Thyroid palpation as smooth firm oval nodule

Introduction Thyroid spasm and smooth, solid oval nodules are clinical manifestations of autonomous hyperfunctional thyroid adenomas. Thyroid Adenoma is a benign thyroid tumor that originates in thyroid follicular cells. Clinically and pathologically divided into two types of follicular and papillary adenoma: Thyroid adenomas can occur in all ages, with the most common in 15 to 40 years old, more women than men, and the ratio of male to female is about 1:6. Young and middle-aged patients with papillary adenoma are more common, and middle-aged and elderly people often have follicular adenomas.

Cause

(1) Causes of the disease :

This disease is different from toxic nodular goiter, the exact cause is not very clear, mainly for thyroid nodules (adenomas) partial function increase, and autonomy, that is, not regulated by TSH of the pituitary, and extranodal thyroid tissue Still maintain normal feedback, but when the adenoma is large (more than 3cm), excessive secretion of thyroxine can cause hyperthyroidism. Most of the pathological examinations of toxic solitary nodules are follicular adenomas, and a few are cancers.

(2) Pathogenesis:

This disease is different from toxic nodular goiter, mainly for thyroid nodules (adenomas), and has autonomy, that is, it is not regulated by TSH of the pituitary, and the extranodal thyroid tissue still maintains normal feedback, but When the adenoma is large (more than 3cm), excessive secretion of thyroxine can cause hyperthyroidism. Most of the pathological examinations of toxic solitary nodules are follicular adenomas, and a few are cancers.

Pathological examination showed adenoma changes in the nodules. Under the microscope, there were hyperplastic follicles in the nodules. The nucleus was large, and the central position contained less gelatinous tissue. The epithelium was cuboidal and could absorb vacuoles.

an examination

Related inspection

Thyroid B-mode ultrasonography for thyroid blood flow imaging

The onset of this disease is quite slow. It is more common in middle-aged and elderly patients aged 40 to 60 years. Most of them have neck nodules, which gradually increase. The symptoms of hyperthyroidism appear only a few years later. Hyperthyroidism is generally mild, and most patients have only tachycardia or fatigue, weight loss or diarrhea, no skin lesions of the eye and Graves disease, but may have cleft palate and gaze.

The thyroid palpation can be smooth and smooth oval nodules, the boundary is clear, the texture is solid, can move up and down with swallowing, and the neck auscultates no vascular noise. In patients with longer course of disease, adenomas may occasionally undergo degenerative changes on their own during the course of the disease, which may be necrotic, atrophic, degenerative or disappearing. Or a case of degenerative changes after TSH stimulation in individual cases, the adenoma disappeared.

Mainly rely on clinical manifestations and radionuclide imaging. Determination of T3 and T4 in serum helps to determine if the patient has hyperthyroidism. Thyroid nodules in middle-aged and elderly people, clinical tachycardia, weight loss, fatigue or diarrhea, accompanied by or without symptoms of hyperthyroidism, elevated serum T3, T4, or only T3, T4 normal, TSH can be decreased TSH has low or no reaction, and the rate of 131I is normal or elevated. The patient with negative heat nodules inhibition test is diagnosed as the disease.

Differential diagnosis

1, multiple nodules: multiple nodules are a type of thyroid nodules. Thyroid nodules are a very common condition, especially in middle-aged women. Thyroid nodules are divided into two categories: benign and malignant. Benign nodules account for the majority, and malignant nodules are less than 1%. There are many thyroid diseases in the clinic, such as thyroid degeneration, inflammation, autoimmunity and new organisms, which can be expressed as nodules. Thyroid nodules can be single or multiple, and multiple nodules have a higher incidence than single nodules, but the incidence of single nodular thyroid cancer is higher.

2, glandular nodules: nodular goiter, also known as adenoma-like goiter, actually refers to multiple nodules formed by endemic goiter and sporadic goiter. The incidence rate is very high, and it has been reported to reach 4% of the population.

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