I. Definition
A thyroid nodule is a mass of one or more abnormal tissue structures in the thyroid gland due to various causes. Thyroid nodules can be classified by their nature as hyperplasia, cyst, adenoma, cystic adenoma, carcinoma, sarcoma, etc. Until their nature is determined, they are collectively referred to as thyroid nodules. Until the nature of the nodules is determined, they are collectively referred to as thyroid nodules. According to the number of nodules, they can be divided into single nodules and multiple nodules.
1.Single nodule
①Thyroid adenoma;
②Thyroid cancer;
(3) Hyperplastic thyroid nodules;
④Thyroid cysts;
⑤ Metastatic tumor.
2.Multiple nodules
①Non-toxic goiter;
②Iodine deficiency goiter;
③Chronic lymphocytic thyroiditis;
④Toxic nodular goiter;
⑤ Metastatic tumor. According to the benignity of the nodules, they can be divided into benign and malignant nodules.
Diagnosis
1. Palpation of the deep thyroid gland and small nodules in the back are not easily detected by palpation.
2.Functional diagnosis
(1) Blood TSH, T3, T4 measurement;
(2) Nuclear tests and nuclear scans are used to diagnose the function of the nodule and the location of the ectopic thyroid. lTSH is low – if it is a “hot” nodule, identify a high-functioning adenoma; if it is a “cold” nodule, do a thyroid puncture cytology ( For “warm” nodules, “cool” and “cold” nodules – perform FNAC and thyroid ultrasound; l99mTc-MIBI – diagnosing thyroid cancer has some value.
3. Thyroid-related antibodies – TGAb, TMAb and TPOAb – are important for the diagnosis of autoimmune thyroid disease.
4.TgC thyroglobulin assay Tg is elevated in most thyroid diseases; the sensitivity and specificity of diagnosing thyroid cancer are not high; as a follow-up indicator after thyroid cancer surgery.
5.CTC calcitonin assay CT screening helps to detect C-cell hyperplasia and MTC at an early stage; pentagastrin stimulation test can improve the specificity; 100pg/mL suggests MTC.
6.Thyroid imaging examination
(1) High-resolution ultrasound
①To determine the number, size and distribution of nodules;
②Identify solid or cystic;
③Whether the “mass” in the neck is related to the thyroid gland;
④Guiding fine needle aspiration biopsy and injection of sclerosing agent.
(2) Ultrasound elastography is useful for the differential diagnosis of benign and malignant thyroid nodules.
(3)CT
①Single or multiple nodules;
(2) The extent of the nodule and its relationship to the surrounding area;
(3) Malignant lesions;
④compressive or invasive lesions;
⑤ Preoperative localization and postoperative follow-up.
(4) MRI is generally not performed as a routine examination.
①The extent of the nodule and its relationship to the surrounding area;
②Vascularity of the thyroid gland or adjacent vascular lesions of the thyroid gland.
(5) PET-CT is generally not performed as a routine examination. It is used as a screening tool for metastasis to assess the rapid progression of disease and morbidity and mortality in high-risk patients.
7. FNAC is the most reliable and valuable diagnostic method to identify benign and malignant nodules. FNAC should be performed for all suspected malignant changes; FNAC can be used to clarify the cytological type of the cancer before surgery, which helps to determine the surgical plan.
III. Treatment
1.Treatment of benign nodules
(1) L-T4 inhibition therapy.
To shrink existing nodules and prevent the production of new nodules. The overall effect is not satisfactory, and the adverse effects are clear osteoporosis/atrial fibrillation. Not recommended for widespread use, but only for a small number of patients with benign thyroid nodules living in iodine-deficient areas, with small nodule size and younger age.
(2) Ultrasound guidance.
Subcutaneous percutaneous alcohol injection (PEI): mainly used to treat thyroid cysts or nodules combined with cystic changes. This method has a high recurrence rate. Large or multiple cysts may require multiple treatments to achieve better results. This method is not recommended for solid benign nodules.
(3) Radioactive 131 iodine treatment.
①Autonomous high-functioning adenoma;
②Toxic nodular goiter with thyroid volume less than 100 ml;
(3) Those who are not suitable for surgical treatment or those with recurrent toxic nodular goiter treated by surgery. Forbidden for pregnant and lactating women.
(4) Surgical treatment.
①Patients with thyroid nodules presenting with local pressure symptoms;
(ii) With hyperthyroidism;
③Progressive enlargement of the nodule;
(4) Surgery: ①Patients with local pressure symptoms; ②Patients with hyperthyroidism; ③Patients with progressive enlargement of nodules; ④FNAC suggesting suspicious cancer
(2) Treatment of malignant nodules Most malignant tumors of the thyroid gland require surgery as the first choice.