Q: What is a thyroid nodule?
A: A thyroid nodule is a raised lesion on the thyroid tissue that is different from normal tissue and can be detected by palpation or ultrasound. In layman’s terms, it is a lump in the thyroid gland, which usually has no symptoms.
Q: What is the incidence of thyroid nodules in China?
A: Since the use of ultrasound for physical examination, the detection rate of thyroid nodules in the population has increased from 4% to 20% to 50%, with female patients being four times more likely than male patients. Among thyroid nodules, 80% are nodular goiter, which is a proliferative and degenerative disease of the thyroid gland, not a tumor. 5% to 10% are thyroid cancer, which requires surgery. Another 10% or so are benign nodular diseases such as Hashimoto’s thyroiditis and thyroid adenoma.
Q: Will there be any pain or redness?
A: Some inflammatory thyroid conditions such as subacute thyroiditis and Hashimoto’s disease can be painful, also manifesting as nodule-like hardness and swelling that hurts when touched, and possibly fever, which are called inflammatory nodules. There are also patients who need to have a puncture to confirm whether it is an inflammatory disease or a malignant tumor.
Q: What tests will the doctor do to determine the nature of the nodule?
A: First, they will look at the neck for abnormal protrusions, and large nodules can be clearly seen. Secondly, the doctor will ask the patient to do swallowing action to see if there is any lump in the neck and whether it can be moved. In addition, a routine ultrasound is needed to decide whether to do a fine needle aspiration biopsy as needed, and a CT or MRI of the neck if necessary, because sometimes the nodule can distort the surrounding tissues, and the CT or MRI looks at the size of the mass and its relationship to the surrounding tissues to decide the next step of treatment. There is also an ECT scan to see if the nodule is a cold function nodule or a hot function nodule. Hot nodules are usually benign.
Q: Does the larger the nodule, the more malignant it is?
A: There is no direct correlation between nodule size and malignancy. Small nodules may not be fine, and large nodules may not be cancerous. A particularly large nodule usually has bleeding inside and is soft to the touch, which may still be benign. Generally speaking, large nodules are benign, while small malignant nodules may be overlooked by patients.
Q: What conditions are highly suspicious of malignancy?
A: If the nodule changes rapidly within a day, yesterday it was 2cm and today it is 4cm, it is usually benign, it may be a bleeding inside the nodule and it becomes bigger all of a sudden. But if it is gradually increasing, such as 1cm, 1.5cm, 2cm, hard to the touch, especially the border is blurred, ultrasound found that this thing is solid, this situation can not exclude malignant. And especially pay attention to the presence of enlarged lymph nodes in the neck and change of voice.
Q: Should I have a puncture test for thyroid nodules and what are the benefits and risks of puncture?
A: Not all patients need puncture. For example, if the nodule is suspected to be bad at first glance, or if the nodule is large and can be easily found intraoperatively, you can do the surgery directly without puncture. There are many nodules on the thyroid gland, some of them are suspected to be malignant, some of them are not suspected to be malignant, and some of them are very small, so puncture can clarify whether the thyroid nodule is malignant or not, and if it is benign, surgery can be avoided, and if it is malignant, surgery can be chosen. Puncture can avoid unnecessary surgery. It is much less invasive and less expensive than surgery, and the accuracy rate of fine needle aspiration for papillary cancer diagnosis can reach 80%, so it is most important that patients can benefit from it.
Q: Is puncture always able to confirm whether it is benign or malignant?
A: There are three types of puncture results, one is definitely malignant or definitely benign, malignant needs surgery, benign should be reviewed. The second is ambiguous, highly suspicious or suspicious of malignancy, this patient is still recommended to actively operate, it may be found to be benign only after the cut. There is another situation where the puncture is not worn, but in fact it is still malignant, the probability of this is very small. This is because the first puncture result is not in line with clinical judgment, and according to clinical experience, it is considered malignant, but the puncture report is benign.
Q: Why do you recommend re-puncture in 3 to 6 months?
A: After the puncture, there will be local inflammation, so we need to wait for the inflammation to disappear. Secondly, if the test is done too soon, it will increase the patient’s psychological burden and make him feel that the disease is so serious. If there is little or no change and the B-ultrasound is still highly suspicious of malignancy, we will do the puncture again.
Q: Will puncture accelerate the spread and metastasis of thyroid cancer?
A: Fine needle puncture is still highly recommended internationally, and there is a mechanism to protect patients, which is relatively safe. If tumor metastasis and local implantation occur after puncture, it is definitely not popular internationally.