Thyroid nodules are caused by local abnormal growth of thyroid cells. Why does this piece of tissue grow faster than other thyroid tissues? Is it because of malignant transformation?
Whether treatment is needed or not depends on the benign or malignant evaluation of thyroid nodules.
What tests are needed to judge benign and malignant?
In order to determine its benign and malignant diseases, the following examinations may be required:
- Determination of thyroid function, especially detection of serum thyroid stimulating hormone (TSH) level; Neck ultrasound examination, including thyroid color Doppler ultrasound and neck lymph nodes; For thyroid nodules with diameter > 1 cm and serum TSH reduction, thyroid thyroid radionuclide imaging and even fine needle aspiration pathology should be performed to determine their benign and malignant tumors.
How to treat thyroid nodules found?
1. Malignant nodules
Surgical treatment is required for malignant nodules.
2. Benign nodules
Most benign thyroid nodules need only regular follow-up and no special treatment.
In a few cases, surgical treatment, TSH inhibition treatment, radioactive iodine treatment, or other treatment methods can be selected.
Do benign thyroid nodules need medication?
For most patients, medication is not recommended to treat benign thyroid nodules, but follow-up is the main method.
How effective is TSH inhibition therapy?
TSH inhibition therapy is a treatment scheme commonly used for drug therapy of thyroid nodules. Specifically, levothyroxine (LT4) is applied to inhibit the serum TSH level to the low limit of normal value, in order to reduce thyroid nodules by inhibiting the growth promoting effect of TSH on thyroid cells.
In iodine deficiency areas, TSH inhibition therapy may help reduce nodules, prevent the occurrence of new nodules and reduce the volume of nodular goiter. In non-iodine deficiency areas, TSH inhibition therapy may also reduce nodules, but its long-term curative effect is not exact, and nodule regrowth may occur after drug withdrawal.
Long-term inhibition of TSH can lead to subclinical hyperthyroidism, causing discomfort symptoms and some adverse reactions, such as increased heart rate, osteoporosis in postmenopausal women, etc.
Therefore, weighing the pros and cons, TSH inhibition therapy is not recommended for most patients to treat benign thyroid nodules routinely, but is mainly followed up. For young patients with goiter complicated with small nodules, combined TSH level can be considered. If used, the goal is to inhibit TSH level to the low limit of normal value.
Which benign thyroid nodules need surgical treatment?
Surgical treatment of thyroid nodules may be considered under the following circumstances:
- Occurrence of local compression symptoms obviously related to nodules; Complicated with hyperthyroidism and ineffective medical treatment; The tumor is located behind the sternum or in the mediastinum. Progressive growth of nodules, clinical consideration of malignant transformation tendency or high risk factors of thyroid cancer; Those who strongly require surgery due to excessive appearance or ideological concerns that affect normal life can be used as relative indications for surgery.
How to Follow up Patients with Thyroid Nodules?
The follow-up interval for most benign thyroid nodules is 6 ~ 12 months. Suspected malignant nodules can shorten the follow-up interval.
Follow-up mainly included neck color Doppler ultrasound, thyroid gland and neck lymph nodes.
Some patients also need to be followed up with thyroid function, such as those who found thyroid dysfunction in the initial evaluation, and those who received surgery, TSH inhibition therapy or isotope iodine 131 therapy.
Follow-up is to detect malignant nodules as early as possible.
During the follow-up, the following conditions were found. It is recommended to perform fine needle puncture to determine the benign and malignant diseases, and to resect them surgically when necessary.
1. Nodules grow obviously
The volume of nodules increased by more than 50%, or at least 2 diameter lines increased by more than 20%, and exceeded 2 mm.
2. Accompanied by symptoms and signs suggesting malignant transformation of nodules
Such as hoarseness, dysphagia/dysphagia, nodule fixation, cervical lymph node enlargement, etc.
3. When ultrasonic signs indicate that the possibility of thyroid cancer is high,
- Solid hypoechoic nodules; TSH is normal, but the blood supply in nodule is abundant. The shape and edge of nodules are irregular, and halos are absent. Microcalcification, needle-like diffuse distribution or cluster distribution of calcification; At the same time, it is accompanied by abnormal ultrasonic images of cervical lymph nodes, such as round lymph nodes, irregular or fuzzy boundaries, uneven internal echo, internal calcification, unclear demarcation of cortex and medulla, disappearance of lymphatic hilum or cystic degeneration, etc.
It should be noted that because the ability to distinguish benign from malignant thyroid nodules through ultrasound examination is related to the clinical experience and equipment of ultrasound doctors, it is suggested that it is better to be examined by the same ultrasound doctor in the same hospital during the follow-up process, and pay attention to keeping the examination results of each time so as to facilitate the comparison before and after.
Two suggestions from the doctor
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Pay attention to rest, avoid overwork, stay up late, and remain optimistic.
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Avoid repeatedly stimulating thyroid gland with hands, including when cleaning neck, be gentle and do not rub repeatedly.