Statement: This article is for popular science purposes only. In order to protect the privacy of patients, the relevant information in the following content has been processed) [Basic Information] Male, 67 years old [Disease Type] Thyroid Nodules [Treatment Hospital] Shanghai Ton

Statement: This article is for popular science purposes only. In order to protect patient privacy, the relevant information in the following content has been processed)

[Basic Information] Male, 67 years old

[Disease Type] Thyroid Nodules

[Treatment Hospital] Shanghai Tongji Hospital (Triple A)

[Treatment Plan] Ultrasound Under the guidance of the right thyroid nodule microwave ablation

[Treatment cycle] 2 days, 1 week and 1 month later,

[Treatment effect] The patient's neck pain was relieved, and there were no postoperative complications

First met the patient

, male, 67 years old, previously healthy, without hypertension, heart disease, diabetes, nor hepatitis or tuberculosis. No history of thyroid disease, no exposure to radioactive or poisonous substances, no fever, fatigue, nausea, vomiting, excessive eating, weight loss, loss of appetite, palpitations, chest tightness, or breathing, no difficulty breathing or swallowing.

The patient found a tumor of egg yolk size on his neck 10 days ago, and felt pain in the tumor when he turned his neck. Today, we came to our hospital for further treatment. The physical examination results: a 3.0cm×2.5cm mass was found in the anterior area of ​​the right cervix. The TSH, T3, T4 and other indicators were normal. The thyroid color ultrasound examined the multiple capsule mixed echo nodules on both sides of the lobe, and several lymph node-like echoes on the neck on both sides. Performing a puncture examination of the right neck mass suggests nodular goiter. Thyroid nodules were admitted to the hospital for further treatment.

Diagnosis and treatment process

Physical examination results after admission: the neck is soft, the trachea is in the middle, the right thyroid gland can palpate the mass of about 3.5cm×2.0cm, the surface is smooth, the tension is high, there is no tenderness, the boundaries are clear, and it moves up and down as swallowing, there is no vascular tremor, no vascular murmurs, and the surrounding lymph nodes are not swollen. The patient found that the thyroid nodules were found in the physical examination, and the TSH index was normal. The thyroid ultrasound examination showed multiple capsule mixed echo nodules on both sides of the lobe. The larger on the left side was about 0.7cm×0.3cm, and the larger on the right side was about 2.9cm×2.2cm. The edge was clear, and some nodules were probed inwardly and a few dot-like strong echoes. CDFI: The blood flow distribution of the glands is normal. Several lymph node-like echoes can be detected on both sides of the neck, the largest is about 1.1cm×0.6cm, with clear boundaries and clear boundaries of the cortex. It indicates that thyroid nodules are TI-RADS grade 3, and multiple lymph nodes on both sides of the neck are mildly enlarged.

To clarify the properties of thyroid nodules, a fine needle aspiration was performed under ultrasound guidance for pathological testing. After careful physical examination before the operation, auxiliary examination was performed, blood routine, blood coagulation, urinary stool, seven dysfunctions, biochemical, electrolyte, infectious disease series, electrocardiogram, thyroid ultrasound, abdominal color ultrasound, and chest scanning. Patients should avoid eating greasy and spicy irritating foods before the operation, monitor the normal basal metabolic rate, and avoid eating. 2-3 hours, under local anesthesia, the sizes of two solid cumulative nodules in the middle and lower part of the right thyroid were detected under ultrasound, with a small amount of capsule fluid being aspirated with a fine needle and sent to the cytology test. Then, ultrasound guided microwave needles to penetrate the nodules for ablation treatment. The treatment was performed until the ablation area was completely covered by the nodules. Ultrasound observation clearly showed that there were no residual lesions in the ablation area, and the patient had no burning sensation or pain in the neck during the operation. The operation was successfully completed after 1 hour, and the patient pronunciation was clear. Postoperative pathological results were diagnosed as a benign nodular goiter in the right lobe cystic solid mass. The cytology results were resting cells. The patient lies flat and rests on the surgery day, and the neck ice pack is cold compressed for 4 hours.

6 hours later, the patient had no choking and coughing when drinking water. He could eat warm and cool liquid food. He changed to a semi-recumbent rest and told the patient to speak less and avoid turning his neck. On the second day, the patient's body temperature was normal. No hematoma or bleeding was found after the neck ultrasound was checked. The patient had no cough, sputum, or swelling in the neck. Inform the precautions for discharge from the hospital, the neck cannot be cleaned within 5 days after the operation, and the thyroid ultrasound should be checked on time.

Precautions for patients in treatment

Trusts for patients to face the disease correctly, control their emotions themselves, and keep a happy and peaceful mood. Arrange rest and diet reasonably to maintain the body's metabolic needs.

Regular follow-up: Patients with neck lumps should strengthen follow-up, clarify the cause as soon as possible, and treat symptomatically.

Self-examination: Teach patients how to check their necks by themselves, pay attention to observing the growth of the lump, including size, mobility, texture, and whether it is accompanied by local tenderness; pay attention to the relationship between the lump and systemic symptoms. The treatment effect of

patient

12 days later, the patient was discharged from the hospital without complaining of neck pain, the neck was not tender, the trachea was in the middle, the right lump decreased compared with the previous one, the thyroid stimulating hormone and thyroxine index was normal, the basal metabolic rate was basically normal, the nodules on the right side were nodules after the right thyroid surgery were examined, and the left nodules were not enlarged. After one week, the patient had no hematoma or infection in the neck. After one month, the electrolyte showed no abnormal calcium and phosphorus. The basal metabolic rate was -20%-+20%. A small amount of nodules on the right thyroid gland could be seen by thyroid ultrasound. The absorption of nodules was still acceptable. Continue to follow up on time to observe the condition of the thyroid nodules on the left, and detect abnormal growth in time. If necessary, microwave ablation was used.

5. Doctors understand that

Microwave ablation reduces the damage to thyroid function and retains the function of the parathyroid gland. Avoid infection and recurrence, and do not affect activities, normal life and work after surgery. The only disadvantage is that the nodules are absorbed by themselves after ablation for a long time. Generally, thyroid nodules are absorbed and disappeared within 6 months if they are 1-2cm, and 1-1.5 years if they are greater than 2cm. If they are thyroid punctured and aspirated nodule fluid, they can help absorb and disappear. They can also take traditional Chinese medicine to accelerate the absorption of nodules and shorten the course of treatment, and improve local microenvironment changes after ablation.

The patient's thyroid nodule is greater than 2cm, the biopsy shows that benign nodules are identified, and microwave ablation surgery is selected to treat properly, with significant prognosis effect. The review of the neck ultrasound, thyroid workmanship, and electrolytes is not abnormal, indicating that the patient's thyroid and parathyroid glands have not been damaged, and the nodules are not swollen. The patient has good compliance during the treatment process, and the surgical effect is satisfactory. After the operation, there is little trauma, no bleeding, and no pain in the surgical incision. Because nodule regression is a long process, the patient needs to be reminded to conduct regular resections to understand the regression of the nodule. If necessary, appropriate measures should be taken to promote the regression of the nodule, improve the efficacy, and strive to recover health as soon as possible.