At the end of November 2021, with the decline in e-commerce performance and the crisis of project dissolution, a cold wind spread in the company. At the same time, I unfortunately had a cold and fever, accompanied by swollen lymph nodes on the left side of my neck. At its worst, the lymph nodes were so swollen and painful that I couldn't even turn my head.
I concluded that it was lymphadenitis again. This is not the first time I have had lymph node inflammation, I had a similar situation when I went on a road trip to Gansu two years ago.
Small strips of meat floating in a test tube
It was fresh tissue from my neck
A week later, the cold and fever were cured, and I was also laid off due to the dissolution of the project. But there is always a lump in the swollen lymph nodes on the left side of the neck. After two months of observation, I went for a color ultrasound again, which showed that "reactive hyperplasia is possible". After another two weeks, under the persuasion of my partner, I was called a specialist in the otolaryngology department of a tertiary hospital in the city.
Faced with my condition, the doctor was very cautious and arranged for me to have a laryngoscopy and lymph node puncture.
After the puncture, the doctor gave my partner two test tubes. The small strands of flesh floating in the liquid in the test tube were fresh tissue from my neck.
Sample of lymph node puncture丨Courtesy of the author.
I didn't expect that this puncture, which I was not psychologically prepared for, would become the beginning of the next year's medical treatment and the beginning of six punctures.
While waiting for the results, I received a ** when I was on a field trip at a new company. The other end says, "Did you have a thyroid problem before?"”
Confused, I replied, "No problem." ”
* The other end said, "Are you sure it's okay?".”
Me: "yes, what's the problem?".”
* The other end: "Nothing, just ask." ”
And then hung up**.
I didn't think much of it and kept working. When I got back to the office, I received a report on my phone: "Patches of dysmorphic cells, combined with the puncture site,Prone to cancer metastasis, papillary thyroid carcinoma metastasis is possible, please combine it with clinical practice. ”
The results of the first pathological examination of left lymph node puncture丨Courtesy of the author.
No primary lesion was found
I had three more lymph node punctures
Looking for a weekend, I hung up the number of a specialist in head and neck surgery at another hospital. The doctor took my puncture report and his eyes became serious. He said straight to the point: "You are going to have surgery, it is very serious, the surgical area will not be small, the thyroid gland will be removed entirely, the lymph nodes around the neck will be dissected, and the sequelae of the operation will be ......."”
He stood up, raised his arms, and demonstrated to me, "Your arms may not be lifted;Some people will have a lifelong calcium deficiency (surgery may damage or remove the parathyroid glands that regulate blood calcium levels, resulting in hypocalcemia) and will have calcium transfusions for the rest of their lives. ”
I never thought it would be so serious, and I was stunned: "Can I not have surgery?"The answer is no.
My dad who accompanied me asked, "Is there a possibility that the puncture will go wrong?"”
The doctor said, "Basically, you can't be wrong." ”
My dad insisted on sending the puncture sample to this hospital for another examination, so the doctor issued an application letter to borrow the sample, and at the same time prescribed color ultrasound and CT at the hospital.
Tissue section loaned from the first hospital丨Courtesy of the author.
The results of the re-examination showed that there was no doubt that it was still papillary cancer cells. But the ultrasound results were very strange, and the sonographer hesitantly gave me a rating of "ti-rads: 0".This is because there is no obvious mass on both sides of the thyroid gland。Contrast-enhanced CT results also showed "suspicious small nodules" in the left thyroid gland and "enlarged lymph nodes" in both necks. And this "suspicious nodule" is actually a benign small nodule that has existed for many years and has a rating of 2.
Ultrasonography to evaluate the TI-RADS classification of thyroid nodules (Ref. 2)丨Homemade.
After reading the results, the doctor's words rumbled in my mind: "You are in trouble, the thyroid gland cannot find a bad nodule, it may be diffuse sclerosis, that is, it looks good, but in fact, the entire thyroid gland is cancer cells." ”
The atmosphere in the clinic was heavy again, and I didn't understand why it was judged that the entire thyroid gland was cancerous because there were no special symptoms
Under the doctor's arrangement, I had another right lymph node puncture and no cancer cells were found. My dad suspected that the first puncture had gone wrong, so at our insistence, he did a new puncture on the left lymph node. The familiar needle pierced again**, and I sucked 3 times under negative pressure under the skin, and the familiar pain, I couldn't help but look at the bright ceiling ......The results came out, and no tumor cells were found
This result made my dad very happy, and it confirmed his judgment. The doctor didn't say anything, so I asked me not to have surgery first, keep observing, and recheck the color ultrasound after 3 months.
However, in my heart, I don't think the first piercing was an oolong incident. Puncture can be proven, but not none. I wanted to solve this disease happily, but I put it on hold like this. However, my biggest concern is that I can't find the primary lesion on my thyroid gland.
In June 2022, the color ultrasound was re-examined, and the results still showed that only the benign small nodule on the left thyroid gland that had existed for many years and was rated 2, and there was no abnormality in the lymph nodes. It seems like all that was just a dream.
In November, the color ultrasound was re-examined. After listening to my complicated medical experience, the ultrasound doctor carefully scanned my neck and pointed to the image on the screen to show me: "The lymph node on the left doesn't look very good, it's oval and calcified, so you should check it again.......""I looked at the conspicuous, real oval on the screen and realized that I wasn't dreaming.
I sat back in the doctor's office, did a new ultrasound, and had a new puncture of the left lymph node. The results of this puncture revealed papillary carcinoma cells, and there werebrafGene mutations, indicating a high degree of malignancy of the tumor.
After listening to my puncture experience, the ultrasound doctor worked hard and seemed to find an abnormal nodule on the thyroid gland. She said strange things while sweeping, calling me to get up and lie down, and finally unconvinced, she pulled out a tricky nodule on the outside of the right thyroid pole and said, "I'll give a 4a at best!."”
After seeing the results, the doctor prescribed a hospitalization order, and he said, "You are more troublesome, and you may have to dissect both lymph nodes." My dad asked tentatively, "This operation is not small, is it?" The doctor said, "This operation is not small, it is big." ”
After returning home, I waited for the notification of the operation. The doctor clearly told that there will be a long queue for the operating bed, and it will not be admitted until at least the Chinese New Year. Wait, wait, wait, wait for the New Year, wait for the Lantern Festival, two months have passed, and there is still no news at all.
An experienced sonographer has found the primary lesion
Thinking back to the last time the doctor "must find something", I feel a little uneasy. Although it seems to have come up with a result, the words "at best" seem a bit far-fetched. My thyroid gland has malignant nodules
I started searching online again and found a color ultrasound doctor who was highly respected by my patients, working at the same hospital where I had my first piercing. So I went to the doctor and added the number.
To my surprise, the sonographer quickly found the primary site I had been looking for for a year!In cases like mine, where the primary focus cannot be found, it may be because the nodule is too small, or it may be because the location is unusual," he said. If you can't find it on the thyroid gland, you need to look straight up along the thyroid gland.
He asked me to look up, and I felt the cool probe slowly move up and up from the thyroid gland to finally pause at the chin. He said gently, "Found it, it should be this." ”
I wondered, "Is there a thyroid gland here?"Is it metastasis or primary?”
He drew me a stick figure and explained that the thyroid gland starts at the base of the tongue and slowly sinks to the position we know it well. Mine may not have sunk completely, and there are some thyroid glands left in the sinking route, which is the primary lesion. He said that my situation was very rare, and in order to leave more images, he took more than 20 color ultrasound**. At the same time, he said that it was not like diffuse sclerosis papillary carcinoma, and there was no nodule under the capsular far lateral thyroid gland on the right side.
Eventually, the result of the color ultrasound report was "".Pretracheal proximal submental nodular lesions, ectopic thyroid nodules
This is the first time I have learned about the development of the thyroid gland. I was relieved, like a mystery game, I finally found the truth!
The location of the puncture is under the left chin丨Courtesy of the author.
A week later, the sonographer gave me a puncture. Maybe because of my special situation, the doctor paid special attention to it, and the results came out quickly, and they were found on the same dayDiagnosed with papillary carcinoma cells
The results of the fifth lymph node puncture丨Courtesy of the author.
This visit was a turning point in my condition. Looking back on it now, I'm still thrilled.
Then, I found the ideal head and neck surgeon to perform the surgery.
When the doctor saw me, he first examined the base of my tongue and told me that the most common part of the ectopic thyroid gland was the base of the tongue, but fortunately the base of my tongue was normal. After further palpation, the doctor felt an abnormal nodule under my chin. He has a lot of experience in surgery, but he still says that I don't have a few cases like mine in a year. On that day, I saw a joint outpatient clinic and a nuclear medicine doctor was there, so I was urgently arranged for a whole body CT and completed the examination all the way quickly.
The surgical plan is total thyroidectomy with left lymph node dissection. I asked if the right lymph node should also be dissected. He said that the surgery only dissected the lymph nodes that had been confirmed by puncture, and if he was worried that there was a problem with the right side, he could go to the sonographer for puncture.
So I met the gentle and powerful sonographer again. All in all, this is the sixth lymph node puncture on my way to the doctor, and I have been punctured at least 18 times based on at least 3 punctures each time. To be on the safe side, he gave me four punctures this time and said that he wished my right lymph node well. The results of the sixth puncture came out, and there was no malignancy, and the auspicious words were borrowed.
The operation was scheduled fifteen days later, in mid-March of this year. Before the surgery, I took a good shower and had a hot pot. On the morning of the day of the operation, before the city woke up, my dad and my partner took me to the hospital, and I saw the rising sun on the elevated highway, red and hanging in front of the car window, peaceful and warm.
The morning sun on the day of admission丨Courtesy of the author.
The surgery was a success!
There was a relaxing song in the operating room, and the temperature and atmosphere were just right. After typing the indwelling needle ***, I was dizzy and fell asleep after saying "I'm so dizzy". I had several sweet dreams until I was woken up in the wake room. The operation lasted from 11:30 p.m. to 3:30 p.m., which was shorter than I expected.
The doctor said that the lymph nodes in my left neck were cleaned, and then he showed us the ** of the excision, and then I could clearly see what my thyroid gland looked likeThe part of the gland under the chin is attached to the thyroid gland and is long and conical with a rounded tip；As for the cut lymphatic tissue, it looks like a raw steak from a rotisserie.
Despite the psychological preparation, there are still a lot of uncomfortable places after the operation: the neck is connected to two drainage tubes, swaying, and the movements should be extra careful, for fear that the tube will leak (it does miss a sheet);When I hiccup, the burp gets stuck in my throat and spreads out, and I feel a dull pain that keeps hiccupsYou can't lie on your side when you sleep, and you have to hold your neck when you lie down;The left ear, the left side of the face, the left neck and the left shoulder all lost their normal sense of touch;Lost strength in the left shoulder and could not be raised sideways;Severe allergies ...... the reducer
But the hardest thing is the severe pain in the respiratory tract, and even the breathing is with a shuddering pain!When I lay down, my airways were compressed, causing a deafening snoring, and I was woken up and unable to sleep. There was even one night when I was visibly having trouble breathing, and that was the only time I cried after I was hospitalized.
My partner helped me comb my hair and found a gray hair that made me a little sad. I was inexplicably cranky in pain, afraid that I would never be able to return to my normal life. I used to even look forward to being sick and having a respite from the heavy work. But in the face of illness, I realized that I was so afraid of being deprived of the freedom of normal life, such as the freedom to eat, the freedom to lie on my side, the freedom to travel, and even the freedom to excrete. So, a healthy body is the foundation of everything.
On the third day after surgery, the TV station came to interview my surgeon, and the doctor invited me to be a patient and took some pictures of the conversation丨Courtesy of the author.
After 5 nights in the hospital, I was discharged. When I got home, I was really relaxed by the familiarity that came my face. I started taking yonaila every day. One week after the surgery, the sharp pain in my throat disappeared, the swelling under my chin was relieved, and I was able to eat some rice. Gradually, I was able to sleep on my side, I could raise my hands to lower my ponytail, my head could turn more, my allergies subsided, and I was able to eat the tempting potato chips ...... againMy mindset has gradually stabilized because the sense of control over my life has returned.
Pathological examination results of postoperative lymph nodes丨Courtesy of the author.
A month's later review brought good news:More than 30 lymph nodes were removed from the left neck, and only one was metastasized, and the postoperative calcium level was normalI am very grateful to the doctor for his skill. The doctor also said that my case had been written as ** and would be published in a journal in the future.
More than 50 days after the operation, I often felt numb like an electric shock from my left ear to the side of my shoulder, but I already had a slight sense of touchThe feeling of submental pulling is strong, and there is a choking sensation when swallowing, which will last for a long time according to the patientThe strength of the left shoulder is still lacking, and the pain is unstoppable as soon as the force is exerted, and it is slowly recoveringThe high pitch can't go up, and the quarrel can only be done in a deep low voice. There was no other discomfort,I have been able to live a normal life and am Xi to the good luck of the morning。After all, there are so many items that people have to rely on in their lives, is there still a small pill?
50 days after the operation, everything is slowly getting better (**The left side is my left side)丨Courtesy of the author.
In order to eliminate the hidden danger of the right lymph node, I performed iodine-131** again after surgery. This period of medical history, from accidental discovery, confusion, hesitation, to the opening of the moon and the moon, overcoming thorns and thorns, and now finally entering the end, can be described as twists and turns. But compared to other patients with second, third, and distant metastases, I have been much luckier.
Doctor's review
Zhao Jun |Attending physician of the Department of Thyroid Surgery, Shanxi Bethune Hospital.
The author's road to seeing a doctor began with the puncture of the neck mass, and was diagnosed as thyroid cancer metastasis, but the thyroid cancer nodule could not be found in the normal thyroid position.
The author's journey to medical care suggests that many times we don't know enough about the ectopic thyroid gland. Ectopic thyroid gland is a relatively rare disease caused by defects in embryonic development and is currently unknownMost scholars believe that the abnormal process of descending thyroid in embryonic stage is the main reason for its occurrence。The normal thyroid gland is located anteriorly and inferiorly to the thyroid cartilage, on either side of the trachea, and is butterfly-shaped (see figure below). Ectopic thyroid can occur anywhere along the descending thyroid gland, such as the trachea, esophagus, sternum, and most commonly at the base of the tongue.
Normal thyroid location丨Tencent Medical Codex.
So how can you be sure that the abnormal lumps in these areas are thyroid tissue and not other tissues?There are two waysOne is the puncture examination done by the authorIf you find a normal follicular cell of the thyroid gland, then the lump is thyroid tissue. Another option is a thyroid scanIf the lump has the same "iodine-absorbing" function as thyroid tissue, then the suspicion of ectopic thyroid is high. Thankfully, the authors were able to locate the ectopic thyroid gland and were diagnosed as the primary lesion of thyroid cancer after a needle biopsy.
Thyroid cancer is the most common endocrine tumour and its incidence has increased globally in recent years, with some studies attributing the increased incidence of thyroid cancer to the increased sensitivity of ultrasound, the use of thyroid cross-sectional imaging, and the increasing popularity of fine needle needle biopsy, while others have suggested that environmental and psychological stressors are also associated with an increased incidence of thyroid cancer.
Thyroid cancer can be divided into differentiated thyroid cancer and undifferentiated thyroid cancer, of which differentiated thyroid cancer accounts for about 99%, including papillary thyroid cancer (the pathological type of the author in this article) and follicular thyroid cancer. At present, the main method of differentiated thyroid cancer is surgery, supplemented by endocrine suppression and radioactive iodine. In general, differentiated thyroid cancer has a good prognosis, a low mortality rate, and a long survival time. Clinically, according to the specific situation of the patient, an individualized plan and postoperative follow-up plan should be formulated.
In general, if thyroid nodules or thyroid cancer are found, you must go to a regular medical institution for standardized diagnosis and treatment to obtain satisfactory results.
References: 1] Endocrinology Branch of Chinese Medical Association, Thyroid and Metabolic Surgery Group of Surgery Branch of Chinese Medical Association, Head and Neck Tumor Professional Committee of Chinese Anti-Cancer Association, Nuclear Medicine Branch of Chinese Medical Association, Thyroid Cancer Professional Committee of Chinese Anti-Cancer Association, Thyroid Surgeon Committee of Surgeon Branch of Chinese Medical Doctor Association, Ultrasound Medicine Branch of Chinese Medical Association. Guidelines for the diagnosis and treatment of thyroid nodules and differentiated thyroid cancer (second edition)[J].Chinese Journal of Endocrinology and Metabolism,2023,39(3):181-226doi:10.3760/cma.j.cn311282-20221023-00589.
2] Guidelines for the diagnosis and treatment of thyroid cancer (2022 edition)[J].Chin J Practical Surg,2022,42(12):1343-1357+1363doi:10.19538/j.cjps.issn1005-2208.2022.12.02.
The sharing of personal experience does not constitute diagnosis and treatment advice, and cannot replace the doctor's individualized judgment of a specific patient.
Author: Hu Weihu.
Editors: Xiao Ai, Li Xiaoqiu.
This is a husk patient, focused on telling health stories.
If you have an experience of getting sick or seeing a doctor to share, or want to tell interesting health-related stories about your own experience, please submit your post to[email protected], please send a private message to the background for cooperation, thank you.