There was a time when you were in an emotional slump, depressed and anxious, with symptoms of weight gain, constipation, dry skin and hair loss. You have tried the best weight loss products, eaten imported physical supplements, and applied brand-name moisturizers, but nothing helps. You’ve guessed all the causes of the disease, but you didn’t expect your thyroid function to be disrupted, causing endocrine disorders. When the cause is identified, you think that everything will be fine if you go to the doctor. If we knew more about thyroid disorders, we would not be as blind and passive as we are today. If you know what you are doing, you can be prepared and take better care of yourself. There are tens of millions of people with undiagnosed thyroid problems, with women suffering eight times more than men. One of the most problematic aspects of thyroid disease is that it is easily overlooked or misdiagnosed. If left untreated, it can lead to other serious illnesses. Let’s take a look at the true face of thyroid disease. 1, the onset of thyroid disease People have heard of the thyroid gland more or less in life, when it is normal it is invisible but touchable, many people do not know much about it. In fact, the thyroid gland is a butterfly-shaped gland located on both sides of the throat, do not underestimate this small thing, but it is in charge of the thyroid hormone secretion of the “human engine”. If the body is missing or more of this “hormone”, the body’s energy metabolism, body temperature, heart, brain, muscles and other organs can not work properly, or even life-threatening, as the saying goes, holding a gland (line) and moving the whole body. In recent years, the thyroid gland of the country is getting unhealthy. The incidence of thyroid disease is increasing and is second only to diabetes. Thyroid nodules, hyperthyroidism, hypothyroidism and thyroid cancer have also become common thyroid problems. According to incomplete statistics, about 50% to 80% of women and 40% to 60% of men over the age of 60 have thyroid nodules; according to the epidemiological survey of thyroid diseases, the prevalence of hypothyroidism has reached 6.5%, and the prevalence of hyperthyroidism is also as high as 3.7%. More seriously, thyroid cancer has become a common head and neck malignant tumor, accounting for about 35% of all head and neck malignant tumors. Why are there more and more thyroid diseases? The reason is that a history of irradiation of the neck, especially in early childhood, is a known high risk factor for thyroid cancer. Both iodine deficiency and excessive iodine intake may lead to thyroid nodules. In addition, mental and emotional fluctuations can eventually lead to the development of nodules. I am a slightly peach-colored, butterfly-shaped gland that rides on the trachea below the laryngeal node and moves up and down with the larynx when swallowing. Don’t look at my small size, weighing only 30 grams, but in the human endocrine gland family, I am the “boss”, but can do a lot! My main mission is to produce thyroid hormones, including triiodothyronine (T3) and thyroxine (T4). The raw materials are iodine and tyrosine from protein breakdown that are consumed by the body. Thyroid hormones are essential for the normal functioning of human life, such as promoting the metabolism of proteins, fats, carbohydrates, as well as water and salt, ensuring the development of the brain and other nervous systems, promoting heat production and maintaining normal body temperature. Insufficient secretion can lead to cretinism in children and hypothyroidism in adults; conversely, excessive secretion can lead to hyperthyroidism. Because my thyroid hormones are so powerful, they must be precisely controlled so that they are secreted in the right amount and at the right time to meet the body’s energy needs. I am not only chemically controlled, but also neurologically governed, which explains why stress and worry can cause me to produce excessive amounts of hormones, which can put people on edge. I respond to iodine deficiency by swelling up and growing new cells by the thousands in an effort to take in whatever iodine I can possibly get. My weight rises dramatically from less than 30 grams to tens or hundreds of grams, which is called iodine deficiency goiter – commonly known as “big neck disease”. However, seafood and vegetables grown on sea land are rich in iodine; in some mountainous areas where the soil and water are deficient in iodine, iodized salt can be used to meet the body’s iodine needs, even if iodine-containing foods are not available. At the other extreme: excess iodine can also stimulate me to overproduce, which makes me swell up just as much as when I am iodine deficient. In addition, if a person has a tumor in the pituitary gland, it can also produce an excess of thyroid stimulating me to overproduce and flood my body with hormones. Calcitonin is another important hormone secreted by me, which has the function of lowering blood calcium. It acts primarily on the bone marrow, inhibiting bone resorption and increasing osteoblast activity, resulting in a decrease in the outward release of bone calcium and phosphorus, thus keeping calcium in the plasma and bones relatively constant. I am subject to multiple “leaders” in that the pituitary gland can secrete thyrotropin, which stimulates me to secrete thyroxine, which in turn is regulated by thyrotropin-releasing hormone secreted by the hypothalamus. Therefore, hypothalamic-pituitary lesions can cause me to become ill. At the same time, I have a “rebellious spirit” that can have a feedback inhibitory effect on the hypothalamus-pituitary gland, which forms the regulatory system of the hypothalamic-pituitary-thyroid axis. I am sick with some common diseases, how can I detect these lesions in time? Tell you a tip: If you love beauty you find me while admiring your beautiful neck, that’s me whistling: “Please care about care about me!” 3. Screening for benign and malignant thyroid nodules As people’s awareness of self-care has increased in recent years, more and more people have begun to pay attention to their thyroid gland. Since many people do not have enough knowledge about thyroid nodules, and most patients with thyroid nodules have no conscious symptoms and are only found by chance during physical examinations. Generally, when thyroid nodules are found, people’s first reaction is: “Is it cancer?” and “Will it metastasize? , “Will it metastasize?” The first reaction is: “Is it cancer? Many patients undergo surgery for fear of malignancy, only to find out after surgery that the nodule is just an adenoma or a nodular goiter, or in some cases, just a thyroid infection. Therefore, it is essential to differentiate between benign and malignant thyroid nodules. (1) What types of thyroid nodules are there? Thyroid nodules are very common in the population. Ultrasound examinations reveal nodules in the thyroid gland in about 20% to 70% of people, especially in women, where there are far more nodules than in men. In fact, the term “nodule” is only a description of the shape, and is generally called a mass if it is larger than 3 cm, or a nodule if it is smaller than 3 cm. Thyroid nodules are divided into different types, and can be simply classified into two categories: benign and malignant: benign nodules account for the majority of cases, while less than 1% are malignant; thyroid nodules can be classified according to the cause: nodular goiter, inflammatory nodules (subacute and chronic inflammation), thyroid cysts, thyroid tumors (benign tumors, thyroid cancer, part of multiple endocrine adenomatosis, metastatic cancer), etc.; and according to the number of nodules They can be divided into: single and multiple nodules. (2) What are the conditions that suggest a nodule may be malignant? Thyroid nodules can occur in both men and women of all ages, with women outnumbering men by about 4:1 and middle-aged and elderly people outnumbering teenagers. Once a nodule is found in the thyroid, don’t panic because more than 95% of thyroid nodules are benign. You need to be alert to the possibility of malignancy when a thyroid nodule is accompanied by: 1) a male or pediatric thyroid nodule. Studies have shown that although thyroid nodules tend to occur in women, nodules in men and pediatric patients are more likely to be malignant, and nodules in children in particular should be taken seriously; 2) thyroid nodules that are more than 50px in diameter, irregular in shape, not smooth on the surface, hard in texture, and not painful to the touch; 3) thyroid nodules that have existed for many years and have increased significantly in size within a month; 4) thyroid nodules that are poorly mobile and swallowed with (5) thyroid nodules accompanied by invasion of surrounding tissues such as hoarseness and difficulty in inspiration; (6) history of diagnosis and treatment of radiation exposure to the head or neck, especially in adolescents, which is more likely; (7) enlarged lymph nodes in the neck with hard texture, which do not shrink after anti-infection treatment; (8) long-term diarrhea without thick blood, often with (8) those with prolonged diarrhea without thick bloody stools, often with facial flushing or multiple mucosal neuromas. (3) What should I do if a nodule is found? Once a thyroid nodule is found, further examination and evaluation should be done at the first opportunity to determine the nature of the nodule in order to obtain the correct treatment direction. Thyroid nodules should neither be left to chance nor be treated hastily, but need to be judged comprehensively with various symptoms and signs. If thyroid cancer or giant goiter compressing the trachea is highly suspected or confirmed, timely surgery is needed. Most other thyroid nodules are not urgently treated by surgery, and it is best to follow up every 3-6 months with non-invasive ultrasound examinations to observe any further development of the nodules. If the nature of the nodule cannot be determined by conventional imaging and laboratory tests, a puncture may be performed to extract some of the nodule cells for pathological examination. However, a single negative test result is not indicative of the problem, and it is possible that cancerous cells may not be extracted. Therefore, patients with thyroid nodules should be followed up regularly according to medical advice and closely monitor the movement of the lesions. Once all evidence suggests that the nodule has a tendency to become malignant, it should be removed surgically without hesitation. In short, when thyroid nodules are found, the correct procedure should be followed: find a thyroid nodule – find out if it is a single nodule or multiple nodules – differentiate between thyroid function (elevated?) and thyroid function (decreased?). Decreased? normal?) -Identify the nature of the nodule (benign? (benign? malignant?) -Develop a treatment plan (medication, surgery, purely clinical follow-up, etc.) -Review regularly. Therefore, thyroid nodules are not scary, the key is to see your doctor promptly. (4) How can thyroid nodules be prevented? (1) Maintain a good mood. We all know that the social pressure is now more and more, so many people are in a good mood and more and more irritable, which is very bad for your health, do not put too much pressure on yourself. 2) Pay attention to the diet regimen. Iodine in the diet also has a great impact on thyroid nodules, too little or too much intake can lead to the occurrence of this disease. Nowadays, with the improvement of the quality of life, diseases caused by iodine deficiency are rare. Therefore, we coastal residents must control the intake of iodine in our daily life and do not consume long-term and large amounts of food with high iodine content, such as various kinds of sea fish and shrimps; we can consume salt without iodine or heat iodized salt for a longer period of time to promote the dissipation of iodine to avoid the occurrence of this disease. 3) Maintain regular work and rest. Pay attention to the combination of work and rest. Regular work and rest is very important for every office worker, which is conducive to the normal metabolism of the body and can regulate the body tension; meanwhile, it is also necessary to actively participate in physical exercise to improve the body immunity. 4, “strange” hyperthyroidism 【Example 1】 The beautiful Lisa has been married for 3 years, but she has not seen her belly “showing”, which has made the whole family anxious. She has been taking Chinese medicine to nourish the kidneys and blood to help her conceive for more than a year, but she has not seen any effect. She has a good appetite, snacks are always around, but people are “curtain rolled west wind, people are thinner than yellow flowers”, menstruation once every two or three months, the amount of menstruation is small. She was diagnosed with infertility caused by hyperthyroidism after a doctor friend proposed to check serum T3, T4, and TSH, and the results showed that T3 and T4 were increased and TSH was decreased. Later, she was treated with anti-thyroxine medication for more than half a year, and she gradually became plump and had monthly menstrual periods; the young woman finally became pregnant one year later. Example 2] 17-year-old Xiaoyu is a sophomore in high school, and usually has a heavy study load. In recent months, people around Xiaoyu noticed that she had some abnormalities, as if she had changed: her temper had always been very good, she suddenly became very irritable, not moving; usually not very interested in eating, she suddenly became particularly fond of food, but people are losing weight. In recent days, Xiao Yu’s performance is even more unintelligible, not only can not concentrate on class, but also insomnia at night, and her academic performance is falling. Her mother was so worried that she took her daughter to the hospital and was diagnosed with hyperthyroidism. Example 3] 35-year-old Yaru is a sales manager of a property, working under pressure and stress. She had no symptoms of urinary frequency, urinary urgency, painful urination or lumbar pain, and her urinary routine, ultrasound and kidney function tests were all normal, so it was difficult to find the cause of the swelling. It was difficult to find out the cause of the swelling. The diuretic and swelling reduction medication also had no effect. She was referred to Professor Ma of the Department of Internal Medicine, who told her to hold her hands flat with her eyes closed and found that her fingers were trembling involuntarily. Professor Ma prescribed a thyroid function test and found that T3 and T4 were increased and TSH was decreased, and she was diagnosed with hyperthyroidism. Expert comment: I am afraid that hyperthyroidism is not unfamiliar to you. It is a clinical syndrome caused by excessive secretion of thyroid hormones from various factors, resulting in increased excitability and hyper-metabolism in the nervous, circulatory and digestive systems of the body. It is a common endocrine disease and an autoimmune thyroid disease. The incidence rate is about 31/100,000, and it is more common in women, with the ratio of men to women being about 1:4 to 6. The typical manifestations of hyperthyroidism include: fear of heat, excessive sweating, large food intake and weight loss; impatience, agitation, insomnia, hyperactivity, rapid heartbeat, palpitations, protruding eyes and thickening of the neck, etc. It is not difficult to diagnose. However, atypical hyperthyroidism symptoms like the above three patients can be quite confusing, and it is difficult to recognize their “true colors” without careful screening and necessary laboratory tests. We know that the amount of thyroxine produced by the thyroid gland and the rate of flow into the bloodstream are regulated by thyrotropin (TSH), which is secreted by the pituitary gland. When the body’s immune system fails, it produces a substance called TSH, which stimulates the thyroid gland to work harder to produce large amounts of thyroxine. The secretion of too much thyroxine causes hypermetabolic symptoms, increased neurological and cardiovascular excitability, accompanied by enlarged thyroid glands and protruding eyes. However, many hyperthyroid patients are found to have insidious onset and no typical hyperthyroid symptoms, but only some symptoms of a certain system, such as paroxysmal palpitations, chest tightness, tachycardia, atrial fibrillation, unexplained swelling, chronic diarrhea that cannot be easily cured, weight loss, menstrual disorders or infertility, or anxiety, depression, insomnia, or periodic muscle paralysis that can be improved by potassium supplementation, etc. All of them should be highly alerted to the possibility of atypical hyperthyroidism. hyperthyroidism. Those with clinical suspicion of hyperthyroidism, those with enlarged thyroid gland without typical hyperthyroidism symptoms, those with angina pectoris and atrial fibrillation without obvious effect of treatment for heart disease, those with unexplained infertility, chronic diarrhea, and those who lose weight should go to the hospital for thyroid function tests to check whether T3, T4 and TSH are normal to facilitate early detection of hyperthyroidism. Once hyperthyroidism is diagnosed, patients should receive treatment under the guidance of a doctor and adhere to follow-up visits to prevent recurrence and to avoid the health effects of prolonged hyperthyroidism. There are three main treatment methods for hyperthyroidism: medication, surgery and isotope therapy. Each of these three methods has its own advantages, but the first choice is internal medication. In addition, patients should pay attention to control their emotions and be open-minded in general. It is necessary to take reasonable iodine-containing food, too much and too little are not good for the disease. It is important to combine work and rest, prevent and treat infections and infectious diseases in time, and keep the immune function normal. As long as hyperthyroidism is treated for a period of time, the symptoms of the chronic illness that have been lingering for a long time will gradually disappear. 5, the elderly become stupid to prevent hypothyroidism in the “strange” [example] Xiao Wei recently felt that more than 60 years old mother is a bit strange: memory is significantly weaker than before, often to the supermarket but forget what you want to buy; several times out have forgotten to turn off the gas at home, almost caused a big disaster; with the family when the words are very little, seems to be a bit indifferent, reaction He also seems to be slow. “Could it be that she has Alzheimer’s?” Xiaowei was worried and took time off work to take her mother to the hospital for a checkup, but nothing unusual was found from head to toe. “Mom is still young, it’s unlikely to be Alzheimer’s, so why don’t we go check again?” With the idea of giving it a try, Xiao Wei changed hospitals. After taking a detailed medical history, the doctor ordered a thyroid function test and sent it for testing. Although Xiao Wei did not quite understand the doctor’s intention of prescribing this test, he did so. The test results indicated that the thyroid function was low, and the diagnosis of hypothyroidism was confirmed. The doctor told Xiao Wei that the reason his mother had become stupid was because of a thyroid problem, not Alzheimer’s disease. Expert comment: Hypothyroidism (hypothyroidism for short) is an endocrine disease caused by insufficient synthesis or secretion of thyroid hormones, resulting in a decrease in the body’s metabolic function. Depending on the cause, hypothyroidism can be divided into two types: primary and secondary. Hypothyroidism caused by thyroid disease is called primary hypothyroidism, which is mostly caused by subacute or chronic thyroiditis, followed by hypothyroidism caused by thyroidectomy or radioactive iodine treatment, and endemic hypothyroidism caused by iodine deficiency in food. This type of endemic hypothyroidism is commonly found in iodine-deficient areas. The main clinical manifestations of hypothyroidism are weakness, sleepiness, fear of cold, memory loss, not eating much but gaining weight, indifferent expression, slow speech and movement, slow reaction, hoarseness, hearing loss, pale face, mucous edema of face and limbs, dry skin, no sweating, cold limbs, thinning and loss of hair, brittle finger (toe) nails, etc. Some patients also experience anxiety, depression, hallucinations, and even mania, which can be easily misdiagnosed as psychosis. Some patients may also experience anxiety, depression, hallucinations, or even mania, which may be misdiagnosed as psychosis. Hypothyroidism can occur at all ages, and its pathophysiological changes vary according to the age of onset, so the clinical manifestations also vary, but all types of disease can show significant mental disorders. The main psychiatric symptom of hypofunction, which begins in the fetus or newborn, is intellectual deficiency, which can reach the level of idiocy in severe cases. If hypofunction begins in the developing child, it is called “juvenile hypothyroidism” or, in severe cases, “juvenile mucinous edema”. If hypothyroidism begins in adulthood, it is called “adult hypothyroidism”, or “hypothyroidism in the narrow sense”. The prevalence of hypothyroidism increases with age, and the prevalence of hypothyroidism in the elderly is about 0.8%. In most cases, elderly patients with hypothyroidism lack specific symptoms and are often mistaken for aging when they experience drowsiness, deafness, confusion, unresponsiveness, dry skin or hair loss. Many elderly patients with hypothyroidism whose main manifestation is memory loss are often misdiagnosed as senile dementia. Therefore, be alert to the possibility of hypothyroidism if you have symptoms such as fear of cold, weakness, memory loss, and dry and rough skin. If an elderly person shows signs of “aging” that are incompatible with age, hypothyroidism should also be considered. In addition, if anemia, proteinuria, hyperlipidemia, edema or pericardial effusion cannot be explained by the corresponding disease, hypothyroidism should also be excluded. The clinical diagnosis of hypothyroidism mainly relies on clinical manifestations and thyroid function tests. Thyroid function tests are an important basis for the diagnosis of hypothyroidism. In the early stage of hypothyroidism, there may be no obvious clinical symptoms, and thyroid function tests only show elevated TSH, which is clinically known as subclinical hypothyroidism. If the disease progresses further, it may show a decrease in serum T4, and finally T3 is also lower than normal, and hypothyroidism symptoms appear at the same time. Since hypothyroid patients lack thyroxine in the body, the main treatment is thyroxine supplementation, which is called thyroid hormone replacement therapy. One is thyroid tablets (containing T3 and T4) and the other is levothyroxine (containing T4), which must be taken under the guidance of a doctor, and the thyroid function must be tested regularly to adjust the dosage according to the situation. Treatment of hypothyroidism in the elderly must be cautious, starting with a small dose and gradually increasing to the required dosage, not too fast to prevent a sudden increase in metabolic rate to increase the load on the heart, inducing angina, myocardial infarction and serious arrhythmias. If hypothyroidism can be diagnosed in time and reasonable replacement therapy is given, most of the patients can live like normal people. Elderly patients with hypothyroidism have atypical symptoms, so they should be more aware of them, take a detailed medical history and have a careful physical examination to avoid misdiagnosis and missed diagnosis. 6.Beware of thyroid cancer attack 【Example】Since 3 years ago, Xiaoqian felt that there was something growing in her neck and it was hard to touch. Later, the lump became bigger and bigger, and it was a little difficult to eat and drink. Xiaoqian was terrified, but the doctor told her that the thyroid cancer she was suffering from was usually not a big problem after surgery. After the radical resection surgery, Xiaoxian was able to live her life as usual. Expert comment: Thyroid cancer can occur at all ages, especially in young people. According to statistics, about 80% of thyroid cancer is well differentiated adenocarcinoma and the five-year survival rate can be over 80% after early surgery. There are four types of thyroid cancer, namely, papillary, follicular, undifferentiated and medullary carcinomas. Papillary carcinoma is the most common type, accounting for about 60% of the cases, and is of low malignancy, mostly seen in young women; undifferentiated carcinoma is the most malignant, accounting for 10%-15% of the cases, mostly seen in the elderly, and can develop systemic metastasis very early, which should be considered if symptoms appear rapidly within a short period of time. Patients often find a hard lump of uneven height at the front of the neck unintentionally when they are wearing a tie or taking a bath. It is worth mentioning that in some patients, the thyroid lump is not obvious, but the metastases in the neck, lungs and bones are the prominent symptoms. Therefore, when a lump with unknown primary focus appears in these areas, the thyroid should be carefully examined. Treatment of thyroid cancer usually depends on the type of thyroid cancer and usually includes the following methods: (1) Surgical excision. This method is also the primary treatment for thyroid cancer. The scope and efficacy of surgical treatment are closely related to the pathological type of the tumor. Generally, surgery is best for papillary carcinoma, followed by medullary carcinoma and follicular carcinoma, while undifferentiated carcinoma is not suitable for surgery and radiotherapy is the main treatment. (2) Endocrine therapy. It is suitable for differentiated papillary carcinoma and follicular carcinoma. Thyroxine tablets are given orally after surgery, which can reduce the stimulation of residual thyroid tissue by TSH and prevent the recurrence of cancer, and should be taken for life. (3) Radiotherapy. There are two kinds of radiotherapy: internal radiotherapy and external radiotherapy. Internal radiotherapy is the application of radioactive iodine to treat thyroid cancer, and its efficacy is related to the amount of radioactive iodine taken up by cancer cells. This method is suitable for differentiated papillary and follicular carcinoma, while undifferentiated carcinoma has lost the structure and function of thyroid cells, so the amount of radioactive iodine uptake is very small and the efficacy is not good; as for medullary carcinoma, the application of radioactive iodine is also ineffective. External radiotherapy is external irradiation treatment. (4) Chemotherapy. This method is still controversial. Most scholars believe that the effect of chemotherapy on thyroid cancer is uncertain and brings many adverse effects, so it should be determined on a case-by-case basis. 7.How to read hyperthyroidism laboratory test? Thyroid function tests mainly include the following items: (1) Thyroxine. Thyroxine is an important hormone secreted by the thyroid gland, which has many functions such as promoting nutritional metabolism, physical growth, brain development, and improving neurological and cardiovascular functions. The measurement of thyroxine includes five components: total serum T3 (TT3), total T4 (TT4), free T3 (FT3), free T4 (FT4) and anti-T3. The level of these indicators directly reflects the functional status of the thyroid gland, with an increase indicating hyperfunction and a decrease indicating hypofunction. The FT3 and FT4 are not affected by the above factors and are the most accurate indicators for the diagnosis of hyperthyroidism and hypothyroidism. At present, most hospitals examine TT3, TT4, FT3 and FT4 together for the purpose of differential diagnosis of some rare conditions. FT3 and FT4 should be used when there is a contradiction between TT3 and T4, FT3 and FT4 should prevail. It has a certain significance for the diagnosis of hyperthyroidism and the determination of its efficacy. (2) Thyroid stimulating hormone: TSH is produced by the pituitary gland and has the function of promoting the production of TT3 and TT4 by thyroid follicular cells. (3) Thyroid immune indicators. Thyroid immune indicators include: (1) thyroid immunoglobulin (TG): normal value <30%; (2) thyroid microglobulin (TM): normal value <15%; (3) thyroid stimulating antibody (TSAb). It is of great significance in the diagnosis of hyperthyroidism. In addition, TSAb is also a mandatory test at the end of hyperthyroidism treatment. As long as it is positive, the medication cannot be stopped, otherwise it is very easy to relapse.