Zhimei recently received many people's inquiries:
Going for a physical exam, the doctor said he found me with thyroid nodules. Seriously? Do you want to take medicine or have surgery? What should I do next?
This article, let's talk about 7 important issues related to thyroid nodules.
01. Are thyroid nodules serious?
Survey data show that about one in five people has a thyroid nodule, and more than 90% of thyroid nodules are benign [1].
So, after finding a thyroid nodule, you really don't have to panic. As long as you can follow the doctor's advice, clarify the nature of the nodule, and take appropriate treatment, most of the cases will be a "false alarm".
02, the same thyroid nodules, why do some people "regularly review", some people have to do surgery?
Early detection of smaller nodules, the doctor usually recommends follow-up observation every 3 to 6 months, please be sure to listen to the doctor's words and review it regularly.
However, even if it is a benign nodule, in most cases, it is impossible for the nodule to slowly become smaller or even disappear on its own, so if it is a benign but larger nodule, surgery also needs to be considered.
If thyroid function is also found to be abnormal on examination, it may also be necessary to take medication or take other treatments.
03. Can benign thyroid nodules become malignant?
In general, thyroid nodules that are identified as benign do not undergo malignant changes because thyroid cancer and benign nodules are genetically distinct [2].
Cancer occurs because a certain type of cell does not proliferate and mutate abnormally, becoming a malignant "cancer cell".
Nodules that have been identified as benign, benign cells holding a "good guy card", have a low probability of becoming malignant cells.
However, this does not mean that benign nodules are completely free of malignant changes, because the cells of benign nodules may also quietly mutate in some special cases (such as radioactive radiation, etc.) and hide in benign nodules.
Over time, it gradually grows and dominates, forming new malignant nodules.
Therefore, as long as the biopsy is not excised, no one dares to be completely sure that a nodule is 100% benign.
04. After the nodule is found, what tests may need to be done?
Depending on your situation, your doctor will use a "quadruple assessment" to determine the good or bad of a thyroid nodule, including clinical evaluation, serum TSH, thyroid ultrasound, and puncture biopsy.
Tests you may need to do include a blood test for thyroid function, thyroid ultrasound or neck ultrasound, and puncture biopsy.
05. What do you think of the thyroid function test report sheet?
The results of the blood test can only reflect whether there is a problem with thyroid function, but cannot give a definitive conclusion as to whether the thyroid nodule is benign or malignant.
You can check the pictures and instructions below to see how your thyroid is functioning.
(Click to enlarge)
●T3, T4 & FT3, FT4 are all indicators that directly reflect thyroid function, and their elevated levels often suggest the possibility of hyperthyroidism, on the contrary, decreased levels may have hypothyroidism.
●The concentration change of TSH is usually the opposite direction of change of FT3 and FT4. Studies have also shown that patients with high levels of TSH are three times more likely to have thyroid nodules than patients with normal levels of TSH [3], but this can only be used as a reference and cannot be used as a basis for determining whether thyroid nodules are benign or malignant.
●Tg has no special significance for benign disease and is mainly used to evaluate tumor recurrence after alpha-cancer surgery.
06. Can thyroid color ultrasound distinguish benign nodules from malignant nodules?
Inexpensive and non-invasive, ultrasonography can find nodules with a minimum diameter of 2 mm [4], and estimates of the nodule's position and size are quite accurate, so they can provide an important reference for the nature of the nodule.
Overall, low-echo, "tall," lean (flat), solid, calcified, irregularly shaped, and seemingly "teeth-dancing" (infiltrative growths) nodules are more likely to be malignant and require further evaluation [2].
In addition to these points in the table, calcifications are found in the nodules and further evaluation is recommended.
07. What kind of nodule should be punctured biopsy?
If a nodule is found to be suspicious after a thyroid ultrasound, your doctor may recommend that you have a further puncture biopsy.
Puncture biopsy can provide 97% sensitivity and 99% specificity for the diagnosis of nodules, although there are also small numbers of results that are difficult to determine.
That is, the pathological results of a puncture biopsy can be conclusive for the nature of the nodule.
Puncture results are generally divided into three categories [5]:
1. Almost certainly benign;
2. Possible neoplastic lesions;
3. Lesions of a clear nature (including malignant and inflammatory lesions).
Having said all that, to sum up in one sentence: thyroid nodules are not "terrible".
It is right to follow the doctor's advice, review the review, take the medicine, and do not delay the operation.
After understanding these, you will save a lot of unnecessary worries, click "watching" to tell others ~ ~
Reviewer
Miao Li | Deputy Chief Physician, Department of Endocrinology, Beijing Chaoyang Hospital, Capital Medical University
bibliography
[1] Durante C, Grani G, Lamartina L, Filetti S, Mandel SJ, Cooper DS. The Diagnosis and Management of Thyroid Nodules: A Review. JAMA. 2018 Mar 6;319(9):914-924. doi: 10.1001/jama.2018.0898.
[2] Huang TW, Lai JH, Wu MY, Chen SL, Wu CH, Tam KW. Systematic review of clinical practice guidelines in the diagnosis and management of thyroid nodules and cancer. BMC Med. 2013 Aug 29;11:191. doi:10.1186/1741-7015-11-191.
[3] Pacini F, Castagna MG, Brilli L, Pentheroudakis G; ESMO Guidelines Working Group. Thyroid cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2012 Oct;23 Suppl 7:vii110-9. doi:10.1093/annonc/mds230.
[4] Tessler FN, Middleton WD, Grant EG, Hoang JK, Berland LL, Teefey SA, Cronan JJ, Beland MD, Desser TS, Frates MC, Hammers LW, Hamper UM, Langer JE, Reading CC, Scoutt LM, Stavros AT. ACR Thyroid Imaging, Reporting and Data System (TI- RADS): White Paper of the ACR TI-RADS Committee. J Am Coll Radiol. 2017 May;14(5):587-595. doi: 10.1016/j.jacr.2017.01.046.
Shi Bingyin,Zhao Yuan. Cytology of thyroid fine needle aspiration and clinical application. Chinese Journal of Endocrinology and Metabolism. 2004，20:180-182
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