1.What is a thyroid nodule? The thyroid gland is located in the neck below the thyroid cartilage, on both sides of the trachea, and is shaped like a butterfly, like a shield nail, so it is called the thyroid gland. As the name implies, thyroid nodules are nodules found in the thyroid gland and are a very common condition, especially among middle-aged women. Thyroid nodules are divided into two categories, benign and malignant, with benign nodules accounting for the majority. 2. Incidence of thyroid nodules and thyroid cancer The incidence of thyroid nodules increases with age, with women being four times more common than men. Radiation exposure is a major cause of benign and malignant thyroid nodules. According to statistics, between 1973 and 2002, the annual incidence of thyroid cancer in the United States increased from 3.6 per 100,000 to 8.7 per 100,000, an increase of about 2.4 times (P < 0.001), and this trend is still increasing year by year. the leakage of radioactive materials from the Fukushima nuclear power plant caused by the earthquake in Japan in March 2011 is a warning to us that thyroid nodules cannot be ignored. 3. What should I do if I find a thyroid nodule? Do not worry if thyroid nodules are found, not all thyroid nodules are malignant, even if they are thyroid cancer, most of them are papillary carcinoma, and their prognosis is relatively optimistic compared to other malignant tumors. First of all, for thyroid nodules found, we need to determine its benign and malignant nature. Hot nodules (highly functional nodules) found on ECT scan have low malignancy rate, while cold or warm nodules need further investigation. Certain features of ultrasound-detected thyroid nodules suggest the possibility of malignancy, including hypoechoic, microcalcified foci, abundant internal blood flow, poorly defined borders, and nodules with an aspect ratio greater than 1. Single nodules are more likely to be malignant, but multiple nodules should also be beware of malignant changes in individual nodules. 4. Do all thyroid nodules require surgery? No. The majority of thyroid nodules are malignant. Most of the thyroid nodules are benign and usually only require endocrine treatment and ultrasound follow-up. Surgery is only required when the nodules have symptoms of compression on the trachea, esophagus or nerves, when the giant thyroid gland affects life, when the thyroid gland behind the sternum is swollen, when there is secondary hyperthyroidism, or when malignancy is suspected. Of course, for thyroid cancer, surgery is the first choice. 5.Do I need to have a total thyroidectomy if I have thyroid cancer? Not necessarily. Some patients with thyroid cancer require total thyroidectomy plus lymph node dissection. In some cases of good thyroid cancer, only the affected thyroid lobe can be removed. For women between the ages of 15 and 45, patients with papillary thyroid cancer who have no history of radiation exposure, nodules confined to the thyroid, small diameter, no infiltrative growth, no lymph node metastasis, and no distant metastasis may have only the affected thyroid gland removed. Total thyroidectomy is risky, as it may damage the recurrent laryngeal nerve, superior laryngeal nerve, parathyroid glands, etc. Therefore, sometimes total excision of the affected side + near total excision of the opposite side is also chosen. 6. Do I need to clear the lymph nodes when removing the thyroid gland? For abnormal lymph nodes found by ultrasound, palpation or intraoperative exploration, therapeutic debridement is chosen. These include group VI lymph nodes located in the middle of the neck and group III and IV lymph nodes on the lateral side of the neck. If no abnormal lymph nodes are found, prophylactic lymph node dissection is considered because of the risk of nerve damage and parathyroid gland damage during the dissection. 7. Are there any risks during the procedure? Yes, because the laryngeal entry point of the recurrent laryngeal nerve is just behind the thyroid gland, group VI lymph nodes are very close to the recurrent laryngeal nerve and parathyroid gland, and group III and IV lymph nodes on the left side are closely related to the thoracic duct. Therefore, more patience and care are needed when performing total thyroid dissection and lymph node dissection during surgery. The technique of intraoperative thyroid nerve monitoring introduced by our department has greatly reduced the chance of nerve damage during thyroid surgery, which is especially suitable for patients with difficult and recurrent thyroid cancer surgery. 8.Will the appearance be affected after thyroid surgery? Thyroid nodules are more common in women than men, and female patients often ask this question. The incision of the thyroid gland is located two fingers above the superior sternal fossa, a location that is often exposed during the hot summer months. Therefore, we use cosmetic sutures (intradermal sutures) for all thyroid incisions, and the impact of the incision is minimal. However, some patients are scarred and are prone to scarring regardless of the type of suture. For these patients, we also perform lumpectomy thyroid surgery, which selects other hidden parts of the body without any incision in the neck, so even scarred patients do not have to worry about the aesthetic impact.