Thyroid nodules are a common disease, however, usually there are no obvious symptoms, and many people are accidentally discovered during the physical examination. Relevant survey data show that the palpation rate of thyroid nodules is about 2% to 6%, the detection rate of neck sensitive ultrasound is about 19% to 35%, and the proportion of thyroid nodules found during autopsy is 8% to 65%. It can be seen that the incidence of thyroid nodules is quite high, there is no need to be too nervous, but at present, the incidence of thyroid cancer worldwide is growing rapidly, and the incidence of thyroid cancer is already the 4th in the female malignancy of our compatriots, and it will continue to grow at a rate of 20% per year. Therefore, timely identification between benign and malignant can reduce the harm of cancer and, at the same time, avoid overtreatment.
Thyroid nodules are a general term for lumps inside the thyroid gland that move up and down with the thyroid gland when swallowed. Thyroid nodules, depending on the cause, can be divided into hypertrophic and inflammatory nodules. According to the nature of the nodule, it can be divided into benign and malignant. From the morphological point of view, it can be divided into solid, cystic, cystic solid, spongy. From a functional point of view, it can be divided into high-function hot nodules, normal-function warm nodules, and low-function cold nodules. According to the number of nodules, it can be divided into single and multiple. The overall malignancy rate of thyroid nodules is about 4% to 7%, and in general, multiple nodules, the risk of malignancy is relatively low. To assess the risk of malignancy, a history of radiation exposure, a family history of thyroid cancer, changes in voice, growth rate, pain, and dysphagia need to be considered.
Thyroid nodules, most of which are insidious in the onset and have no clinical symptoms. If the nodules become malignant and progress to advanced thyroid cancer, they compress the trachea or esophagus, causing hoarseness, dysphagia, pain in the ears and shoulders, and enlarged lymph nodes in the neck. If it is a nodule caused by subacute thyroiditis, it may cause local swelling and fever, the nodule is hard in texture, the tenderness is obvious, and the pain can radiate under the jaw and behind the ear.
The incidence of thyroid nodules has obvious gender differences, and the prevalence of women is significantly higher than that of men, with an incidence of about 52% in women and about 29% in men aged 70 to 74 years. The incidence of thyroid nodules, especially multiple nodules, increases with age. Studies have shown that the occurrence of thyroid nodules and thyroid cancer may be associated with mutations or deletions in tumor suppressor genes, iodine intake, which also has an impact on prevalence, and ionizing radiation is a risk factor for nodule formation and tumorigenesis.
Thyroid nodules are detected on physical examination, serum thyroid-stimulating hormone TSH levels are measured, and if TSH levels are low, thyroid imaging or thyroid nuclide scans should be performed. Color ultrasound is required in patients with suspected or confirmed thyroid nodules. If TSH levels increase, more attention should be paid to the risk of malignancy. Serum calcitonin levels are sensitive indicators for screening for C-cell proliferation and early-stage medullary thyroid cancer.
A thyroid nuclide scan can help determine the functional status of thyroid nodules, and most high-functioning nodules are benign. Thyroid color ultrasonography is the key technical means to find and evaluate thyroid nodules, the application of high-resolution ultrasound and high-frequency sensors, can detect lesions from 2 mm to 3 mm, small calcifications in the nodules, irregular morphology, low echo of nodules, aspect ratio size of 1, rich blood flow signals in the nodules, which is a feature of malignant nodules. Thyroid fine needle puncture FNAB, is currently the identification of benign and malignant nodules of the accurate and reliable assessment method, this method can be the thyroid nodule puncture, the acquisition of cellular components, pathological analysis, ultrasound guidance can improve the success rate and accuracy of obtaining test materials.
There is a lot of controversy and overtreatment in the management of thyroid nodules. As a rule, for benign nodules with normal or hypothyroid function, thyroid hormone therapy is mainly used to suppress TSH and shrink the nodules. For warm nodules, close observation for 2 to 3 months, if the nodules shrink after treatment, most of them are benign nodules, if the nodules do not change significantly or become larger, a puncture biopsy or resection should be performed, and thyroid hormones need to be taken after surgery to prevent recurrence. For cold nodules with a high suspicion of malignancy, surgery is usually recommended as early as possible.
It is worth noting that the FNAB puncture test results as benign tumors, and there are still about 3% of tumors that may be malignant nodules, and may require multiple biopsies to be used for final determination. Studies have shown that differentiated thyroid cancer, although the degree of malignancy is not high, but the treatment effect of surgery is better, in addition, some papillary carcinoma or follicular carcinoma, bone or lung metastases may occur, it is recommended to actively take surgical treatment. At present, genetic testing methods, which help to find genetic mutations, are an important supplement to cytology tests, can help detect nodules, and provide a reasonable basis for treatment, avoid excessive treatment, continuous thyroid ultrasound, and are also an important method for evaluating thyroid nodules.
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