Patients with various thyroid diseases may encounter situations requiring surgery:
- Hyperthyroidism: If goiter is especially obvious, Or drug therapy is ineffective and iodine 131 therapy cannot be carried out. Or hyperthyroidism is caused by thyroid adenoma… it requires surgery to remove part of the thyroid gland, To treat hyperthyroidism. Thyroid nodules: If the nodules are compressed to surrounding organs, or the nodules tend to be malignant, or the nodules are complicated with hyperthyroidism and drug therapy is ineffective… thyroid surgery is also required. Thyroid cancer: If thyroid cancer is confirmed by thyroid color Doppler ultrasound and fine needle biopsy, surgery must be carried out as soon as possible.
The following are the five most common problems encountered by thyroid patients before and after surgery. Let’s see how doctors can answer them.
Question 1
Physical examination found thyroid nodules, some doctors suggest regular review, some doctors suggest immediate surgery, what should I do?
Answer:
A doctor once joked: “If I have to have a cancer, I will definitely choose thyroid cancer.” It can be seen from this that thyroid cancer is not so dangerous and poses less threat to life than other cancers.
In recent years, there has been a dispute in the medical field about the treatment of thyroid cancer.
- Some doctors believe that thyroid cancer is over-diagnosed and over-treated. For some low-risk patients with small cancer foci and no signs of metastasis, In fact, there is no need for surgery, long-term observation and follow-up. However, some doctors believe that some thyroid cancer progresses rapidly. If there is no surgery and only observation, cancer metastasis may occur, delaying the best treatment time.
Both views in the medical field are reasonable. Since there is no effective means to help doctors judge which patients’ cancer progresses slowly and will not threaten their lives, and which patients’ cancer progresses faster and is prone to metastasis, doctors have certain subjectivity when giving treatment suggestions.
If the doctor tells you that you can also operate or observe, it is probably because the doctor cannot judge whether your thyroid nodule can benefit from the operation, so he cannot give a clear treatment suggestion.
The patient does not understand medicine, but the doctor has to let the patient make his own decisions, which is really quite tangled, and the doctor is also very helpless.
In this case, one can make a decision according to one’s specific situation and psychological endurance.
If you don’t think about food and tea because you are worried about the progress of cancer and worry all day long, then it is suggested that you choose active surgery to relieve thousands of worries with one knife.
If you are more open-minded, you can live normally even with a nodule around your neck that may become cancerous. Or more worried about the risk of surgery, don’t want to take medicine for a long time or even for life after surgery, then it is recommended that you choose regular observation.
Question 2
Is thyroid adenoma what? Is it a kind of nodule? Is it easy to deteriorate? Need surgery?
Answer:
Before answering this question, we must first distinguish between [adenoma] and [adenomatoid nodule]. Although both belong to benign thyroid nodules, the treatment methods are different.
[Thyroid adenoma] is mostly a single nodule, and the possibility of malignant transformation is relatively high (3 ~ 19%). Therefore, surgical treatment is the first choice.
[Thyroid adenomatous nodule] belongs to nodular goiter, generally multiple nodules, the possibility of malignant transformation is relatively low. Therefore, surgery is generally not required, only regular observation is required, unless compression symptoms, secondary hyperthyroidism or suspected malignant transformation occur, surgery is performed.
Adenomas and adenomatous nodules are mainly distinguished by thyroid color Doppler ultrasound. However, sometimes the two are not so easy to distinguish and may require repeated examination and identification.
Question 3
Is hoarseness the cause of what after thyroid surgery? How long will it take?
Answer:
The most common cause of hoarseness after thyroid surgery is vocal cord movement disorder caused by recurrent laryngeal nerve damage.
The recurrent laryngeal nerve is close to the dorsal side of thyroid gland, so thyroid surgery is easy to hurt the recurrent laryngeal nerve.
Injury of recurrent laryngeal nerve is divided into temporary and permanent.
Temporary recurrent laryngeal nerve injury, mostly caused by nerve traction or compression, can recover on its own. The recovery time varies from a few weeks to a few months according to the patient’s own situation.
Permanent recurrent laryngeal nerve injury is mostly caused by tumor erosion or direct surgical injury and cannot be completely recovered. However, with the extension of time, the vocal cord function on the normal side will gradually compensate and the hoarseness degree will also be reduced.
Temporary recurrent laryngeal nerve injury generally does not need treatment. If hoarseness is severe, mecobalamin can be taken orally to promote nerve self-repair.
Permanent recurrent laryngeal nerve injury is relatively rare, and surgery may improve hoarseness.
Question 4
Who needs iodine 131 treatment after thyroid cancer surgery? Pay attention to what before and after treatment?
Answer:
First of all, iodine 131 is only effective for differentiated thyroid cancer (differentiated thyroid cancer refers to papillary cancer and follicular cancer), and other types of thyroid cancer are not treated with iodine 131.
Secondly, not all differentiated thyroid cancer needs to do iodine 131, low-risk patients generally do not need iodine 131 treatment. Low risk, medium and high risk, is judged according to tumor stage and recurrence risk, please consult your surgeon.
Iodine 131 can be absorbed by residual thyroid cancer foci to eliminate cancer cells. Therefore, the more iodine 131 is absorbed, the better the cancer removal effect.
In order to improve the absorption of iodine 131 by cancer foci, attention should be paid before iodine 131 treatment:
- Stop levothyroxine for at least 2 weeks, or use recombinant human thyroid stimulating hormone (rhTSH) to increase blood TSH level. Avoid iodine diet (eat non-iodized salt, do not eat seafood such as kelp and laver) for at least 1 week, and avoid using iodine-containing contrast agents and iodine-containing drugs.
Attention should be paid to iodine 131 after treatment:
- Patients may suffer from temporary fatigue, neck swelling, pharyngeal discomfort, dry mouth, taste changes, etc. As long as pay attention to rest, supplement nutrition, these symptoms can be relieved by themselves. Iodine 131 treatment 1-3 days after oral levothyroxine. Iodine 131 treatment 2-10 days after a whole body imaging examination, according to the imaging results to decide whether to need iodine 131 treatment again. Women receive iodine 131 treatment, at least half a year later can consider pregnancy, men at least three months later to consider.
Question 5
Take levothyroxine once a day after thyroid cancer surgery. The dosage is very large and palpitations occur. Can you take the dosage separately for one day?
Answer:
Patients with differentiated thyroid cancer usually need to take a large dose of levothyroxine after surgery for thyroid stimulating hormone (TSH) inhibition therapy to prevent cancer recurrence and metastasis.
Such a large dose of drugs may lead to a series of side effects:
- Symptoms of hyperthyroidism, such as palpitation, shaking hands, insomnia, diarrhea, irregular menstruation, etc. Lead to heart disease, such as tachycardia, arrhythmia, heart failure, etc. Causes osteoporosis and increases the risk of fracture.
If the above side effects occur, especially heart disease, or the above side effects seriously affect normal life, the dosage should be reduced.
If you don’t want to reduce the medicine, you can also try to take the medicine separately for a day, once on an empty stomach in the morning and once before going to bed at night. However, taking the medicine separately may not reduce the above side effects. If there is no improvement, it is recommended to reduce the dosage.