There are more and more people around who have thyroid nodules. With the increasing technology of screening devices, when the resolution of ultrasound reaches 1mm, 60-70% of Chinese people can detect thyroid nodules. This means that 2 out of 3 Chinese people have nodules. This makes it seem like thyroid nodules are not even a disease anymore.
We often hear about people who go for medical checkups and find out that they have multiple thyroid nodules. Whoever has a nodule in the thyroid gland that was detected during a physical examination at work has to undergo surgery. Yes, thyroid nodules are so painless and insidious. More and more people are suffering from thyroid nodules, does it matter or not?
Of thyroid nodules, 85-95% are benign nodules. Of the malignant thyroid nodules, more than 90% are low-grade malignant.
1. Is ultrasound or CT or MRI better to check the thyroid?
Ultrasound is the most accurate imaging test for the thyroid, but CT and MRI are not as good. Unless you want to see the details of the surrounding tissues, you can do MRI again.
2. How do I look at the ultrasound results of the thyroid?
Ultrasound looks at 3 points: in order of weight: border – calcification – blood flow.
The following are some of the common descriptions on the report.
(1) “Poorly defined borders”.
Benign nodules generally have clear borders, and malignant ones because they have invasion of surrounding tissues. The borders can be unclear. However, inflammatory lesions, which are not malignant because they can be exudative, also have unclear borders.
(2) “Dotted strong echogenicity”.
It can be seen in two conditions: one is colloid, which is a sign of benign. One is calcification, malignant generally have calcification, and mostly microcalcifications; however, having calcification is not always malignant.
(3) “Internal blood flow disturbance”.
Blood flow is divided into internal blood flow and external blood flow. Malignant ones mostly have internal blood flow disturbances.
(1) Poorly defined borders.
(ii) Microcalcifications.
③Internal blood flow disorder.
If these 3 points are not present at all, there is no need to be concerned, as the possibility of benign is high. If you have 1-2 points, you should have a puncture, and if you have all 3 points, there is a high possibility of malignancy.
To identify benign and malignant nodules, in addition to the above three points, we can also look at: whether there are adhesions with surrounding tissues, whether there are lymph node metastases, whether there is rapid growth within a short period of time, the growth pattern (malignant nodules with longitudinal growth are more likely), the size of the nodule (surgery is also recommended for nodules >50px), and so on.
It is worth noting that the experience of the ultrasound doctor and the resolution of the machine may have a great impact on the judgment of the ultrasound results, and the ultrasound results are a particularly important reference for determining the nature of the nodule, so it is recommended that those who need to clearly identify the nature of the nodule can go to a large hospital to find an experienced ultrasound doctor to do the examination.
3. What about benign nodules?
High TSH can cause thyroid nodules to grow, so people with nodules require low TSH, between 0.5-1.0.
TSH has a feedback relationship with T3 and T4. High TSH can promote higher T3 and T4 levels; and higher T3 and T4 will in turn feedback to make TSH levels lower.
People with nodules should lower their TSH levels appropriately. What are the methods? The first choice is dietary therapy.
What foods shrink nodules?
Seafood. Yes, you read that right, seafood. People with benign thyroid nodules eat more seafood, not seafood as people think they can’t eat if they have nodules, but if TSH is >2.5, they need to take Eugenol to control the nodules.
What foods will grow nodules?
Cruciferous foods: cabbage, white radish, etc., because it can make T3, T4 synthesis is blocked, thus elevating TSH, so it is long nodules, eat less, but is not contraindicated, after all, you can not eat too much a day.
In addition, it is worth noting that patients with thyroid nodules, as long as TpoAb, TgAb, TRAb these antibodies are negative, no need to avoid iodine; if TpoAb, TgAb, TRAb positive, it is necessary to eat less kelp, nori type high iodine food.
Benign nodules can be reviewed regularly by ultrasound. It is normal to have a deviation of a few millimeters from the nodule size described on the result report due to the difference in the ultrasound probe section each time. Although benign nodules can be treated with dietary therapy, there are no measures that can significantly reduce the size of nodules. There is no need to be demanding, as benign nodules need not be too concerned at all, as long as they are not significantly larger, do not hurt, and do not affect thyroid function.
4. Talking about iodine in food
If the iodine in table salt is counted 1 times, then
① seafood such as seaweed, nori and seaweed is 1000 times;
② shellfish and crab are 100 times more;
③Fish, shrimp, squid, squid is 10 times;
④ Chicken essence is 700 times.
5.Thyroid cancer.
Malignant thyroid tumors, according to pathological types, are classified as papillary carcinoma, follicular carcinoma, medullary carcinoma, undifferentiated carcinoma, lymphoma and metastasis. Among them, low-grade malignant ones, including papillary carcinoma and follicular carcinoma, account for about 92%. The three-year survival rate is over 90%. These low-grade malignant tumor tissues can take in iodine, and even if there is metastasis, it can be killed with isotopes (radioactive iodine) regardless of the part of the body to which it has metastasized.
Follicular tumors and follicular carcinomas cannot be distinguished by fine needle aspiration, and only by biopsy can we observe whether they break through the envelope and thus distinguish them. Moreover, even in the case of follicular tumors, there is no way to predict when they will break through the envelope. Therefore, as long as it is a follicular tumor, surgery is recommended regardless of whether it is a tumor or a cancer.
There has been controversy about the need for surgery for papillary carcinoma. One side believes that knowing the pathological result is malignant, it is easy to have long-term psychological burden if not operated; and if metastasis occurs, it needs to be treated with isotope, and surgery is still necessary before treatment. So they think that as long as it is determined to be malignant, it must be operated. On the other hand, the other side believes that it is over-medication to operate one thyroid cancer when one is found. Because according to a Japanese study, the metastasis rate of papillary thyroid cancer is 1% at 5 years and 5% at 10 years, and no post-operative re-metastasis has been observed to occur when you go for surgery after metastasis is found. Therefore, surgery does not need to be so aggressive, resulting in over-medication.
And there is a controversy about whether the surgery should be total or partial resection.
The standard treatment process for differentiated thyroid cancer: total or near-total surgical excision – radioactive iodine therapy for residual lesion removal – levothyroxine T4 drug for TSH suppression therapy for more than 10 years – whole body scan and Tg examination within 1 year.
Postoperative TSH suppression therapy: for those with metastasis, TSH control is required at 0.1-0.5. for those without metastasis, control is required at 0.5-1.0.
In addition to the postoperative nail function check, CEA and other tumor markers should be followed up, and blood calcium and parathyroid hormone (PTH) levels should be checked at least once to clarify whether the parathyroid glands, which are easily damaged during surgery, have been affected, and the parathyroid glands are related to the regulation of blood calcium and blood phosphorus levels in the body.