Hashimoto's thyroiditis review should pay attention to two major issues: nodules and nail work, especially to be wary of nodules becoming malignant!
The patient is a female, 55 years old. At the beginning of 2019, the patient's physical examination found multiple thyroid nodules, of which the largest nodule in the right lobe saved 2.1 cm. The patient then went to the hospital for re-examination, and the doctor said that the nodule may be benign and recommended observation.
In August 2019, the patient went to the hospital for a re-examination of color ultrasound, and the result was diffuse thyroid enlargement, multiple nodules, of which the maximum nodule in the right lobe saved 2.8 cm, and the maximum nodule in the left lobe saved 1.2 cm; Blood testing is normal, but thyroid antibodies are high. In order to consider "Hashimoto's thyroiditis complicated with nodules", doctors recommend observation and regular review.
Thereafter, the patient is reviewed semi-annually.
In August 2021, color Doppler suggested an increase in bilateral thyroid nodules, but color Doppler suggested poor nodule morphology and abnormal thyroid function, and patients still chose to observe.
At the beginning of 2022, the patient's neck was significantly thickened and he had symptoms of chest tightness. Therefore, the patient went to the hospital again to review the color ultrasound tips:
1. The thyroid gland is enlarged in volume, full in form, the surface is not smooth, and it shows diffuse heterogeneous changes;
2. Multiple solid nodules are visible in thyroid bilobes, of which the right leaf nodule is 3.5 cm larger, the left leaf nodule is 1.4 cm larger, the boundary is still clear, and the morphology is still regular;
3. The right lobe is extremely visible with a solid low echo, the size is 0.51cm, the boundary is not clear, the nodule is adjacent to the anterior membrane, and the multi-point strong echo and blood flow signal are visible inside;
4. Lymph nodes are visible on both sides of the neck and have a clear structure.
Ultrasound suggests: diffuse echoes of the thyroid gland are uneven, thyroid nodules are frequent, and the right lobe is calcified with solid nodules, which is of high risk.
Therefore, the patient was given a manicurization prompt:
1. Nodules of about 0.5 cm in the right lobe cannot exclude papillary thyroid carcinoma;
2. Benign bilateral thyroid nodules;
3. Mr. Tsugamoto's thyroiditis;
4. There is no metastasis of the lymph nodes.
For this patient, ultra-micro interventional surgery is a better choice.
The rationale for this is:
1. The patient has many thyroid nodules, and the largest nodule in the right lobe saves 3.5 cm, and the nodule is larger;
2. Among them, the right lobe thyroid envelope proximal node has a knot of 0.5 cm, which is not in good shape, indicating that nail wearing "thyroid cancer is not excluded";
3. The left leaf nodule is frequent, and the maximum nodule saves 1.5 cm;
4. The patient has a thick neck and a feeling of pressure that leads to chest tightness;
5. Patients with lymph nodes without metastases;
In early March 2022, the patient underwent ultra-micro interventional surgery under local anesthesia, and the operation went smoothly. Postoperative pathology of the thyroid gland is reported as papillary carcinoma of the right lobe of the thyroid gland; Bilateral thyroid multiple nodules, benign; Hashimoto's thyroiditis. The patient was discharged from the hospital safely 2 days after surgery.
【Note】
1. Papillary thyroid cancer is not directly related to the size and number of nodules. In other words, large nodules are not necessarily malignant, and small nodules are not necessarily benign;
2. Cancerous nodules may be mixed with other benign nodules;
3. Armor piercing is a technical work. Colored Doppler nodules are poor in morphology and suspected malignant, but nail puncture suggests benign nodules. This may refer to the fact that the nail is not worn on the diseased tissue at the time of nail piercing, especially the nodule with small and poor position, which is difficult to wear the nail, and sometimes multiple manicures are necessary for diagnosis;
4. Hashimoto thyroiditis with nodules, not only blood collection to detect nail work, but also regular thyroid ultrasound examination, according to the shape of the nodules, found that the thyroid nodule morphology is not good, the probability of malignancy is very high. #Hashimoto's Thyroid Disease ##Thyroid ##Focus on Thyroid Nodules##Thyroid Test##甲状腺乳头状癌 #
