Anatomy and physiological functions.
The thyroid gland is located in the anterior middle of the neck and consists of two conical lateral lobes, with fibrous tissue anchored above the trachea and on either side of the thyroid cartilage, so that it moves up and down with the trachea when swallowing. The thyroid gland is surrounded by many important nerves and blood vessels, including the recurrent laryngeal nerve, which governs the movement of the vocal cords and can lead to hoarseness.
Overview.
Thyroid tumor is a common tumor of the head and neck, more common in women. Symptoms are a lump in the middle of the front of the neck that moves with swallowing, and some patients also have hoarseness and dysphagia and dyspnea. There are many types of thyroid tumors, benign and malignant. Generally speaking, a single mass with faster growth has a higher possibility of malignancy, and the younger the age, the more likely the thyroid mass is to be malignant. Due to the obvious symptoms, patients are usually seen in time.
Examination.
The following auxiliary examinations are required for suspected thyroid tumor.
Laboratory tests: thyroid function (TT3, TT4, FT3, FT4, TSH, etc.) is used to determine whether the patient has combined hyperthyroidism; serum calcitonin is specific for the diagnosis of medullary thyroid cancer; thyroglobulin is meaningful for the diagnosis or judgment of postoperative recurrence.
2.Thyroid ultrasound: distinguish the relationship between the swelling and the thyroid gland, and identify whether the swelling is solid or cystic.
3.Thyroid nuclear scan: to understand the location and function of thyroid nodules, etc.
4.Fine needle aspiration cytology examination: to clarify the pathological diagnosis of thyroid nodules before surgery, with an accuracy rate of 95%.
5.Thyroid CT: It can clearly show the location of the tumor and the relationship with important organs, and also help to judge the benign and malignant.
Benign thyroid tumors.
Multiple nodular goiter: associated with iodine deficiency, puberty, pregnancy, etc. It accounts for about 1/3 of thyroid disorders and is clinically manifested as diffuse enlargement of the thyroid gland. The enlarged thyroid gland may compress the trachea, esophagus, and laryngeal nerve to produce symptoms, and in a few cases, malignant changes may occur. For those with symptoms of compression and malignancy, surgery is required and thyroxine tablets are routinely taken after surgery.
Thyroid adenoma: It is the most common disease of the thyroid gland, accounting for 60% of thyroid tumors. It may be related to the chronic stimulation of thyroid stimulating hormone by radiation exposure and patchouli. The tumor grows slowly and patients often find the lump unintentionally. When the tumor suddenly increases in size and local pain, it is mostly due to adenoma bleeding. Surgical excision is effective.
Thyroid cancer.
Thyroid cancer is a malignant tumor of the thyroid gland. There are four types of pathological classifications, and the symptoms and treatment vary from one classification to another.
Papillary thyroid cancer: It is the most common type of thyroid cancer, accounting for about 60% to 89% of the cases and is more common in women. Due to slow growth, it is easy to be overlooked clinically. Most of them are found within 2 years and come to the clinic with a neck lump, and the diagnosis can be confirmed by fine needle aspiration for biopsy or rapid sectioning during surgery. Treatment is mainly surgical, with special emphasis on the first treatment, which, in layman’s terms, means a clean cut the first time. This includes excision of the thyroid gland and lymph node dissection of the neck. The prognosis of this disease is good, with a 10-year survival rate of 90%.
Follicular carcinoma of thyroid gland: It accounts for 10.6%-15% of thyroid carcinoma. Compared with papillary carcinoma, it is more common in men and has a longer course, manifesting as multiple lumps in the thyroid gland and neck and growing more slowly, but it is easy to metastasize through blood.
Medullary thyroid carcinoma: It accounts for 3-10% of thyroid cancer and is clinically divided into disseminated type and hereditary type, with hereditary type accounting for 10-20%.
Due to the secretion of endocrine hormones by the tumor, it can produce lower blood calcium, intractable diarrhea, facial flushing, palpitations, etc. Treatment is mainly surgical, with most or all of the thyroid gland removed and distant metastatic lesions treated with radionuclide.
Undifferentiated thyroid cancer: Less common, but highly malignant and rapidly developing, patients are mainly of advanced age and often come to the clinic with hoarseness and dyspnea.
Treatment of thyroid cancer.
The principle of treatment for thyroid tumor is mainly surgery, regardless of the pathological type, as long as there are indications, surgery should be performed as much as possible. The results of surgery vary depending on the pathological classification, but the overall results are good and the patient has a high quality of life. Other adjuvant treatments are nuclear therapy, radiotherapy, endocrine therapy, etc.
Advantages of head and neck surgery for thyroid tumors.
Thyroid surgery is a traditional surgery in surgery, however, with the change of professional scope and the in-depth development of the discipline. However, with the change of the specialty and the development of the discipline, thyroid diseases have come under the scope of research and treatment of otorhinolaryngology – head and neck surgery.
First of all, they are familiar with the anatomy of the neck, especially the anatomy of the recurrent laryngeal nerve, which can effectively avoid the injury of the recurrent laryngeal nerve. Secondly, for head and neck tumors accumulating multiple regions and organs, otorhinolaryngology-head and neck surgeons have more advantages, such as malignant thyroid tumors invading the larynx, pharyngeal cavity or cervical esophagus, or hypopharyngeal cancer or laryngeal cancer invading the thyroid gland, especially in whether the function of larynx such as pronunciation and breathing can be preserved.