This year, Mr. Li, 36, was found to have a thyroid nodule during a physical examination at his workplace a while ago. After a review, the diagnosis was “more likely to be benign and regular follow-ups are recommended”.
This “benign nodule” has left Mr. Li torn with fear: Will it develop into thyroid cancer or not? The company’s main goal is to provide the best possible service to its customers.
Benign nodules can also be malignant, so you can’t just let them go
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Recently, the endocrine team at Shanghai Ruijin Hospital demonstrated through genetic evolutionary analysis that thyroid cancer does not evolve from benign nodules, but is more likely to arise from cancer of normal thyroid tissue.
Does this mean that benign nodules can be left alone? Professor Xu Bo, director of thyroid surgery at Guangzhou First People’s Hospital, gave a negative answer. The first is that multiple nodules may appear in a single thyroid gland, and while this nodule is currently benign, other nodules may appear in the future and other lesions may occur; second, unlike a fetus whose sex is determined at birth, a benign nodule may still have the potential to become malignant, and although the likelihood is small, it does not mean that the patient does not need to be followed up and observed.
The most significant aspect of this study is the discovery that benign nodules and malignant tumors are different at the genetic level, and it is expected that genetic mutations will be used in the future to help identify benign and malignant nodules.
What should I do if I find a thyroid nodule?
In recent years, there are few people like Mr. Lee who have had a thyroid nodule detected during a physical examination.
Once a thyroid nodule occurs, only a small percentage of them will go away on their own. You still need to see a specialist to identify the nature of the nodule. Most people can determine this with a thyroid ultrasound plus an immunoassay of thyroid function. If there is still doubt, further puncture tests are needed to confirm.
Some data show that malignancy accounts for only about 5% of thyroid nodules. Of the remaining 95% of benign nodules, more than 90% do not require treatment and only require follow-up. If the nodules are judged to be very benign, they can be followed up every six months to a year; nodules that are not completely certain of their benignity or malignancy are best followed up every 3 to 6 months. The specific situation depends on the nature of the nodule to be treated.
There are clear indications for surgery for thyroid nodules, including:
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1. Definite malignancy, high suspicion of malignancy, and local occurrence of metastases;
2. Considered benign, but large (more than 5 cm in diameter), with local symptoms such as protrusion, interference with breathing, swallowing, etc.
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3. Localized lesions progressing to the thoracic cavity and endangering health.
In addition to the above, it is sufficient to keep benign nodules under observation.
To find a thyroid nodule, avoid the two “extremes”
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There are two “extremes” of reaction to the detection of a nodule: one is to be overly concerned and have surgery even if the nodule is only a few millimeters; the other is to be too calm and ignore it even if it is highly suspected of being malignant, delaying treatment.
Doctors sometimes encounter patients whose thyroid nodules were found on physical exams 4 or 5 years ago and who were instructed by their doctors to follow up regularly, but they heard that thyroid nodules were nothing to worry about, so they kept ignoring them. However, when they heard that thyroid nodules were nothing to worry about, they ignored them. By the time they were seen, they had advanced thyroid cancer and metastases had appeared in the neck and lungs. Other patients come to the clinic only when they have distant metastases and are unexpectedly found to have thyroid cancer.
Who needs special attention for thyroid cancer risk?
Be especially concerned about thyroid cancer risk and watch for regular follow-up if you have:
- Had radiation therapy or exposure to radiation as a child;
- A family history of thyroid cancer;
- Rapid nodule growth;
- Irregular shape of the nodule, fixed adhesion of surrounding tissues, and accompanying pathological enlargement of lymph nodes in the neck.