thyroid nodules (TNS) are one of the most common thyroid diseases. They refer to localized mass in the thyroid tissue after abnormal thyroid cells proliferate. Most thyroid nodules are benign, and most patients have no symptoms and are often accidentally discovered by doctors during physical examinations or examinations. High-resolution ultrasound is a simple and important means to determine thyroid nodules, and the detection rate of thyroid nodules is as high as 50%. Cancer nodules can be surgically removed
Clinical classification
1. According to the severity of thyroid nodules, they can be divided into benign and malignant. Benign thyroid nodules include polynodular goiter, Hashimoto thyroiditis, cysts, follicular adenomas, and Hürthle cell adenomas. Most of the malignant thyroid nodules are thyroid cancer, and a few are primary thyroid lymphoma or metastatic thyroid cancer (breast cancer, kidney cancer, etc.).
2. According to the texture state of the nodule, it can be divided into solidity and cysticity. The inside of solid nodules is tissue hyperplasia, which is the main type of adenomas and cancer. The inside of the cystic nodules is fluid, and some may cause intracystic bleeding, causing local pain.
3. According to the different uptake capacity of the nodules to radionuclides, they can be divided into hot nodules and cold nodules. Thermal nodules are autonomous thyroid nodules with endocrine functions, and are mostly benign. Cold nodules have no endocrine function and may be cancer. In addition, if there is bleeding or cystic change in the nodule, it can also be manifested as a cold nodule.
Causes
General description
The cause of thyroid nodules is currently unclear, and it is generally believed to be related to factors such as insufficient iodine intake, exposure to radiation and genetics. Among them, ionizing radiation may not only induce thyroid nodules, but also increase the risk of cancer.
Risk factors
1, history of radiation exposure
ionizing radiation is an important risk factor for thyroid nodules formation and cancer. Long-term exposure to radiation environments or a history of radiotherapy (mostly head, neck, and chest radiotherapy, especially in childhood), will increase the risk of thyroid nodules.
2, family history of thyroid nodules
thyroid nodules are family hereditary. Studies have shown that due to the defect of hereditary enzymes, hormone synthesis disorders are caused, which makes thyroid hormones unable to be isolated and released from thyroglobulin and then enter the blood. This congenital defect is recessive.
3, insufficient iodine intake
Iodine element plays a key role in the synthesis and secretion of thyroid hormones. Iodine deficiency can cause abnormal thyroid hormone levels in the body, resulting in goiter, with or without thyroid nodules.
Symptoms
General description
Most patients have no symptoms and are often accidentally discovered during physical examinations or examinations by doctors. When the nodules increase and cause compression, the patient may have symptoms such as foreign body sensation in the throat, shortness of breath, and difficulty swallowing.
Typical symptoms
1. Some patients will experience pain around the nodules and foreign body sensation in the throat, and some patients in the late stage will experience neck edema.
2. Coughing and shortness of breath will occur when the trachea is compressed, and hemoptysis will occur when the trachea is invaded; dysarthria will occur when the recurrent laryngeal nerve is involved; dysphagia will occur when the esophageal pressure will occur.
3. When the patient is accompanied by hyperthyroidism, he may experience palpitations, sweating, hand shaking, and weight loss; when accompanied by hypothyroidism, he may experience cold and general fatigue.
treatment
Treatment principles
For asymptomatic benign thyroid nodules, no treatment is required, and regular follow-up inspection is allowed; for thyroid nodules with obvious symptoms, surgical resection is required, and drugs can also play an auxiliary role in the treatment.
Drug treatment
If nodules cause hyperthyroidism, radioactive iodine treatment, compound iodine oral liquid, antithyroid drugs, etc. can be used. Currently commonly used antithyroid drugs are thiourea compounds, including propylthiourea (PTU), methylthiourea (MTU), methimazole, carbimazole, etc.After surgical treatment, some patients may experience hypothyroidism and may need to take levothyroxine for a long time to maintain normal thyroid hormone levels in the body.
Related medicines
Compound iodine oral liquid, propylthiorrhiole (PTU), methylthiorrhiole (MTU), methimazole, carbimazole, levothyroxine
Surgery treatment
If the nodule is large and there are symptoms of compression, or the nodule is cancerous or suspected to be cancerous, surgical treatment is required. The surgical methods include total thyroidectomy, lobectomy, microwave ablation, and laparoscopic thyroid surgery.
Daily
General description
Patients need to maintain a good attitude in daily life, actively cooperate with doctors to treat, pay attention to rest, and avoid excessive fatigue, which can help the recovery of the disease, and pay attention to regular follow-up visits.
Psychological care
1. Psychological characteristics
(1) Patients are prone to excessive excitement and sadness because they do not understand the disease.
(2) Patients with thyroidectomy need to take medication for a long time, and some patients may feel psychologically stressed.
2, Nursing measures
(1) Family members need to provide timely psychological counseling to help them build confidence in overcoming the disease, which can help patients recover.
(2) Patients need to learn more about the disease-related knowledge from doctors, actively cooperate with treatment, relieve psychological pressure, and maintain a calm mind and stable mood.
Postoperative nursing
1. Do not have too much movement after the operation to avoid wound tearing.
2. Keep warm and be careful to avoid colds.
3. After the operation, patients can eat liquid or semi-liquid food. Do not drink too much or too fast at one time to avoid choking and coughing. They should drink water in small sips and gradually increase the amount.
Life management
1. Regular work and rest, ensure adequate sleep, and avoid overwork.
2. When using a microwave oven, try to maintain a certain distance, use less induction cooker, and live around the signal transmission tower far away.
Review instructions
Asymptomatic benign thyroid nodules, follow-up is only possible for 6 to 12 months. If the shape and size of the nodules do not change much, follow-up can be done once every 2 years.
diet
diet conditioning
This disease may be related to iodine intake. According to the individual situation, diet should be adjusted according to the doctor's instructions. In addition, patients with thyroid nodules should develop scientific and reasonable eating habits and avoid excessive smoking and drinking, which can help control the development of the disease, prevent the cancer of the disease, and promote body recovery.
Dietary recommendations
1. Strengthen nutrition and maintain balanced nutrition.
2. Eat more high-calorie and high-protein foods, such as eggs, meat, milk, etc.
3. Eat more high-vitamin foods such as fresh vegetables and fruits.
4. Patients with hypothyroidism can eat more foods with high iodine content to maintain the balance of thyroid hormones in the body.
Dietary taboos
1. Patients with hyperthyroidism eat less foods with high iodine content, such as seaweed, kelp, hairtail, etc.
2. Avoid irritating foods, such as pepper, chili, cinnamon, etc.
3. Try not to smoke or drink alcohol, and do not drink strong tea or coffee.
