Category 3 thyroid nodules refer to nodules that appear inside the thyroid gland and are classified as grade 3 lesions during ultrasound assessment. According to the Thyroid Imaging Reporting and Data System (TI-RADS) classification, Category 3 nodules mean that their risk of malignancy is relatively low, but they still require close observation and monitoring. This type of nodule usually manifests as one or more solitary nodules within the thyroid gland, which may be solid, cystic, or mixed. The causes of its formation may be related to various factors such as abnormal iodine intake, inflammation, hyperthyroidism, thyroid adenoma, etc. In most cases, Category 3 thyroid nodules do not cause obvious symptoms, but some patients may experience symptoms such as neck discomfort, difficulty swallowing, or difficulty breathing.
symptom
Typical manifestations
Category 3 thyroid nodules typically cause the thyroid gland to enlarge, forming a palpable lump in the front of the neck. The degree of goiter may be related to the size and location of the nodule; smaller nodules may not be noticeable, while larger nodules may cause a noticeable neck lump.
Associated symptoms
1. Foreign body sensation in the throat
Thyroid nodules may cause irritation to the throat, causing patients to feel a foreign body sensation in the throat.
2. Neck pain
If the nodule is large or presses on surrounding structures, it may cause neck pain or discomfort.
3. Hoarseness
When the nodule compresses the recurrent laryngeal nerve, it may cause hoarseness or difficulty speaking.
4. Difficulty breathing and swallowing
If the nodule enlarges and presses on the trachea or esophagus, it may cause symptoms of dyspnea and dysphagia. Dysphagia may be painful, especially when eating solid foods.
5. Weight changes
Thyroid nodules may cause thyroid dysfunction, which in turn can lead to changes in metabolic rate and affect body weight. Patients may experience weight gain or loss, and may also experience symptoms such as palpitations and anxiety.
6. Protruding eyeballs
In some cases, particularly when the thyroid gland is overactive, people may experience proptosis.
7. Neurological symptoms
Thyroid nodules may cause thyroid abnormalities, which in turn may lead to neurological symptoms such as insomnia, nervousness, and muscle atrophy.
complication
This symptom generally has no obvious complications.
reason
Overview
The development of type 3 thyroid nodules is the result of a combination of factors. Current research suggests these factors primarily include autoimmune thyroid disease, radiation exposure, the effects of iodine in the environment, and genetic factors.
Cause of symptoms
1. Autoimmune thyroid disease
Autoimmune thyroid diseases are closely associated with the development of thyroid nodules. For example, patients with Graves’ disease are prone to developing thyroid nodules, and these nodules may develop into follicular thyroid cancer. Although the specific mechanism is not yet fully understood, this finding suggests that autoimmune factors play a key role in the formation and progression of thyroid nodules.
2. Radiation exposure
Ionizing radiation is a significant risk factor for thyroid nodules. Studies have shown that individuals exposed to low-dose radiation (800-1000 rads) have a nearly 50% incidence of thyroid nodules. In particular, those who have received head and neck radiation therapy for head and neck diseases, thymus, or facial conditions are at a significantly increased risk of developing thyroid nodules later in life.
3. Impact of iodine in the environment
Iodine is an essential element for the synthesis of thyroid hormones, and its intake significantly influences thyroid health. Specific environmental factors, such as iodine deficiency, can cause goiter, and severe iodine deficiency can even lead to endemic goiter. Furthermore, environmental iodine levels can influence the genotype and phenotype of thyroid nodules.
4. Genetic factors
Genetic factors also play a significant role in the formation and development of thyroid nodules. A variety of candidate genes are implicated in the pathogenesis of thyroid nodules, particularly thyroid tumors. These genes include thyroid-stimulating hormone receptors, growth factor receptors such as GSP, RAS, RET, NTRK, and MET, or proto-oncogenes. Abnormal expression or mutations in these genes may lead to abnormal proliferation and differentiation of thyroid cells, ultimately leading to nodule formation.
Common diseases
Graves’ disease, autoimmune thyroiditis, thyroid adenoma
Seeking medical treatment
Outpatient indications
1. Feel a nodule in the anterior chamber of your neck.
2. Accompanied by thyroid enlargement and foreign body sensation in the throat.
3. Accompanied by neck pain, hoarseness, difficulty breathing, and difficulty swallowing.
4. Accompanied by weight changes and exophthalmos.
5. Other severe, persistent or progressive symptoms and signs occur.
All of the above require prompt medical consultation.
Treatment department
Patients can go to the endocrinology department or thyroid surgery department for treatment.
Medical preparation
1. Make an appointment in advance and bring your ID card, medical insurance card, medical card, etc.
2. If you have had medical treatment recently, please bring relevant medical records, examination reports, laboratory test results, etc.
3. If you have taken some medicine to relieve symptoms recently, you can bring the medicine box with you.
4. Family members can be arranged to accompany the patient to seek medical treatment.
5. Prepare a list of questions you want to ask in advance.
6. Blood tests may be performed, and it is best to visit the doctor in the morning on an empty stomach.
What questions might a doctor ask a patient?
1. What discomforts do you currently have?
2. How long have you been experiencing this condition?
3. Are your symptoms persistent or intermittent? Is there a pattern?
4. Have your symptoms gotten worse or better since you became ill? What’s the reason?
5. Have you ever had similar symptoms before?
6. Have you ever received treatment before? How was it treated? What was the effect?
7. Are you taking any medications?
8. Is there anyone in your family who has a similar situation?
What questions can patients ask their doctor?
1. Is my condition serious? Can it be cured?
2. Why does this happen to me?
3. What treatment do I need? Do I need to be hospitalized? How long will it take to recover?
4. What are the risks of these treatments?
5. If medication is used for treatment, what are the usage, dosage and precautions of the medication?
6. What tests do I need? Are they covered by medical insurance?
7. I have other diseases. Will this affect my treatment?
8. How should I take care of myself after returning home?
9. Do I need follow-up examinations? How often?
examine
Scheduled inspection
Doctors usually perform a physical examination on the patient first to gain a preliminary understanding of the disease; they may then recommend thyroid function tests, tumor markers, thyroid ultrasound, thyroid radionuclide scanning, CT and MRI, ultrasound-guided fine needle aspiration cytology, etc. to confirm the diagnosis.
Physical examination
Thyroid palpation is an important examination method, with a palpation detection rate of thyroid nodules of 4% to 7%. The doctor will ask the patient to swallow and feel the thyroid area with their hands to determine whether there are nodules or abnormal protrusions of tissue, and to observe whether the mass moves with the movement of the thyroid gland.
Laboratory tests
1. Thyroid function
This includes the determination of tetraiodothyronine (T 4 ), triiodothyronine (T 3 ), free T 4 (FT 4 ), free T 3 (FT 3 ), and thyroid-stimulating hormone (TSH). TSH testing is an important initial screening test for thyroid function and can be used to diagnose thyroid dysfunction.
2. Tumor markers
These include thyroglobulin (Tg), calcitonin (Ct), and carcinoembryonic antigen (CEA). Tg is a specific protein produced by the thyroid gland, and its changes are an important basis for determining whether a patient has residual or recurrent tumors.
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 with surrounding tissues of the nodules.
2. Thyroid radionuclide scan
It is suitable for evaluating thyroid nodules with a diameter greater than 1 cm. It can determine whether the nodules have secretory function, but it cannot accurately detect benign or malignant nodules.
3. CT and MRI (magnetic resonance imaging)
CT and MRI are not superior to ultrasound in evaluating the benign or malignant nature of nodules, but they can show the relationship between nodules and surrounding tissues, providing more information for surgery.
Pathological examination
Ultrasound-guided fine needle aspiration cytology (FNAC): This is the gold standard for distinguishing benign from malignant thyroid nodules, with diagnostic sensitivity and specificity exceeding 90%. Cells are extracted from the nodule using a fine needle for pathological examination, helping doctors determine the nature of the nodule.
diagnosis
Diagnostic principles
The diagnosis of Category 3 thyroid nodules requires a comprehensive evaluation through physical examination, ultrasound examination, thyroid function test, pathological examination and radionuclide scanning to determine the size, shape, boundary, calcification and presence of radioactivity of the nodules in order to clarify the nature of the nodules.
Differential diagnosis
1. Graves’ disease
Graves’ disease, also known as toxic diffuse goiter, is an organ-specific autoimmune disease associated with increased thyroid hormone production. Patients with Graves’ disease often present with symptoms of hypermetabolic syndrome, such as heat intolerance, excessive sweating, ruddy skin, low-grade fever, and tachycardia, as well as diffuse, symmetrical thyroid enlargement and distinctive ocular signs. Thyroid function tests may reveal elevated T4 and FT4 levels and decreased TSH levels. Ultrasound examination may also reveal diffuse thyroid enlargement and increased vascularity.
2. Autoimmune thyroiditis
Autoimmune thyroiditis is a disease characterized by the presence of autoantibodies against the thyroid gland and the infiltration of lymphocytes into the thyroid gland. In its early stages, it may present only with abnormal thyroid function, while in later stages, symptoms of hypothyroidism, such as hypohidrosis, bradycardia, and decreased appetite, may develop. Abnormal thyroid function tests may also result in positive antibody tests. Ultrasound examinations often reveal a moderately enlarged, firm thyroid gland, and are often asymptomatic.
3. Thyroid adenoma
Thyroid adenoma is a benign tumor that mostly originates from thyroid follicular cells. It grows slowly and lacks the ability to invade or metastasize. Patients typically have no obvious symptoms, but if the tumor is large or compresses surrounding tissue, it may cause neck pain and dysphagia. Ultrasound examination reveals single or multiple nodules within the thyroid gland with well-defined borders and an intact capsule. Fine-needle aspiration biopsy or pathological examination after surgical resection can confirm the diagnosis.
treat
Expected treatment
For benign thyroid nodules without symptoms, treatment is usually not required and regular follow-up observation is sufficient; for thyroid nodules with obvious symptoms, surgical removal is required and medication can also play an auxiliary role in treatment.
Drug treatment
If the nodule causes hyperthyroidism, antithyroid medications can be used for treatment. Currently, commonly used antithyroid drugs are thiourea compounds, including propylthiouracil, methylthiouracil, methimazole, and carbimazole. After surgical treatment, some patients may develop hypothyroidism and may need to take levothyroxine sodium long-term to maintain normal thyroid hormone levels.
Related drugs
Propylthiouracil, methylthiouracil, methimazole, carbimazole, levothyroxine sodium
Surgical treatment
If the nodule is large and has compression symptoms, or has a tendency to become malignant, surgical treatment is required. Surgical methods include total thyroidectomy, thyroid lobectomy, microwave ablation, and laparoscopic thyroid surgery.
Chemoradiotherapy
Iodine-131 internal radiotherapy: Utilizing the affinity of thyroid tissue for iodine, capsules containing iodine-131 are taken orally to kill abnormally proliferating cells.
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.
Estimated 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.