There are many clinical causes of goiter, so it is important to go to the hospital in a timely manner to see a specialist and have relevant tests done to clarify the diagnosis so that treatment countermeasures and plans can be clarified as soon as possible for early recovery. The following is a brief overview of the current treatment options for common thyroid disorders.
I. Treatment of diffuse goiter with hyperthyroidism.
Diffuse goiter with hyperthyroidism (Graves’ disease) is currently the most common thyroid disorder. Current treatment options include surgery, antithyroid drugs and iodine-131 therapy.
1. Western medicine: The advantage is that the effect of drugs is reversible and permanent hypothyroidism rarely occurs (Western Internal Medicine: the incidence of spontaneous hypothyroidism in hyperthyroidism reaches 20% after 20 years), and is the treatment of choice for adolescents, especially children. Disadvantages include longer duration of administration (at least 1 to 2 years), high recurrence rate (40-60%), toxic side effects of the drug and inability to eliminate enlarged thyroid tissue.
2. Iodine-131 treatment: The advantages are high cure rate (>80%, efficiency >90%), control of hyperthyroidism symptoms and elimination of enlarged thyroid tissue in a short period of time (within 3 months), and no liver or kidney damage, white blood cell reduction and allergy. Therefore, it has been described as “surgery without surgery” and is the classic method of nuclear “oriented therapy”. The disadvantage is the relatively high incidence of hypothyroidism (>20% in foreign countries and 6-17% in China). There is a trend of increasing hypothyroidism year by year after iodine-131 treatment, but there is no obvious evidence that the incidence of hypothyroidism will increase year by year in our clinical follow-up.
3.Surgical treatment: The advantages are high cure rate (85%), low recurrence rate (15%), short-term control of hyperthyroidism symptoms and elimination of enlarged thyroid tissue. The disadvantages are the risk of surgery, scar affecting the appearance, damage to the laryngeal return and superior laryngeal nerve, damage to the parathyroid glands and hypothyroidism (27-49% in foreign countries and 15% in China).
II. Treatment of endemic goiter.
1. Iodine supplementation in appropriate amounts: Iodine deficiency is the main cause of endemic goiter. Therefore, for areas with severe iodine deficiency (such as the Yunnan-Guizhou plateau and Shaanxi, Shanxi, Ningxia, etc.), moderate additional iodine supplementation (eating kelp, nori, etc.) can help reduce goiter. However, when the thyroid gland is obviously enlarged, additional treatment with thyroid preparations (eugenol) is needed, starting with a small dose (25ug per day) and gradually increasing to more than 50ug per day, provided that no hyperthyroid symptoms appear and that the thyroid function is normal.
2. Quit iodine in moderation: The more iodine supplementation is not the better. In fact, too much iodine can also cause goiter, so attention should be paid to screening and reducing iodine intake for goiter in coastal iodine-rich areas or after treatment with iodine-containing drugs.
3, get rid of environmental pollution: waste water and waste contamination of drinking water sources can also cause goiter species. When certain monovalent anions similar in form and size to iodine ions are increased in the blood circulation, they can inhibit the thyroid’s ability to collect iodine, leading to goiter. Elimination of environmental pollution requires epidemiological information and cooperation from all parties, and is also the basis for group prevention and treatment.
Treatment of adolescent goiter and gestational goiter.
Due to enhanced systemic metabolism during adolescence and pregnancy, the organism develops a relative iodine deficiency and compensatory goiter can occur. Iodine supplementation in appropriate amounts is an effective treatment, but it is not advisable to oversupply iodine. If the goiter is obvious, it is advisable to add thyroxine treatment (eugenol) in a timely manner, as in the treatment of endemic iodine deficiency disease.
IV. Treatment of thyroiditis and hypothyroidism.
1. Painless thyroiditis and postpartum thyroiditis: The clinical manifestations and course are similar to those of subacute thyroiditis, manifesting as an enlarged thyroid gland, but without significant pain in the thyroid area. The onset of postpartum thyroiditis mostly occurs 3 to 6 months after delivery and may initially present as hyperthyroidism or directly as hypothyroidism, or may only have an enlarged thyroid gland. Painless thyroiditis and postpartum thyroiditis generally do not require special treatment, and the disease itself is somewhat self-limiting, resolving spontaneously in about 3 to 6 months. In the early stage of thyrotoxicosis (hyperthyroidism), only symptomatic treatment is needed, such as beta-blocker therapy, and not random application of antithyroid drugs. Both have a good prognosis and generally have no sequelae. Painless thyroiditis rarely recurs, but postpartum thyroiditis is more likely to recur after delivery if another pregnancy occurs. The possibility of permanent hypothyroidism has been reported in about 5% of patients with postpartum thyroiditis.
The main symptoms are persistent pain and tenderness in the thyroid gland, increased blood sedimentation at the beginning of the disease, normal, high or slightly low thyroid function, but the rate of iodine-131 uptake is significantly reduced, and nail photography indicates a radioactive sparse area in the thyroid gland and reduced technetium uptake. The main treatment drug is prednisone (hormone drugs), stopping the drug too early will aggravate the short-term symptoms and prolong the course of the disease, so the emphasis is on standardized treatment. For more details, please refer to the related articles in the guide.
3, chronic lymphocytic thyroiditis (Hashimoto’s thyroiditis): the diagnosis of Hashimoto’s disease is very arbitrary, and many doctors say that patients are suffering from Hashimoto’s disease as soon as they see high autoantibodies to the thyroid gland, and even easily assert that they need permanent medication! These unobjective words bring a lot of psychological pressure to patients, and some doctors casually treat patients with eugenol even if their thyroid function is normal, leading to hyperthyroidism, a typical example of “overmedication”. There is no specific treatment for Hashimoto’s thyroiditis, but there are some medications (such as Ceville) that can reduce antibodies to some extent. The true treatment is relative to the eventual hypothyroidism that results, i.e., the prompt selection of eugenol replacement therapy when hypothyroidism occurs. Very few patients need surgery because of the combination of thyroid nodules, otherwise do not easily surgery, so as not to aggravate the process of hypothyroidism.
4, the treatment of hypothyroidism: only slightly increased TSH (8.0 or less) in the thyroid function test, can be ignored, and then review after one month to decide whether treatment is needed, such as accompanied by FT3 / and or FT4 changes, you need to supplement eugenol treatment, the dose of 25ug, gradually increase the dose until the normal thyroid function. If TSH is significantly increased >10 or more, regardless of whether FT3/and or FT4 is normal or not, it is also recommended to supplement eugenol therapy in a timely manner, with the dose depending on the blood test results.
V. Treatment of thyroid nodules.
Thyroid cysts, thyroid adenomas, nodular enlargement of the thyroid and thyroid cancer are most often manifested as thyroid nodules. Benign thyroid nodules can be followed up and observed (review thyroid function and ultrasound every six months), while common medications (Chinese and Western medicines) are ineffective.
1. Thyroid cysts: Simple thyroid cysts are rare, and most of them are clinically manifested as nodular goiter partially combined with cystic changes, while thyroid cancer with cysts is only about 1 to 2%. In the past, thyroid cysts were mostly treated by surgery, but nowadays, the treatment of fine needle aspiration combined with sclerosing agent can achieve satisfactory results. The commonly used sclerosing agents include anhydrous alcohol, tetracycline, streptomycin, hydrocortisone and 2%-3% tincture of iodine. Sclerosing agents can cause aseptic necrosis, fibrosis and occlusion of the cyst wall, with a success rate of more than 90%.
2, thyroid adenoma: mostly non-toxic adenoma, treatment includes surgery and local injection of anhydrous alcohol. For high-functioning adenomas combined with hyperthyroidism, iodine-131 treatment can also be used.
3. Nodular goiter: Mild nodular goiter can be treated with regular observation or moderate application of thyroxine (eugenol), which helps to reduce and inhibit its enlargement; for moderate or above nodular goiter with poor efficacy of drug treatment, iodine-131 or surgery can be chosen, especially for those with hyperthyroidism. For those with severe enlargement and compression symptoms, early surgery is recommended.
4.Thyroid cancer: Thyroid cancer is a malignant tumor, and currently the three-in-one comprehensive treatment plan is promoted, including near-total thyroidectomy + iodine-131 residual foci clearance + thyroxine replacement therapy, which can significantly reduce the recurrence rate and mortality.