Thyroid nodules benign and malignant how to identify and treat?

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Thyroid nodules and thyroid cancer are common and frequently occurring diseases of the endocrine system. Palpation of the general population

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Thyroid nodules and thyroid cancer are common and frequently occurring diseases of the endocrine system. Palpation of the general population the prevalence rate of thyroid nodules was 3% to 7%, the high resolution ultrasound examination of thyroid nodules obtained the prevalence rate was 20-76%. The prevalence of thyroid carcinoma in thyroid nodules was 5-15%. The diagnosis and treatment of thyroid nodules and thyroid carcinoma involving head and neck surgery, endocrinology, general surgery, nuclear medicine and other clinical disciplines, is a typical interdisciplinary disease.

The vast majority of patients with thyroid nodules have no clinical symptoms, often found by physical examination or by their occasional touch. Thyroid nodules were divided into benign and malignant, benign accounted for the majority of thyroid cancer in the proportion of thyroid nodules were reported, most of the reports about 5%, but in recent years there is an increasing trend. According to the etiology of nodules can be divided into: nodular goiter, inflammatory nodules, toxic nodular goiter, thyroid cysts, benign thyroid adenoma and thyroid cancer.

Patients are particularly concerned about whether thyroid nodules are malignant. Due to the benign and malignant thyroid nodules and no characteristic clinical manifestations, therefore, the need to consider a variety of indicators in the differential diagnosis.

Prompt clinical evidence of malignant thyroid nodules, including: age less than 20 years or 70 years; the family history of thyroid cancer; the children during neck irradiation history; the male; the nodules increased rapidly, and the diameter of more than 2cm; the patients with persistent hoarseness, difficulty swallowing and breathing difficulties, tone the difficulties; nodules of hard texture, irregular surface or nodular fixation; the patients with cervical lymph node enlargement.

That benign thyroid nodules, including: the clinical evidence with clinical manifestations of hypothyroidism or hyperthyroidism; the family history of the benign thyroid disease; thyroid nodules have pain or tenderness. Benign nodules by nodular goiter, thyroid adenoma, cyst (adenoma degeneration and hemorrhage, congenital thyroglossal cyst with cystic), acute suppurative thyroiditis, subacute thyroiditis, as a result of Hashimoto's thyroiditis.

Auxiliary examination has important reference value in differentiating benign and malignant thyroid nodules. Mainly the following.

1. Thyroid radionuclide imaging can evaluate the function of nodules, which is of great value in judging the nature of nodules. Radionuclide imaging (85-90%) found that the majority of thyroid nodules are nonfunctional cold nodules or cold nodules, which malignant about 10-20%; radionuclide imaging also showed that 10-15% is a function of the temperature and hot nodules and malignant nodules, only 1%. Thyroid scintigraphy is of particular value in the diagnosis of thyroid autonomous functional adenoma, which is characterized by the presence of hot nodules and the suppression of normal thyroid imaging.

2. Ultrasound examination showed evidence of malignant nodules: (1) the thyroid nodules were irregular, the boundary was unclear, solid or cystic solid, (2) there were tiny calcifications in the nodules, (3) the blood flow was abundant in the nodules. The three indicates that the specificity of malignant lesions is high, but only one feature is not enough to diagnose malignant lesions. Nodules associated with cervical lymph node enlargement also suggest that the nodules are malignant.

3, test: all patients with thyroid nodules should have a work. The vast majority of patients with thyroid malignant tumor with normal thyroid function; thyroid nodules caused by Hashimoto's thyroiditis, detection of serum thyroid peroxidase antibody (TPOAb) and thyroglobulin antibody (TgAb) increased, the increase of TSH. Elevated serum calcitonin levels suggest that thyroid nodules are medullary carcinoma.

4. Fine needle aspiration cytology is the most reliable and valuable diagnostic method for the diagnosis of benign and malignant nodules, and the results are consistent with the results of surgical pathology in 90%.

Treatment of nodules

Thyroid cancer: total or subtotal thyroidectomy, 131 iodine removal of residual thyroid tissue and thyroid hormone suppression therapy.

The majority of patients with benign lesions do not need treatment, follow up as the main means, every 6 to 12 months to review once. A small number of benign lesions need to be treated with oral therapy, or to reduce the nodules. However, attention should be paid to the long-term use of osteoporosis, atrial fibrillation, etc..

Ultrasound guided percutaneous ethanol injection may be considered in the treatment of thyroid cysts or nodules with cystic degeneration.

131 iodine therapy is especially suitable for the patients with autonomous high function adenoma and toxic nodular goiter.

February 24, 2010

 

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