Thyroid nodules can be single or multiple. The incidence of multiple nodules is higher than that of single nodules, but the incidence of thyroid cancer in single nodules is higher. What is that? What are the clinical manifestations of thyroid nodules? What are the treatment methods for thyroid nodules? Let me tell you!

Causes of thyroid nodules

1, iodine deficiency:

This is one of the main causes of endemic goiter. The iodine content in soil, water and food in epidemic areas is inversely proportional to the incidence of goiter. The fact that iodized salt can prevent goiter can prove that iodine deficiency is an important cause of goiter. In addition, the increased demand for thyroid hormone can cause relative iodine deficiency, such as growth and development, pregnancy, breastfeeding, colds, infections, trauma and mental illness, which can aggravate or induce goiter.

2, goiter-causing substances:

Radish foods contain thiourea-induced goiter, and soybeans and Chinese cabbage also contain some substances that can prevent the synthesis of thyroid hormone, causing goiter. The contents of minerals such as calcium, magnesium and zinc in soil and drinking water are also related to the occurrence of goiter. In some endemic areas, besides iodine, these elements are also lacking. In some areas, the incidence of goiter is directly proportional to the hardness of drinking water. Drugs such as potassium thiocyanate, potassium perchlorate, p-aminosalicylic acid, thiourea pyrimidine, sulfonamides, phenylbutazone, colchicine, etc. It can hinder the synthesis and release of thyroxine, thus causing goiter.

3, hormone synthesis disorder:

The pathogenic cause of familial goiter lies in the deficiency of genetic enzymes, which leads to the disorder of hormone synthesis, such as the deficiency of peroxidase and deiodinase, which affects the synthesis of thyroxine, or the deficiency of hydrolase, which makes it difficult for thyroid hormone in thyroglobulin to be separated and released into the blood, which can all lead to goiter. This congenital defect belongs to recessive inheritance.

4, high iodine:

This is rare and can be distributed locally or sporadically. Its pathogenesis is that excessive iodine intake leads to excessive occupation of TPO functional genes, which affects tyrosine iodization, the organic process of iodine is blocked, and the thyroid gland is compensatory.

5. Gene mutation:

This abnormality includes the point mutation of thyroglobulin gene exon 10. Nodular goiter generally does not show functional changes, and the basal metabolic rate of patients is normal; However, when the nodule is large, it can compress trachea, esophagus, blood vessels and nerves, causing various symptoms. Therefore, experts remind patients that once diagnosed with thyroid nodules, they should actively cooperate with doctors for treatment, and pay attention to diet care and daily health care in their lives.

Clinical manifestations of thyroid nodules:

Large performance

Thyroid nodules or lumps and goiter are the main symptoms. In addition, most patients with thyroid nodules have no clinical symptoms. They can find thyroid nodules through self-touch or physical examination, or see a doctor to check goiter, and have physical examination or B-ultrasound and other imaging examinations.

Secondary performance

A few people have a regional thyroid mass that grows rapidly with pain. The main clinical manifestations of a few patients with hyperthyroidism are palpitation, hyperhidrosis, shaking hands and emaciation. It may also be manifested as fear of cold, fatigue and edema due to hypothyroidism; When combined with acute or subacute thyroiditis, obvious pain and tenderness may appear in and around the thyroid gland; When the nodule compresses the surrounding tissues, there may be corresponding clinical manifestations such as hoarseness, dyspnea and dysphagia.

Treatment of thyroid nodules;

Principles of treatment

The choice of treatment plan is determined according to the nature of thyroid nodules and the benign and malignant degree of thyroid nodules.

Second, the specific treatment methods

Treatment of malignant thyroid nodules

1 surgical treatment: surgical treatment is the first choice for most malignant thyroid nodules. The surgical method is almost total thyroidectomy, that is, two thyroid lobes and isthmus are removed, and only one lobe of thyroid tissue below 5g is reserved.

Chemotherapy or radiotherapy: Thyroid lymphoma is sensitive to chemotherapy and radiotherapy, so once diagnosed, chemotherapy or radiotherapy should be used. There are three commonly used chemotherapy regimens.

MOPP regimen: nitrogen mustard 6mg/m2, vincristine 1.4mg/m2, intravenous drip, day 1.8; From day 1 day to day 14, methylphenylhydrazide 100mg/m2 and prednisone 40mg/m2 were taken orally. Take the medicine for 2 weeks, rest for 2 weeks, and repeat on the 28th. It takes at least 6 cycles. The remission rate is above 80%. MOPP is the first choice for elderly patients and patients with cardiac insufficiency, because it affects reproductive function and hematopoietic system and is not suitable for teenagers.

ABVD regimen: adriamycin 25mg/m2, bleomycin 10U/d, vincristine 6mg/m2 and dacarbazine 375mg/m2, all of which were intravenously infused on 1 and 15 days. Suitable for teenagers.

CHOP regimen: cyclophosphamide 750mg/m2, adriamycin 50mg/m2, vincristine 1.4 mg/m2, all of which were injected intravenously on 1 day; Prednisone 100mg/m2, oral, day 1~5. CHOP is considered as the standard chemotherapy for highly malignant non-Hodgkin's lymphoma.

Radiotherapy generally adopts 60Co external irradiation. The curative dose was 2Gy, five times a week, and the total dose was 40 ~ 50 Gy.

Comprehensive treatment: Thyroid cancer with nodules larger than 1.5cm needs near total thyroidectomy and radiotherapy. Undifferentiated thyroid cancer is extremely malignant, with distant metastasis at the time of diagnosis, and it is difficult to achieve the therapeutic goal by simple operation, so comprehensive treatment should be chosen.

2. Treatment of Benign Thyroid Nodules Most benign thyroid nodules do not need treatment and need to be followed up every 6~ 12 months/time. If necessary, thyroid ultrasound examination and repeated thyroid FNAC examination can be performed. A few patients need treatment.

1 levothyroxine levo-T4 inhibition therapy: The purpose of levo-T4 therapy is to make thyroid nodules smaller, that is, the volume of thyroid nodules after treatment is reduced by more than 50% compared with that before treatment. A few patients with benign thyroid nodules can use it, but it is not recommended to use it widely; Serum TSH level

2 surgical treatment:

Indications for operation: ① Patients with thyroid nodules have symptoms of regional compression; ② Thyroid nodules with hyperthyroidism; (3) Progressive enlargement of thyroid nodules; ④FNAC examination suggested suspicious canceration.

Surgical methods: ① Simple thyroidectomy can be used for benign thyroid nodules; ②FNAC was benign, but clinically suspected to be malignant, so thyroidectomy was performed; ③FNAC examination showed suspicious canceration, and the frozen section during operation was benign or uncertain, so thyroid lobectomy and isthmus resection were performed; If the frozen section results show that it is a new follicular cell organism, the thyroid gland is almost completely removed.

Ultrasound-guided percutaneous ethanol injection of PEI: PEI is a minimally invasive method for the treatment of thyroid nodules. Its mechanism is that anhydrous ethanol is used as sclerosing agent, which causes coagulation necrosis and venous thrombosis in the tissue cells in the central area of thyroid nodules. Alcohol diffuses along the blood vessels, causing scattered bleeding foci and interstitial edema around it, which separates it from normal tissues. PFI therapy is mainly used to treat thyroid cysts or nodules with cystic changes; It can also be used to treat benign autonomous high-function adenoma.

Advantages: low hypothyroidism probability; Radioactive pollution caused by iodine-free treatment; Compared with L-T4 inhibitor, the course of treatment is shorter and the curative effect is better. Compared with surgical treatment, the operation is simpler, with no damage to normal thyroid tissue, less bleeding and nerve damage, and less mental stress of patients. Low cost and easy to be accepted by patients. The overall effect of ethanol in the treatment of functionally autonomous thyroid nodules is that the complete cure rate of patients with hyperthyroidism is 68%~ 100%, and that of patients with hyperthyroidism is 50%~89%. Nodules larger than 1.5cm and TSH abnormalities have poor response to treatment, while nodules are small, and the normal cure rate of TSH is over 90%.

Disadvantages: the recurrence rate of this therapy is high, and large cysts or multiple cysts may need multiple treatments to achieve better results; Transient local pain in the front of thyroid neck during injection; Temporary recurrent laryngeal nerve injury.

Treatment: Under the guidance of ultrasound, 95% ethanol or sterile ethyl ether ethanol was directly injected into thyroid nodules. The amount of ethanol injected depends on the size of the nodule, 0.5~9.0ml each time, 1~2 times a week, 4~8 times each time. After PEI, ultrasound was checked every month to determine the level of thyroid hormone, and 99mTc radionuclide scanning was performed at 3 months to observe the volume reduction and nature changes of nodules.

In addition to ethanol, the mixture of glacial acetic acid, phenol and glycerol can also be used as a hardener. Injecting about 3 ml of solution per ml of nodules and tissues is better than anhydrous ethanol, and the injection is less painful.

Radiotherapy 13 1I: The purpose is to remove functional autonomic nodules and restore normal thyroid function. This method is not suitable for patients with giant thyroid nodules, pregnant women and lactating women. The effective rate is as high as 80%~90%. After treatment, a few patients may have hypothyroidism, and a few patients may have phobia.

Indications: autonomic high-functioning adenoma mass/"hot" nodule below kloc-0/00g; Toxic nodular goiter with thyroid volume less than 100ml; Over 40 years old; Those who are not suitable for surgery or refuse surgical treatment.

Treatment: High-dose therapy is commonly used. Patients with nodules less than 3cm in diameter were given 555 ~ 740 mbq15 ~ 20mc1131i orally, and those with nodules larger than 3cm were given 740 ~1/0mbq orally. The dosage of 13 1I can also be calculated according to the nodule weight, the uptake rate of1I and the effective half-life, so that the actual absorption can reach 200~300Gy per gram of nodule tissue.

3. Treatment of suspected malignant tumors and thyroid nodules with unknown diagnosis. If FNAC examination cannot diagnose thyroid cystic or solid nodules, FNAC examination should be repeated so that 30%~50% of them can be diagnosed clearly. If repeated FNAC examinations still fail to confirm the diagnosis, especially those large and fixed nodules, surgery is needed.

4. Treatment of thyroid nodules during pregnancy The treatment of thyroid nodules found during pregnancy is the same as that found during non-pregnancy; However, thyroid radionuclide imaging examination and radioactive 13 1I treatment are prohibited during pregnancy. FNAC examination can be performed during pregnancy or postponed until after delivery. If the nodule is malignant, it is safer to perform the operation in 3~6 months of pregnancy, otherwise it should be performed after delivery.

5. Treatment of thyroid nodules in children.

1 Thyroid nodules in children are rare, mainly occurring in children whose head and neck have been irradiated by radiation. The malignant change of this thyroid nodule may be 2~3 times that of other thyroid nodules, and the cancer is as high as 15%~33%. Regardless of the results of FNAC examination, it is best to perform surgical resection.

Patients with thyroid nodules caused by non-radiotherapy factors in childhood should also undergo FNAC examination, and patients with malignant or suspected malignant nodules should undergo surgery when cytological examination shows them.