Thyroid gland (nine) thyroid nodule (1)Interpretation of guidelines for diagnosis and treatment of thyroid nodules:(a) definition of thyroid
Thyroid gland (nine) thyroid nodule (1)
Interpretation of guidelines for diagnosis and treatment of thyroid nodules:
(a) definition of thyroid nodules:
1, thyroid nodules refers to thyroid cells in the local abnormal growth caused by scattered lesions
2, can touch but can not be confirmed in ultrasound examination of the nodules, can not be diagnosed as nodules.
3, failed to touch in the imaging examination found that the nodules are called "thyroid nodules". American Society of thyroid 2009)
(two) the prevalence of thyroid nodules:
The crowd palpation detection rate of 3%~7%, ultrasound detection rate of 20%~70%. (Gharib H, 2010) 5%~15% in the thyroid nodule is malignant, 85%~95% is benign, and the key point is the identification of benign and malignant nodules.
(three), clinical manifestation:
1, most of them have no clinical symptoms, combined with abnormal thyroid function can have the corresponding clinical manifestations, there may be symptoms of oppression.
The risk factors of thyroid cancer, 2 thyroid nodules: 1), childhood head and neck radiation history or history of exposure to radioactive dust; 2), systemic radiotherapy history; 3), male; 4), nodular growth rapidly; 5), including thyroid cancer history or family history: differentiated thyroid carcinoma, medullary thyroid carcinoma, multiple endocrine neoplasia type 2, familial adenomatous polyposis, thyroid cancer syndrome (Cowden syndrome, Carney syndrome, Werner syndrome, Gardner syndrome); 6), hoarseness and dysphonia (excluding vocal cord lesions); 7), difficulty swallowing or breathing difficulties; 8), cervical lymph node pathological enlargement; 9), nodules with irregular shape, fixed with the surrounding tissue adhesion.
1, laboratory examination:
1, the routine check TSH, TSH lower than normal nodules patients, the proportion of malignant lower than TSH normal or increased. (Fiore E, 2012)
2. Tg is secreted by the thyroid follicular epithelial cells, and a variety of thyroid diseases can cause Tg to increase, Tg can not distinguish between benign and malignant nodules.
3 (100pg/ml), calcitonin (CT) secreted by the thyroid follicular epithelial cells (C cells), CT> thyroid medullary carcinoma. The specific diagnosis of medullary thyroid carcinoma is lower than the increase of 100pg/ml.
2, ultrasonic examination:
1. High resolution ultrasonography is the preferred method for the evaluation of thyroid nodules.
2), on suspicion of palpation nodules, or other examination (X-ray, CT, MRI, F-18-FDG, PET) that "thyroid nodules" should be neck ultrasonography. The aim is to confirm the existence of nodules, determine the size, number, location and texture of nodules (solid, cystic), shape, boundary, envelope, calcification, blood supply, and the surrounding tissue, lymph node size, morphology, structure characteristics etc..
3), pure cystic nodules and composed of a plurality of vesicles occupy more than 50% of the volume of the nodules, 99.7% were benign.
4), under the circumstances, the possibility of thyroid cancer: A, hypoechoic lesion; B, nodule rich blood supply (normally TSH); C, nodular morphology and irregular edge, halo absent; D, small calcification, needle like diffuse and clustered calcification; E, with lymph node imaging abnormalities such as lymph nodes, rounded, irregular or fuzzy boundary, uneven internal echo, internal calcification, corticomedullary unclear boundaries, hiler disappeared or cystic degeneration. (5) the ability of ultrasound to identify thyroid nodules is related to the clinical experience of the physician.