Thyroid nodules are common in the population, especially when ultrasound machines are improved with a resolution of 1 mm, and the detection rate of thyroid nodules in a randomly selected population is as high as 70%, meaning that almost 2 out of 3 Chinese have nodules. Therefore, it is especially important to treat thyroid nodules, especially benign ones, correctly. 1. Is B-ultrasound or CT or MRI better for determining thyroid nodules? There is a misconception among some patients that the more expensive the test is, the more accurate it is. However, in thyroid imaging, ultrasound is the most accurate way to determine benign and malignant thyroid nodules, and higher value CT and MRI are not as good, unless you want to look at the goiter behind the sternum or suspect the invasion of surrounding soft tissues, including trachea, esophagus and blood vessels, then you can do CT or MRI. However, the biggest disadvantage of ultrasound is that it is very subjective and different doctors will have their own interpretation of the imaging changes they see, especially in the judgment of early nodules and lymph node metastases. Therefore, if you have doubts about the ultrasound results, it is best to review them with an experienced ultrasound doctor at a large hospital. 2. How to interpret the description of nodules by ultrasound of the thyroid gland The description of ultrasound is mainly based on 3 points, in order of weight: calcification – border – blood flow. ”Calcification”: the description of ultrasound can be strong echogenicity, which can be seen in two cases: one is the change of colloid, often in accompanied by surrounding echoless area, which is a sign of benignity, and one is calcification within the solid area, which is also divided into fine calcification and coarse calcification, tiny calcification is mostly the calcium salt deposition of malignant cells, if there is typical fine calcification, its The possibility of malignancy is nearly 90%; coarse calcifications are generally benign lesions, but some scholars have calculated that there is also a malignant proportion of nearly 20% in patients with coarse calcifications. ”Border is not clear”: benign nodules generally have clear borders, malignant ones because there is invasion of surrounding tissues, the borders can appear burr-like changes, but sometimes inflammatory lesions, because there can be exudation, the borders can also be more blurred. ”Abundant blood flow”: Abundant blood flow alone does not diagnose malignant nodules, often inflammatory nodules can also be present, and such cases require close follow-up. 3. How to look at puncture biopsy Although there is controversy over whether to perform puncture biopsy on all suspicious nodules, it is undeniable that the means to achieve a definitive diagnosis preoperatively is fine needle aspiration cytology of thyroid nodules. However, because of the rich blood supply to the thyroid gland and the inability to effectively compress the area, puncture cannot be done as in the case of breast biopsy, but only fine needle aspiration, and the diagnosis of pathology can only be cellular, with a deviation of about 15% from the histopathological diagnosis, and the actual compliance rate may be even lower based on the skill and experience of the puncture operator and cytopathologist. In contrast, with the current advances in ultrasound technology, including the determination of elasticity index and contrast, the diagnostic accuracy of ultrasound in some large hospitals has reached more than 90%, therefore, puncture may not be more advantageous than ultrasound in terms of diagnostic value. 4. How to treat benign nodules The location of the thyroid gland is on both sides of the trachea, so if there are no symptoms of pressure on benign nodules, there is no need to ask for the disappearance of benign nodules, the most important thing is to review the ultrasound regularly, once a year, and consider surgery if there is a significant increase. There are no medications available to eliminate the thyroid gland, and although ultrasound ablation is now recommended by many hospitals, it is equivalent to surgical excision and has a high chance of recurrence. Therefore, as long as a benign nodule is not significantly larger, is not painful, and does not affect thyroid function, there is no need to be concerned.