Cool nodules

Introduction Cool nodules: Nodular tissue has no function of absorbing iodine, so there is no radioactivity at the nodules. This type of knot saves about 20% of cancer. For a single hair, the boundary with the surrounding tissue is not very clear, the possibility of cancer is greater. Combined with the determination of serum calcitonin, the diagnosis rate can be improved. Cool nodules are more common in the undifferentiated thyroid cancer, medullary carcinoma, thyroid cystic changes and subacute thyroiditis in the acute phase.

Cause

The cause of thyroid tumors is not clear. At present, there are two reasons for the etiology of differentiated thyroid cancer (including papillary and follicular carcinoma): one is radiation, and the other is endemic goiter.

an examination

Related inspection

Ultrasound examination of thyroid gland and parathyroid gland

(1) Asking about medical history and physical examination

The cervical lymph nodes must be examined at the same time to distinguish whether the neck mass is derived from the thyroid gland.

(2) Radionuclide inspection

This test should be a routine diagnostic tool for the thyroid gland, with radionuclides: 131I and 99mTc. According to the absorption function of the thyroid, the nodules can be divided into four categories:

1. Thermal nodules: The concentration of radionuclides in the thyroid nodules is higher than that in the surrounding tissues, and is more common in follicular adenomas or adenocarcinomas or toxic adenomas.

2. Warm nodules: more common in the recovery period of adenoma, nodular goiter, Hashimoto's disease, subacute thyroiditis.

3. Cool nodules: more common in thyroid undifferentiated cancer, medullary carcinoma, thyroid cystic changes and subacute thyroiditis in the acute phase.

4. Cold nodules: often thyroid cancer, but not absolute.

(3) Ultrasound examination

Detect the shape, size, number of the thyroid mass and the positional relationship with the carotid sheath; determine whether the mass is cystic or solid; determine the condition of the cervical lymph nodes; and as a means of positioning for puncture examination.

(4) X-ray and CT, magnetic resonance imaging (MRI) examination

The positive lateral radiograph of the neck can understand the extent of the tumor, different calcification images and the relationship with the trachea and esophagus. CT and MRI can clearly show the size and shape of thyroid tumors and their positional relationship with trachea, esophagus, blood vessels and even nerves, fully clarify the scope of cancer invasion, and provide scientific basis for surgical implementation.

(5) Fine needle aspiration cytology

The advantages are super simple; no anesthesia is needed (children are acceptable); there is no risk of bleeding and cancer cell transfer; the positive rate is high, the false positive is very small, and the false negative rate is about 10%.

(6) Laboratory inspection

Find out if there is abnormality in thyroid function and help to define the nature of the thyroid mass. Commonly used are: T3, T4, TSH, FT3, FT4, TGA, MCA, plasma calcitonin, ESR, and the like.

Differential diagnosis

Differential diagnosis of cold nodules:

1, hot nodules: the ability to absorb iodine at the nodules is greater than normal thyroid tissue. Mostly benign autonomous functional thyroid adenoma. Due to the secretion of a large amount of thyroid hormone at the nodules, the secretion of TSH is inhibited, resulting in a decrease in 131I absorption in thyroid tissue other than nodules. Therefore, there is no absorption of 131 around the nodules.

2. Warm nodules: The radiation intensity at the nodules is not different from other thyroid tissues. Most are benign tumors.

3, cold nodules: thyroid adenoma: most of them are single, slow growth, asymptomatic. The thyroid scan is a "warm nodule." If it is a toxic adenoma, it shows "hot nodules." Adenomas can also develop hemorrhage, necrosis and liquefaction as "cold nodules."

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