Editor’s Note: It’s that time of year again, and one of the regular items in the medical checkup package is drawing more and more attention – the thyroid ultrasound. Why is the thyroid, a small butterfly-shaped organ attached to the thyroid cartilage in the neck, so “loved”? It turns out that hyperthyroidism, Hashimoto’s thyroiditis, thyroid nodules, thyroid cancer …… are some of the most difficult medical terms that appear frequently on medical examination reports or medical record cards, causing a great psychological burden to people. Compared to diseases of the heart, brain, liver and kidneys, patients with thyroid disorders are often confused when seeking medical treatment and do not know exactly which department to register for. The Tenth People’s Hospital of Tongji University has integrated three major departments related to the treatment of thyroid diseases – endocrinology, nuclear medicine and thyroid surgery – and opened a joint specialist clinic. Patients no longer need to travel between the three departments, but can receive the most timely and effective treatment through the one-stop consultation. In this issue of “Hot Topics”, we invited several experts from the Tenth People’s Hospital of Tongji University to give a “three-class review” on thyroid diseases. The first trial: Tearing off the pretense of hyperthyroidism Case: Ms. Chen, who is just in her early 50s, has been suffering from tachycardia and shortness of breath for several months. She had similar symptoms when she experienced menopause syndrome five years ago, but menopause doesn’t have to come twice, right? Thinking about this, Ms. Chen became more and more uneasy about her health and rushed to the cardiology department for a 24-hour electrocardiogram, which showed a high frequency of premature beats. “It’s not really a heart attack, right? ” a sense of foreboding welled up in her heart. After analyzing her physical condition, the doctor concluded that there was no organic lesion in her heart and suggested that she should have her thyroid function checked. With a lot of doubts, she went to the joint thyroid clinic. After taking blood tests for T3, T4 and TSH, she was found to have hyperthyroidism, and the symptoms of tachycardia and shortness of breath were all due to hyperthyroidism. Analysis: Professor Qu Xin, director of the Department of Endocrinology at the Tenth People’s Hospital of Tongji University, said that the gag name of the thyroid gland – “the human engine” – shows its powerful role in promoting the body’s metabolism. The thyroid gland of hyperthyroidism patients is always in “high speed”, and the thyroid hormones it secretes make the body break down a large amount of protein, sugar, fat and other nutrients. The open supply of life-sustaining “fuel” naturally raises the metabolic rate of the body, resulting in a fear of heat and excessive sweating, red and sweaty skin, palms, face, neck and armpits, and often low fever, or in severe cases, high fever. In addition to the various manifestations of hypermetabolism, many patients will have tachycardia and shortness of breath like Ms. Chen. In addition, the patient’s appetite will increase, and although he eats a lot, he will lose weight day by day. Professor Lu Zhongwei, director of the Department of Nuclear Medicine at the Tenth People’s Hospital of Tongji University, pointed out that although hyperthyroidism can be treated by taking medication, the treatment period is long and prone to relapse. Considering that Ms. Chen has just turned 50 this year, taking medication for hyperthyroidism for a long time will inevitably affect her quality of life, so she was advised to use isotope therapy. The thyroid gland has the property of absorbing and enriching iodine elements. Using this property, radioactive 131 iodine is introduced into the body and enriched in the thyroid tissue. During the decay of 131 iodine, beta rays are released, which contain energy that can destroy the hyperactive thyroid tissue, thus restoring calm to the overly “hyperactive” thyroid. Many people worry that the radiation released by 131 iodine will affect other parts of the body, but such concerns are superfluous. Physically, beta radiation is a stream of electrons that travels a very short distance through the body and therefore does not adversely affect organs other than the thyroid gland or people around the patient. The second trial: Hashimoto’s thyroiditis Case: Under the pressure of a heavy workload, Ms. Liu felt increasingly overwhelmed. This overwhelm is not only psychological but also somatic. Although she was working in a light office job, every day she felt as if she was carrying heavy objects and her limbs were weak. What scares her even more is that her legs and feet swell up every afternoon, and in severe cases, she can’t even put on her shoes. She has always taken her health seriously and immediately went to the hospital for a series of tests to rule out the possibility of heart, kidney and liver disease. What was the problem? The doctor gave her a name she had never heard of – Hashimoto’s thyroiditis. This is an autoimmune disease of the thyroid gland in which the patient’s immune system attacks her own thyroid gland, triggering hypothyroidism. She was triaged to the Department of Endocrinology to receive thyroxine replacement therapy according to the Joint Thyroid Disease Clinic treatment protocol. Analysis: According to Professor Qu Shen, Director of the Department of Endocrinology at the Tenth People’s Hospital of Tongji University, Hashimoto’s thyroiditis progresses slowly and when the disease is in its early stages, patients often have diffuse goiter with hard and well-defined borders. Many people will have a transient hyperthyroidism. However, after a short period of “splendor”, all body functions fall into decline, especially energy and strength, with symptoms such as fatigue, weakness, and drowsiness appearing one after another. As the disease progresses, patients may also experience dry skin, coldness, swelling, etc. Men may have a decreased libido, and women may have irregular menstruation. The reason for this is that the normal thyroid tissue is attacked by the immune system due to the autoimmune reaction of the body, and the synthesis and secretion of thyroid hormones are insufficient. Dr. Fei Yu of the Tenth People’s Hospital of Tongji University said that, in terms of the nature of the disease, Hashimoto’s thyroiditis is a special kind of “hypothyroidism”, so exogenous thyroxine must be introduced to make up for the lack of synthesis by the body itself. For patients in the acute phase, glucocorticoids can be used under medical supervision to increase thyroid hormone levels by suppressing the autoimmune response. For patients with longer duration of illness and irreversible damage to the thyroid gland, thyroid tablets should be taken to maintain the normal metabolism of the body. The various hormones synthesized by the human endocrine system have a “four-by-two” effect, and thyroxine is no exception, so the dosage and timing of medication are very important and must be guided by a medical professional. The third trial collects evidence of malignant thyroid nodules Case: Mr. Li has been preoccupied recently, because a nodule on the thyroid gland was detected during a routine physical examination organized by the unit. When he saw the word “nodule”, his heart was in his throat. He was afraid that he was suffering from an incurable disease and strongly requested the doctor to operate to remove the nodule. The Joint Thyroid Clinic analyzed his condition and recommended that he first go to the Department of Nuclear Medicine for a functional thyroid ECT imaging, and then the Thyroid Breast Surgery Department would determine whether to perform surgery based on the function of the nodules. Analysis: Professor Lu Zhongwei, director of the Department of Nuclear Medicine at the Tenth People’s Hospital of Tongji University, said that the thyroid gland has a special characteristic – it has a special “taste” for iodine, and all the iodine consumed by the body is basically concentrated in the thyroid gland. This feature facilitates the examination of the thyroid gland by nuclear medicine. A small amount of radioactive technetium (whose physiological properties are similar to iodine) is introduced into the body and enriched in the thyroid gland through blood circulation. By means of a special gamma-ray camera, it is possible to visualize the thyroid gland. Depending on the concentration of technetium in the thyroid tissue, it is marked with different colors. Nodules with less technetium uptake are darker and are called “cold nodules”; nodules with the same level of technetium uptake as the surrounding tissue are called “warm nodules”; nodules with more technetium uptake than the surrounding tissue are more brightly colored and are called “hot nodules “. The “temperature” reveals exactly the nature of the nodule. In general, malignant nodules are less likely to absorb technetium, so once nuclear medicine examination finds “cold nodules”, we should be highly alert. Professor Fang Lin, director of thyroid surgery at the Tenth People’s Hospital of Tongji University, pointed out that thyroid nodules should not be left to chance, but should be judged in conjunction with the various symptoms and signs of the patient. If the nature of the nodule cannot be determined by conventional imaging and laboratory tests, a puncture can be performed to extract some of the nodule cells for pathological examination. However, a single negative test result does not indicate 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 surgically removed without hesitation. The thyroid gland is the largest endocrine gland in the body, with an average weight of about 20-25 grams. Compared to men, the thyroid gland is slightly heavier in women. The gland’s primary function is to synthesize thyroid hormones to regulate the body’s metabolism of substances and energy. Thyroid hormone accelerates the oxidation process of cells throughout the body and promotes the decomposition rate of three major substances: protein, sugar and fat, and plays an important role in the development of the skeletal and nervous systems of young children, hence the name “human engine”. It is such an endocrine organ that has a “four-two punch” effect, but it often receives attention due to various pathologies.