Multiple nodules

Introduction 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.

Cause

Thyroid nodules are divided into two categories: benign and malignant. The benign is the majority, and the malignant is less than 1%. According to the pathology of nodules can be divided into: nodular goiter, inflammatory nodules, toxic nodular goiter, thyroid cysts, thyroid tumors. Early clinical understanding of the nature of thyroid nodules, especially distinguishing them as benign or malignant lesions, is of great significance for the choice of treatment options, prognosis and so on.

The nodules on the thyroid may be thyroid cancer, or may be thyroid tumors, nodular goiter and other causes. Before the nature is clearly defined as thyroid nodules, only the adenocarcinoma is a malignant disease, therefore, the thyroid gland The end of the knot found must be malignant.

Those who are highly suspected of malignant disease should be surgically removed as soon as possible. Although multiple nodules or single adenomas are benign lesions, some patients may have secondary hyperfunction or cancer, so they also advocate early surgical treatment.

Nodular goiter is a common thyroid disorder. Nodular goiter is a benign disease that is more common in middle-aged women. Due to the relative deficiency of thyroid hormone in the body, the secretion of pituitary TSH is increased. Under the stimulation of this increased TSH for a long period of time, the thyroid gland repeatedly proliferates, accompanied by various degenerative changes, and finally forms nodules. The clinical manifestations are thyroid enlargement, and multiple nodules of varying sizes can be seen or touched. The texture of the nodules is mostly medium hardness. The clinical symptoms are not many, only the discomfort of the anterior neck area. Most of the thyroid function is normal. Thyroid scan, thyroid B ultrasound can be clearly diagnosed.

an examination

Related inspection

Thyroid imaging mammography

(1), thyroid B-ultrasound

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.

(2), thyroid nucleus scanning

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". .

(3), 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.

(4), thyroid fine needle aspiration cytology

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

(5), thyroid function test

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

(1) 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 found. The texture of nodules is moderately hard. A few patients can only have single nodules, but they are used for thyroid imaging or surgery. At times, 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.

(2) 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 physical symptoms, but the symptoms of hyperthyroidism are generally lighter , often not typical, and generally does not occur invasive exophthalmos. When the thyroid gland is palpated, it can be smoothed with a smooth round or elliptical nodule. The boundary is clear and the texture is hard. It moves up and down with swallowing, and there is no vascular noise in the thyroid. Thyroid function tests showed elevated thyroid hormones in the blood, caused by functional autonomic nodules, and radionuclide scans showed "hot nodules."

(3) 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, patients with less self-conscious symptoms, can be treated with multiple or single nodules, hard and tough, less tenderness, thyroid globulin antibodies and thyroid microsomal antibodies are often strongly positive during thyroid function tests.

(4) 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.

(5) Thyroid tumor

Including benign thyroid tumors, thyroid cancer and metastatic cancer.

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