How to deal with thyroid nodules?
What is the meaning of grading in the ultrasound report?
Let me give you a science about what thyroid nodules are.
The results of thyroid ultrasound showed that the thyroid double lobe was probed and echoed multiple nodules, and the larger one in the left lobe was about 20x8mm, which was a cystic solid nodule with clear boundaries and regular morphology. The right lobe is an inhomogeneous echo, about 15x8mm in size, with a clear border and regular morphology, with multiple dotted patchy strong echoes and blood flow signals in the nodules. There was no significant enlarged lymph node echo in both necks.
Conclusions: Multiple thyroid nodules, some nodules with calcifications (Tirads classification: 3 categories).
How to deal with thyroid nodules?
What is the meaning of grading in the ultrasound report?
Let me give you a science about what thyroid nodules are.
1. What is a thyroid nodule?
Thyroid nodules are extremely common in clinical practice, and the incidence rate in women is higher than that in men, and the detection rate of ultrasound in the population is as high as 50%-70%, most of which are benign adenomatous nodules or cysts, but 5%-10% of nodules are malignant tumors.
2. How to detect thyroid nodules?
Most thyroid nodules are asymptomatic and are often found during physical examination or physical examination by doctors, or inadvertently through cervical ultrasound, cervical spine CT, MRI and other examinations. At present, thyroid ultrasound is the most accurate and economical test, and it is often the first choice in clinical practice.
3. How to interpret thyroid ultrasound?
Let's first learn about the ultrasound classification of thyroid nodules in China (see the table below).
*: 2023 China Guidelines for the Diagnosis and Treatment of Thyroid Nodules and Differentiated Thyroid Cancer (Second Edition).
Type 2 nodules are the most common, they are benign nodules, no need for a short period of reexamination, long-term follow-up is sufficient, the appearance in ultrasound is usually oval, the boundary is clear, the morphology is regular, if the nodule is large and compresses the tracheoesophagus or affects the appearance, it can be treated according to the specific situation.
Type 3 nodules are the second most common nodules, with 98% of benign nodules and the need for puncture or follow-up is required according to the doctor's definition.
The probability of class 4A malignancy is also relatively small, and it can generally be decided whether to intervene next step after 3-6 months of reexamination, such as excessive anxiety, needle biopsy can also be used to confirm the diagnosis. Nodules of 4b and above have a high probability of malignancy, so needle biopsy or direct surgery is recommended.
A strong echo of punctate shapes can be seen in the nodules, with unclear borders and irregular morphology. (Tirads Classification: Class 4A).
The nodule is a hypoechoic nodule with an unclear border and an aspect ratio greater than 1. (Tirads Classification: Class 4A).
Summary: Benign thyroid nodules, large thyroid nodules that are large and compressive or unsightly, or comorbid with refractory hyperthyroidism, we usually recommend ultrasound-guided ablation** or surgery**.
For pathologically confirmed malignant thyroid nodules, surgery is required**;In addition, for patients with isolated papillary thyroid cancer, less invasive ablation may also be an option after evaluation of indications**.
4. What is thyroid nodule ablation**?
Traditional surgeries often leave unsightly scars on the neck and are more difficult for women to accept. Ablation** has the advantages of small trauma, good effect, fast recovery, almost no scarring, short hospital stay, and less pain for patients, and is welcomed by the majority of female patients.
Ultrasound-guided ablation of thyroid nodules**.
Thyroid nodule ablation** is a minimally invasive ultrasound that has emerged in the past 10 years**, under ultrasound positioning, puncture and high-temperature ablation of the lesion site with radiofrequency needle or microwave ablation, and the ablated tissue will be gradually absorbed, and the speed and degree of absorption depend on the size of the nodule.
After the operation, there is only a puncture point the size of a pin's eye on the neck, and there is basically no scar except for patients with scar constitution. And the postoperative recovery is fast, there are no special circumstances, the hospital can be discharged on the second day of ablation, and the thyroid function is not affected, the postoperative follow-up effect is good, and there are no complications.
Thyroid nodule ablation** After ablation, thyroid function and ultrasound should be evaluated in 1 month, 3 months, half a year, and 1 year, mainly to evaluate the absorption and shrinkage rate of benign nodulesComplete ablation rate of papillary thyroid carcinoma and whether it is ** or metastasis.
5. How to prevent thyroid nodules?
At present, the pathogenesis and pathogenesis of thyroid nodules are unknown, and clinical findings show that the occurrence of thyroid nodules is related to iodine deficiency, history of radiation exposure, genetics, thyroiditis, trace element deficiency, obesity, etc. In addition, many patients with thyroid nodules have anxiety, staying up late, and high work pressure.
Therefore, the prevention of thyroid nodules should pay attention to the following points: regular life, avoid staying up late, enhance physical fitness, adjust emotions, and protect an optimistic attitude. Try to avoid neck exposure to radiation, especially in children. Appropriate iodine supplementation for healthy people who have quit smoking, especially those in iodine-deficient areas. Weight control, obesity is a high risk factor for thyroid cancer. People with a family history or a high risk of thyroid cancer have regular thyroid ultrasounds.
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