Thyroid nodules

Introduction Thyroid nodules are a common symptom, especially in middle-aged women. 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. Thyroid nodules are complicated by various thyroid diseases, such as simple goiter, thyroiditis, thyroid tumors, etc., and their nodules are single or multiple. Clinically, there are good and bad points, which must be identified in detail to distinguish between benign and malignant. Benign nodules account for the vast majority, and malignant nodules are less than 1%.

Cause

If the family has a history of this disease, the incidence of offspring is higher than that of no family history, indicating that the disease is related to congenital inheritance. The nodular tissue is deposited for a long time to form a thyroid tumor, and the local cell tissue proliferates for a long time to form thyroid cancer, endangering the life of the patient.

The cause of this disease is mainly related to emotional internal injuries, diet and water and soil disorders, and congenital factors. Due to long-term anger and anger, or sorrow, the gas is stagnant, the liver is lost, and the body fluid cannot be normalized and condensed into sputum. Gas stagnation and clotting, before the neck is formed, it forms a rickets. When talking about the long-term qi, the blood is blocked and the blood type is stagnant, which can cause hard swelling or nodules and tumors.

Eating disorders or mountains, water and soil are unsuitable, one affects the function of the spleen and stomach, the spleen loses health and transports, gathers warm and phlegm, and the second affects the normal operation of qi and blood, and the sputum is smashed before the neck is sputum, and these two reasons It is often closely related to physical fitness: for example, women's physiological characteristics such as menstruation, pregnancy, labor, and milk are closely related to liver and blood.

an examination

Related inspection

Thyroxine (T4)

Thyroid B-ultrasound examination:

Can show solid nodules, cystic or mixed lesions, a single solid nodule, the possibility of malignancy is higher, mixed nodules also have the possibility of malignancy, and simple cystic nodules are a vicious probability less.

Thyroid nuclides scan:

According to the nodules, the ability to ingest radionuclides is classified into "hot nodules" and "cold nodules." "Hot nodules" are functionally autonomous thyroid nodules, almost mostly benign. "Cold nodule" has the possibility of cancer, but many "cold nodules" are mostly benign adenomas or nodules. In addition, if there is bleeding or cystic changes in the nodules, it can also be expressed as "cold nodules". .

Neck X-ray examination:

There are small or sand-like calcifications on the nodules, which may be the grit of papillary carcinoma. Large and irregular calcification can be seen in degenerative nodular goiter or thyroid cancer. If there is infiltration or deformation in the trachea image, it suggests a malignant lesion.

Thyroid fine needle aspiration cytology:

The inspection operation is simple and safe, and it is very helpful for identifying benign and malignant nodules.

Thyroid function measurement:

The functional autonomous nodules are mostly hyperthyroidism, and the early stage of subacute thyroiditis may also be hyperactive. The thyroid function of chronic lymphocytic thyroiditis may be normal, hyperthyroidism or reduction. Most of the thyroid nodule function caused by the remaining lesions is normal.

Differential diagnosis

The disease should be differentiated from the following diseases:

Nodular goiter:

More common among middle-aged women. In the case of relatively insufficient thyroid hormone in the body, the secretion of TSH from the pituitary gland increases, and the thyroid gland undergoes repeated or persistent hyperplasia resulting in increased thyroid heterogeneity and nodular changes under the long-term stimulation of this increased TSH. There may be bleeding, cystic changes and calcification in the nodules. The size of the nodule can range from a few millimeters to a few centimeters. The main clinical manifestations are thyroid enlargement. When palpation, multiple nodules of different sizes can be touched. The texture of the nodules is mostly medium hardness. A few patients can only touch a single nodule, but when doing thyroid imaging or surgery, Multiple nodules are often found. The patient's clinical symptoms are not many, generally only the feeling of discomfort before the neck, thyroid function test is mostly normal.

Nodular toxic goiter:

The onset of this disease is slow, often occurs in patients with many years of nodular goiter, more than 40 to 50 years old, more common in women, may be associated with hyperthyroidism symptoms and signs, but the symptoms of hyperthyroidism are generally lighter , often not typical, and generally does not occur invasive exophthalmos. The thyroid gland can be touched with a smooth round or elliptical nodule with a clear boundary and a hard texture. It moves up and down with swallowing and there is no vascular murmur in the thyroid gland. Thyroid function tests showed elevated thyroid hormones in the blood, caused by functional autonomic nodules, and radionuclide scans showed "hot nodules."

Inflammatory nodules:

It is divided into two types: infectious and non-infectious. The former is mainly subacute thyroiditis caused by viral infection, and other infections are rare. In addition to thyroid nodules, methylene inflammation is accompanied by fever and local thyroid pain. The size of the nodules depends on the extent of the lesion, and the texture is tough. The latter is mainly caused by autoimmune thyroiditis. Young women have fewer symptoms of self-consciousness. They can touch multiple or single nodules during examination. The texture is hard and tough, with little tenderness. Thyroid globulin antibodies and thyroid microsomal antibodies are often strongly positive in thyroid function tests.

Thyroid cyst:

The vast majority are formed by degenerative changes of nodules or adenomas of the goiter. The cysts contain blood or micro-mixed fluids, which are clear with surrounding boundaries, hard texture, generally no tenderness, and radionuclide scans indicate "cold nodules." ". A small number of patients are caused by congenital thyroid gland cysts or residual cleft palate.

Goiter:

Including benign thyroid tumors, thyroid cancer and metastatic cancer.

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