Thyroid nodules (TNS) are one of the most common thyroid diseases. They are localized masses in the thyroid tissue caused by abnormal proliferation of thyroid cells. Most thyroid nodules are benign, asymptomatic, and are often discovered accidentally during a physical examination or medical examination. High-resolution ultrasound is a simple and important tool for identifying thyroid nodules, with a detection rate of up to 50%. Cancerous nodules can be surgically removed.
Clinical classification
1. Thyroid nodules can be categorized as benign or malignant based on their severity. Benign thyroid nodules include multinodular goiter, Hashimoto’s thyroiditis, cysts, follicular adenomas, and Hürthle cell adenomas. The vast majority of malignant thyroid nodules are thyroid cancer, with a minority representing primary thyroid lymphoma or metastatic thyroid cancer (e.g., breast cancer, kidney cancer, etc.).
2. Nodules can be divided into solid and cystic types based on their texture. Solid nodules contain tissue hyperplasia and are the primary type of adenoma and carcinoma. Cystic nodules contain fluid, and some may experience intracystic bleeding, causing local pain.
3. Nodules can be divided into hot and cold nodules based on their ability to absorb radionuclides. Hot nodules are autonomous thyroid nodules with endocrine function and are generally benign. Cold nodules are non-endocrine and may be cancerous. Furthermore, nodules with hemorrhage or cystic changes may also present as cold nodules.
Epidemiology
Contagious
Not contagious.
Incidence
The incidence rate in adults calculated by physical examination is 5% to 7%, and the incidence rate calculated by ultrasound examination is 20% to 76%.
High-risk population
It is more common in people with a history of radiation exposure or a family history of thyroid nodules. It is more common in women than in men, with a male to female ratio of approximately 1:3.83.
Causes
Overview
The cause of thyroid nodules is currently unknown, but it is generally believed to be related to factors such as insufficient iodine intake, exposure to radiation, and genetics. Ionizing radiation, in addition to potentially inducing thyroid nodules, also increases the risk of cancer.
Risk factors
1. History of radiation exposure
Ionizing radiation is a significant risk factor for thyroid nodule formation and cancer. Prolonged exposure to radiation or a history of radiotherapy (mostly to the head, neck, or chest, especially during childhood) increases the risk of thyroid nodules.
2. Family history of thyroid nodules
Thyroid nodules are hereditary. Studies have shown that due to a genetic enzyme defect, hormone synthesis is impaired, preventing thyroid hormone from being separated from thyroglobulin and released into the blood. This congenital defect is recessive.
3. Insufficient iodine intake
Iodine plays a key role in the synthesis and secretion of thyroid hormones. Iodine deficiency can cause abnormal thyroid hormone levels in the body, leading to goiter, with or without thyroid nodules.
symptom
Overview
Most patients have no symptoms and are often discovered accidentally during a physical examination or examination by a doctor. When the nodule grows and produces pressure, the patient may experience symptoms such as a foreign body sensation in the throat, shortness of breath, and difficulty swallowing.
Typical symptoms
1. Some patients will experience pain around the nodules and a foreign body sensation in the throat, and some patients in the late stage will develop neck edema.
2. When the trachea is compressed, coughing and shortness of breath will occur, and when the trachea is invaded, hemoptysis will occur; when the recurrent laryngeal nerve is affected, dysarthria will occur; when the esophagus is compressed, swallowing difficulties or pain will occur.
3. When patients have hyperthyroidism, they may experience palpitations, sweating, hand tremors, and weight loss; when they have hypothyroidism, they may feel cold and have general fatigue.
complication
There are generally no obvious complications.
examine
Scheduled inspection
Patients experiencing symptoms such as a foreign body sensation or pain in the throat should seek medical attention promptly. The doctor will palpate the patient’s thyroid gland to make a preliminary diagnosis. The doctor may then selectively perform tests such as serum thyroid-stimulating hormone (TSH), calcitonin, thyroid ultrasound, thyroid radionuclide scanning, CT, magnetic resonance imaging (MRI), and fine needle aspiration cytology (FNAC) to further confirm the diagnosis.
Physical examination
Thyroid palpation is an important examination method, with a palpation detection rate of 4% to 7% for thyroid nodules. During the examination, the doctor will ask the patient to swallow and use his hands to feel whether the mass moves with the thyroid gland.
Laboratory tests
1. Serum TSH
Thyroid function can be assessed. A low TSH level suggests that the nodule may be secreting thyroid hormones. Further testing of FT3/TT3 and FT4/TT4, along with a thyroid radionuclide scan, is necessary to assess whether the nodule has autonomous function. Functioning nodules are less likely to be malignant. An elevated serum TSH level suggests hypothyroidism and requires further testing of FT4 / TT4 and thyroid autoantibodies, along with a fine-needle aspiration biopsy (FNAB).
2. Calcitonin
Calcitonin, secreted by thyroid parafollicular cells (C cells), can be used to determine the presence of medullary thyroid carcinoma (MTC). A serum calcitonin level >100 pg/ml suggests MTC. Elevated serum calcitonin levels, but below 100 pg/ml, are less specific for diagnosing MTC. This test is indicated if a family member has had thyroid cancer or other endocrine cancers.
Imaging examinations
1. Thyroid ultrasound
High-resolution ultrasound is the preferred method for evaluating thyroid nodules. It can determine the size, shape, number, location, texture (solid or cystic), blood supply, calcification, and relationship to surrounding tissues. It can also assess the presence of lymph nodes in the cervical region. Signs of cancer include irregular nodule margins, solid hypoechoic areas, microcalcifications, and a rich and turbulent blood supply. Nodules that are purely cystic or exhibit spongiform changes are generally considered benign.
2. Thyroid radionuclide scan
It can determine whether a thyroid nodule has secretory function. However, it cannot accurately distinguish between benign and malignant tumors. Due to the limited resolution of the imaging device, thyroid radionuclide imaging is only suitable for evaluating thyroid nodules >1 cm in diameter. When single (or multiple) nodules are associated with low serum TSH, thyroid radionuclide imaging with 131 I or 99m Tc can determine whether the nodule has autonomous uptake (“hot nodule”).
3. CT and MRI
CT and MRI are not superior to ultrasound in evaluating benign and malignant thyroid nodules. Neck CT or MRI can be performed before surgery for thyroid nodules to demonstrate the relationship between the nodule and surrounding tissues.
Pathological examination
Ultrasound-guided fine needle aspiration cytology (FNAC) is the current gold standard for distinguishing benign from malignant thyroid tumors, with diagnostic sensitivity and specificity exceeding 90%. It can also help reduce unnecessary thyroid nodule surgeries and assist physicians in determining the appropriate surgical plan.
diagnosis
Diagnostic principles
Doctors can usually diagnose this disease after asking about the medical history and performing thyroid palpation, but laboratory tests, thyroid ultrasound and other examinations are still needed for comprehensive judgment to rule out diseases such as Graves’ disease and autoimmune thyroiditis.
Differential diagnosis
1. Graves’ disease
Both Graves’ disease and thyroid nodules present with thyroid enlargement, but Graves’ disease also has obvious hypermetabolic syndrome, with symptoms such as heat intolerance, sweating, and moist skin, which can be used for differentiation.
2. Autoimmune thyroiditis
Both autoimmune thyroiditis and thyroid nodules present with enlarged thyroid gland and normal thyroid function, but autoimmune thyroiditis may also present with symptoms of hypothyroidism such as pale and swollen face, fear of cold, and memory loss. Thyroid autoantibody testing and fine needle aspiration cytology (FNAC) can also help differentiate them.
3. Postpartum thyroiditis
Both postpartum thyroiditis and thyroid nodules manifest as an enlarged thyroid gland, but postpartum thyroiditis often occurs 6 to 12 weeks after delivery and is associated with positive thyroid peroxidase antibodies (TPOAb).
treat
Treatment principles
For benign thyroid nodules without symptoms, no treatment is required, and regular follow-up observation is sufficient; for thyroid nodules with obvious symptoms, surgical removal is required, and drugs can also play an auxiliary role in treatment.
Drug treatment
If the nodules cause hyperthyroidism, radioactive iodine therapy, compound iodine oral solution, and antithyroid medications can be used. Currently, commonly used antithyroid medications are thiourea compounds, including propylthiouracil (PTU), methylthiouracil (MTU), methimazole, and carbimazole. After surgical treatment, some patients may develop hypothyroidism and may require long-term levothyroxine therapy to maintain normal thyroid hormone levels.
Related drugs
Compound iodine oral solution, propylthiouracil (PTU), methylthiouracil (MTU), methimazole, carbimazole, levothyroxine
Surgical treatment
If the nodule is large and causes compression symptoms, or if the nodule is cancerous or suspected to be cancerous, surgical treatment is required. Surgical methods include total thyroidectomy, thyroid lobectomy, microwave ablation, and laparoscopic thyroid surgery.
Treatment cycle
The treatment cycle is affected by factors such as the severity of the disease, treatment plan, treatment timing, age and physical condition, and may vary from person to person.
Treatment costs
There may be significant individual differences in treatment costs, and the specific costs are related to the selected hospital, treatment plan, medical insurance policy, etc.
Prognosis
General prognosis
Benign thyroid nodules have a good prognosis. Among malignant thyroid nodules, over 90% of thyroid cancers are differentiated thyroid cancer (DTC). Most DTCs progress slowly, following a nearly benign course, with a high 10-year survival rate. Certain histological subtypes of DTC and poorly differentiated thyroid cancer have a low incidence rate but are prone to invasion and distant metastasis, resulting in high recurrence rates and a relatively poor prognosis.
Hazards
1. Some larger nodules may cause compressive symptoms, such as coughing, shortness of breath, difficulty swallowing or pain, affecting daily life.
2. Some malignant nodules may metastasize to distant sites and may be life-threatening.
Curative
Most benign thyroid nodules do not require treatment; malignant nodules are treated as early as possible and most of them do not affect the quality of life.
Cure rate
There is no large sample data statistics yet.
daily
Overview
Patients need to maintain a good attitude in daily life, actively cooperate with the doctor’s treatment, pay attention to rest, avoid excessive fatigue, which can help the recovery of the disease, and pay attention to regular follow-up visits.
Psychological care
1. Psychological characteristics
(1) Patients are prone to excessive emotion and sadness due to their lack of understanding of the disease.
(2) Patients who have undergone thyroidectomy need to take medication for a long time, and some patients may experience psychological stress.
2. Nursing measures
(1) Family members need to receive timely psychological counseling to help them build confidence in overcoming the disease, which can help the patient recover physically.
(2) Patients need to learn more about the disease from doctors, actively cooperate with treatment, relieve psychological pressure, and maintain a calm and stable mood.
Postoperative care
1. After surgery, the patient should not move too much to avoid wound tearing.
2. Keep warm and avoid catching a cold.
3. Postoperative patients can eat liquid or semi-liquid food. Do not drink too much water at one time or too quickly to avoid choking. Drink water in small sips and gradually increase the amount.
Life Management
1. Maintain a regular work and rest schedule, ensure adequate sleep, and avoid overwork.
2. Try to keep a certain distance when using a microwave oven, use induction cookers less often, and live away from signal towers.
Follow-up Instructions
Patients with asymptomatic benign thyroid nodules can be followed up every 6 to 12 months. If the shape and size of the nodule do not change much, follow-up can be done every 2 years.
diet
Dietary adjustment
This disease may be related to iodine intake. Dietary adjustments should be made according to individual circumstances and according to doctor’s advice. In addition, patients with thyroid nodules should develop healthy and balanced eating habits and avoid excessive smoking and drinking. This can help control the progression of the disease, prevent cancer, and promote recovery.
Dietary recommendations
1. Strengthen nutrition and maintain balanced nutrition.
2. Eat more high-calorie, high-protein foods, such as eggs, meat, milk, etc.
3. Eat more fresh vegetables, fruits and other foods high in vitamins.
4. Patients with hypothyroidism can eat more foods high in iodine to maintain the balance of thyroid hormones in the body.
Dietary taboos
1. Patients with hyperthyroidism should eat less foods high in iodine, such as seaweed, kelp, and hairtail.
2. Avoid irritating foods such as pepper, chili, cinnamon, etc.
3. Try not to smoke, drink, or drink strong tea or coffee.
prevention
Preventive measures
The cause of this disease is still unclear and there is currently no effective prevention method.
Medical Guide
Outpatient indications
1. The patient feels a nodule on the front of his neck.
2. Pain around the nodule, foreign body sensation in the throat, and neck edema.
3. Accompanied by cough, shortness of breath, hemoptysis, and dysarthria.
4. Accompanied by difficulty or pain in swallowing.
5. Other severe, persistent or progressive symptoms and signs occur.
The above should be consulted as soon as possible.
Treatment department
You can go to the thyroid surgery, general surgery or endocrinology department for treatment.
Medical preparation
1. Make an appointment in advance and bring your ID card, medical insurance card, medical card, etc.
2. A more comprehensive physical examination may be performed, and you can wear clothing that is easy to put on and take off.
3. If you have had medical treatment recently, please bring relevant medical records, examination reports, laboratory test results, etc.
4. If you have taken some medicine to relieve symptoms recently, you can bring the medicine box with you.
5. Family members can be arranged to accompany the patient to seek medical treatment.
6. Patients can prepare a list of questions they want to ask in advance.
Questions your doctor may ask
1. What is wrong with you? Where do you feel uncomfortable?
2. How long have you been feeling unwell? Are there any patterns in your symptoms?
3. Are there any factors that make your uncomfortable symptoms worse?
4. What tests have you undergone? What were the results?
5. Have you received any treatment? What treatment did you receive? What was the effect of the treatment?
6. Has anyone in your family experienced a similar situation?
7. Do you have other thyroid diseases?
8. Are you often exposed to radiation?
9. Did you receive X-rays or radiotherapy as a child?
What questions can patients ask?
1. Is my condition serious? Can it be cured?
2. What are the consequences if not treated?
3. Why did I get sick?
4. What tests do I need to do?
5. How to treat it?
6. Do I need surgery?
7. Are there any risks associated with these treatments?
8. Will it relapse if cured?
9. What should I pay attention to in my daily life?
10. Do I need follow-up examinations? How often?