8, causing pressure symptoms or hoarseness.
Second, not all thyroid nodules need surgery
Nowadays, many hospitals take a one-size-fits-all approach to thyroid nodules, as long as the nodules are diagnosed, regardless of whether they are single or multiple, benign or malignant, they all take surgery. This is not advisable, Liu Yuewu pointed out. The nodular goiter, itself a multiple nodules, and almost not cancerous, if it is removed at about 1 or 2 cm, it will do more harm than good.
Multiple goiter nodules generally require surgery only if they are large enough in diameter to cause unsightly neck, or to compress the trachea, or to cause hyperthyroidism. If a woman develops a nodule at the age of 40, she may not need surgery until she is in her 50s because the nodule grows slowly, so that even if the nodule grows again after surgery, most of them will not need surgery again in their lifetime. However, if the surgery is performed at the age of 40, you may need to undergo another surgery at the age of 55 because of recurring and growing nodules, and if the surgery is not done properly, you may have to undergo a third surgery after the age of 55.
Moreover, due to the adhesions after surgery, the chance of reoperation causing damage to the recurrent laryngeal nerve increases significantly, leading to hoarseness; for example, the probability of damage to the recurrent laryngeal nerve is about 0.1% for the first surgery and 3% for the second.
Thyroid cancer is a malignant tumor with high cure rate
In recent years, the incidence of thyroid cancer has been increasing significantly, and the incidence rate is almost 300% of the past. The reasons for this are firstly, people pay more attention to their health and pay more attention to medical checkups, especially the update of neck ultrasound, CT and other examination techniques, which make the previously neglected and asymptomatic cases to be discovered. Secondly, other factors such as environment, diet and personal emotions may also be triggering the increased incidence of thyroid cancer.
Thyroid cancer cells grow slowly and are not very malignant, and the most common type of thyroid cancer is papillary cancer, which does not metastasize easily from blood, but mainly from lymphatic metastasis, so most of them only metastasize in the neck, which is easy to treat.
Generally speaking, patients with intermediate to advanced thyroid cancer need radiotherapy after surgery, while early stage and even some intermediate stage patients can be treated without radiotherapy. The prognosis of thyroid cancer in early stage is good, and the survival rate is about 95% in ten years after surgery. However, he also reminded patients that they should not feel that thyroid cancer is “safe” because of its low malignancy. If it is not detected and diagnosed early and treated in time, the prognosis of advanced thyroid cancer will be affected.
In addition, even if the cancer is small, if it grows close to the laryngeal nerve, it will invade the nerve at an early stage and cause hoarseness, which is not uncommon.
Fourth, the nodules on the basis of Choban’s disease have a high cancer rate
Chronic lymphatic thyroiditis, also called Choban’s disease, is one of the most common types of thyroiditis. Simply put, it is a type of autoimmune disease in which the body produces lymphocytes that attack its own thyroid gland.
Most cases are asymptomatic, but in a few cases there is slight pain or pressure symptoms such as tightness in the neck, and the texture is tough and rubbery to the touch.
As the disease progresses, when the thyroid gland reaches a certain level of destruction, more than half of the patients may develop symptoms of hypothyroidism, such as fear of cold, weakness, weight gain, etc.
The nodules that grow on top of Hashimoto’s disease are prone to cancer, and some studies suggest that the percentage of cancer is as high as 23%. Therefore, for people with thyroiditis combined with thyroid nodules, the indications for surgery need to be relaxed.
Five, thyroid regular regular checkup is the way out
With the increase in social competition and work pressure, thyroid disease has been on the rise in recent years. Because this disease has a certain insidiousness, early detection is not easy, so early detection and prevention is more important.
”Especially stressed women, it is best to add a thyroid ultrasound to their routine medical checkups. Ultrasound is the best means of diagnosing thyroid disease, and in addition to being very accurate, it is also economical and non-invasive.”
And for patients who have been diagnosed with benign thyroid nodules, it’s also a good idea to see a specialist every six months for a formal checkup and appropriate treatment.