The thyroid gland is in the upper middle section of the front of the neck and is shaped like a butterfly, like a shield nail. The normal thyroid gland is very thin and is usually not visible or palpable in the neck. Although small, the thyroid gland is the largest endocrine gland in the body and plays an irreplaceable role in human growth and development. Nowadays, hyperthyroidism, hypothyroidism and goiter are becoming more and more troublesome for human beings.
The number of people suffering from thyroid disease is increasing due to environmental factors, lifestyle and work pressure. The results of the “Epidemiological Survey of Thyroid Diseases in Ten Cities in China” show that the prevalence of hyperthyroidism in ten cities in China is 3.7%, hypothyroidism 65% and thyroid nodules 18.6%. In 2010, thyroid cancer ranked sixth among female malignant tumors. Such a high incidence rate is relatively low compared with the awareness rate, treatment rate and treatment compliance rate of patients.
In recent years, the number of outpatient clinics reflects the increasing number of hyperthyroidism, hypothyroidism and thyroid nodules, accounting for one-half of the size of specialist clinics, and thyroid diseases have become the most common type of diseases in endocrinology. On the one hand, this is related to the fast pace of life in modern cities and the high pressure of life; on the other hand, the detection rate and detection rate of these diseases have also increased significantly because the level of detection is higher and the means of detection are more abundant than before.
Nowadays, thyroid ultrasound and thyroid function tests are routine items in the physical examination of many employees. This has resulted in the detection of many patients with Hashimoto’s hypothyroidism and thyroid nodules. Many young staff members have this side of the problem detected in time, so it looks as if the disease is occurring at a younger age.
There are many disciplines involved in thyroid disease. Surgery requires specialists in general surgery and nail and breast surgery, ultrasound requires specialists in ultrasound, postoperative pathology requires specialists in pathology, and radiation therapy requires specialists in isotope therapy. If there is not multidisciplinary cooperation, patients have to go back and forth, which brings inconvenience to the consultation. It is best to have multidisciplinary cooperation in the treatment of thyroid diseases, pooling the strengths of different departments to form a network. “For example, if a patient is found to have a thyroid nodule in the endocrinology clinic and is suspected of having a malignant lesion. The patient will be referred to general surgery.
If iodine 131 radiotherapy is required based on the post-operative pathology, he will also be recommended to the nuclear medicine department for treatment. In fact, we have developed a multidisciplinary mutual support in the physician community.
Because of the overall management issues involved. We advocate multidisciplinary cooperation for various common diseases. This will pool the hospital’s superior resources as much as possible to provide higher services to patients, improve diagnostic efficiency, and improve management, rather than having patients running around inside the hospital.”
Which department should I see if I have a problem with my thyroid? For example, if a thyroid nodule is found, if it is just discovered, the first thing you should do is to visit the endocrinology department, where the endocrinologist will conduct a comprehensive medical history inquiry and physical examination to improve the relevant tests, which is equivalent to the initial screening of the patient. If the lesion is benign, regular follow-up is sufficient: a very small number of patients with suspected malignant lesions require progressive tests, such as fine needle aspiration cytopathology and molecular diagnosis.
Through this process, high-risk groups are identified and confirmed before proceeding to surgical treatment. The entire process is intertwined, with the internist in charge of initial screening and regular follow-up, the surgeon in charge of surgical treatment, the nuclear medicine surgeon in charge of post-surgical isotope treatment, and the endocrinologist again in charge of post-surgical management and follow-up.
Thyroid cancer is preventable and treatable with low recurrence rate
With the prevalence and youthfulness of thyroid disease, the incidence of thyroid cancer is now increasing year by year. Thyroid cancer can be divided into differentiated thyroid cancer including papillary thyroid cancer and follicular thyroid cancer, and low differentiated thyroid cancer such as medullary carcinoma and undifferentiated thyroid cancer.
The cause of thyroid cancer is not well understood and may be related to a number of factors such as history of exposure to radiation, increased estrogen production, genetic factors, or other benign thyroid diseases such as nodular goiter, hyperthyroidism, thyroid tumors, and especially chronic lymphocytic thyroiditis. Differentiated thyroid cancer is more common in females and is commonly seen between the ages of 30-60.
Differentiated thyroid cancer develops slowly. Patients may find a painless lump in the neck that gradually increases in size, which may be discovered unintentionally by themselves or during physical examination, or during ultrasound or other examinations. On physical examination, the cancer is mostly hard, with smooth surface and clear border. If the cancer is confined to the thyroid gland, it can move up and down with swallowing, while if it has invaded the trachea or adjacent tissues, it is more fixed.
”After screening, benign thyroid tumors are not treated by surgery as much as possible, but as long as it is thyroid cancer, that is, malignant tumor, it should be removed by surgery regardless of its size”, Director Shen Meiping introduced. “Our hospital has 30 beds dedicated to thyroid patients, which is already considered a lot, . But it’s still not enough for patient demand, and patients have to wait in line for surgery.” One of the more obvious features of thyroid cancer is that it is detected relatively early, there are more early cancers, and early cancers have a good prognosis and can basically be cured. This makes early thyroid cancer less prone to metastasis, with a high cure rate and a low recurrence rate.
The benignity and malignancy of nodules have little relationship with size
The improvement of the resolution of ultrasound examination nowadays makes the screening detection rate of 20-76% in the population. Small lesions of 1-2mm that were previously undetectable can now be detected, but thyroid nodules are not as benign or malignant as their size, as the Thyroid Imaging Reporting System classifies thyroid nodules into grades 1-6. Grade 4B has a l0-80% chance of being malignant; Grade 5 has a high chance of being malignant, that is, more than 80%: Grade 6 is for patients who have undergone a puncture test or have a history of related surgery. Most hospitals now perform grade evaluation in such a standardized procedure.
The biggest advantage of ultrasound-guided puncture examinations is that they are more precise. Many nodules are small, only a few millimeters, and cannot be done at all without ultrasound-guided localization. Benign nodules are generally regular in morphology and homogeneous in echogenicity. If the nodule is irregular in shape, very hypoechoic, with punctiform calcified echogenicity and starfish-like peripheral borders, the typical characteristics of a malignant thyroid nodule should be taken seriously and a puncture biopsy is often recommended for a clear diagnosis.
Many small nodules are accompanied by uneven echogenicity and nodular changes in the thyroid gland, which are very common in the population and pose no health risk and rarely cause abnormal thyroid function.
The literature shows that the prevalence of thyroid nodules in the population is very high, and if ultrasound is used for screening, there is a 40-60% prevalence rate, and 85-90% of nodules are likely to be benign. When a thyroid nodule is detected, there are two issues that we should be concerned about. One is how the nodule was obtained. The first is how the nodule got there and whether it has affected the normal function of the thyroid gland. A thyroid function test can be done at the hospital to determine the function of the thyroid gland.
If the function is normal and the nodule is not particularly large. If there are no obvious symptoms of pressure, you can observe it first. If you are still unsure, you only need to have a regular annual checkup. Don’t assume that a nodule is cancerous when you see it. In other words, most of them are benign lesions. The second is the benignity and malignancy of the nodules. The most meaningful tests to determine the benignity and malignancy are ultrasound and fine needle aspiration pathology of thyroid nodules.
In general, lesions with calcification have a higher incidence of malignancy than those without calcification. However, it does not mean that calcification equals malignancy, but it depends on the nature of the calcification. If the calcification is coarse and flaky, it is usually a benign nodule, but if the calcification is small and gravelly, it should be taken seriously.
Hyperthyroidism becomes hypothyroidism is not terrible
The clinical manifestations of hyperthyroidism (hyperthyroidism) are mainly caused by excessive circulating thyroid hormones in young and middle-aged women, mainly manifesting as agitation, irritability and insomnia, palpitations, fatigue, fear of heat, excessive sweating, emaciation, hyperphagia, increased stool frequency or diarrhea, scanty menstruation in women, and varying degrees of thyroid enlargement in most patients during physical examination.
Hypothyroidism may affect the metabolism of lipids in the body, and severe hypothyroidism may cause dyslipidemia, which may manifest as hyperlipidemia. This can lead to arteriosclerosis, and can even cause edema of the heart muscle cells and hypothyroid heart disease. In addition to affecting metabolism, hypothyroidism also has an impact on the body’s harmful systems, including the nervous system and cardiovascular system. Severe hypothyroidism may cause patients to be depressed and even show depression. Hyperthyroidism can be treated by three ways: anti-thyroid medication, l31 iodine therapy, and surgery, while hyperthyroidism is often treated as hypothyroidism.
Such a situation is inevitable when hyperthyroidism is treated as hypothyroidism. Hyperthyroidism is characterized by a large neck with high indicators, and iodine 131 is used to reduce the size of the thyroid gland and bring down the indicators. However, it is difficult to grasp the degree of reduction, and it is also difficult to estimate the response of the patient’s own thyroid tissue to the administration of the drug. Some people are very sensitive to Iodine 131 and their thyroid tissue shrinks to a small size; some people are not sensitive to Iodine 131 and it may not work twice.
Eventually, the thyroid gland shrinks too much and becomes hypothyroid. In other cases, the degree of shrinkage is appropriate and the effect is good for a long time afterwards. You don’t take any medication. However, we have only shrunk the thyroid tissue, but the part of the thyroid gland that remains in the body is still a diseased tissue, and this diseased tissue will progress, and its own function will slowly decline, and hypothyroidism may appear after three or five years or longer.
Therefore, hypothyroidism is an inevitable outcome of iodine 13l treatment. In some Western countries, hypothyroidism is the target of treatment for hyperthyroidism because it is more damaging to the body than hypothyroidism, more troublesome to control, and more side effects of the drugs used to treat it. Hypothyroidism, on the other hand, is simpler, requires only one medication and is easy to control, has a longer follow-up interval, and has basically no side effects and is well tolerated by the body. This simplifies a complex disease into a simple, controllable and stable state for the purpose of treatment.
Is there any damage to the patient’s other organs with iodine 131 treatment? Iodine 131 treatment may affect other organs in the short term, such as the gastrointestinal tract, which may cause nausea and a drop in white blood cells, but these are short-term and will recover in a week or two. For patients with hyperthyroidism, it is a small price to pay for a big benefit, a short-term discomfort or damage in exchange for a cure of hyperthyroidism or thyroid cancer, and a big benefit overall.
Uncertainty about the relationship between thyroid disease and diet
Whether there is a relationship between thyroid disease and diet is unclear, says Vu Xiaohong. The iodine intake has increased in recent years with the popularization of iodized salt. With the increase in iodine intake we can see an increase in the incidence of thyroid disease. However, it cannot be said that the increase in iodine intake is a direct result of this phenomenon, but there may be a correlation between them. The results of the urinary iodine survey in Jiangsu province show that there is a mild excess of iodine, but this range is still safe.
The national authorities are aware of this, and in recent years the amount of iodine added to salt has been gradually reduced. The state has made adjustments to the amount of iodine supplementation according to the situation in different regions, becoming more scientific and standardized, rather than a simple one-size-fits-all policy, so that the negative impact on our health is becoming smaller and smaller just in terms of iodization.
Lifestyle, however, has an important impact on thyroid disease. The pace of life in modern society has led to the inevitable pressure on young workers from all aspects of their work careers and families. We should advocate regular life, scientific and reasonable diet, regular exercise, and avoid long-term ambulatory work and late night work. This can have a preventive effect not only on endocrine diseases and thyroid diseases, but also on diseases of the whole body.
The incidence of thyroid diseases is higher in women, such as thyroid nodules, which are three times more common in women than in men. This may be related to women’s hormone secretion, but the specific mechanism is still unclear in the research, this phenomenon is common in the population.
If your thyroid gland is large or swollen, you should rely on medical professionals to check whether your neck is thickened by looking in the mirror. By the time you can see it yourself, it will be bigger and more obvious. Therefore, it is recommended that people over the age of 35 should have an annual thyroid checkup so that problems can be detected and treated in a timely manner.