In recent years, the incidence of thyroid disease has been rising. In my country alone, the number of patients has reached 200 million . Among them, the prevalence of hyperthyroidism is 1.6%, and the prevalence of hypothyroidism is 17.8%. During ultrasound examinations, about 20 to 70% of people found thyroid nodules . Even thyroid cancer continues to grow at a rate of 20% per year...
case
◎ 36-year-old Ms. Wang found thyroid nodules during the physical examination in the unit. As a result, when asked her colleagues around her, five or six people had the same problem...
◎ When Sister Yang was 44, she felt uncomfortable with the cervical spine. She went to the hospital for examination and found that the thyroid nodules were as big as peanuts. The surgery was performed at the advice of the doctor, and the postoperative pathology was shown to be medullary thyroid carcinoma . After
, the doctor suggested that her brothers and sisters also do relevant examinations. As a result, in the other five families, Yang's father, Yang Erjie and Yang's sister were diagnosed with this cancer!
thyroid diseases are so high, but many people don’t even know what tests should be done in the thyroid gland and how to read the thyroid report. Today, Keke will talk to you about thyroid examination~
. Blood test, evaluate thyroid function
Generally speaking, whether thyroid function is good or not, first look at blood test and thyroid ultrasound , among which blood test is an important means to judge thyroid function.
,
,
5 dynamometry
dynamometry mainly detects the levels of thyroid-related hormones. Through the test results, we can understand whether there is hyperthyroidism or hypothyroidism. Generally, it includes the following 5 items:
①TSH (thyroid stimulating hormone)
Hormones secreted by the pituitary gland have the effect of promoting thyroid growth and related functions.
, These words should be wary ofhiccupis commonly found in Hashimoto's disease with primary hypothyroidism, accompanied by hypothyroidism, exogenous thyroid hormone secretion tumors (pulmonary, breast), subacute thyroiditis recovery stage, etc.;decrease is commonly found in patients with pituitary hypothyroidism, non-thyroid stimulating hormone tumors, as well as intake of aspirin, corticosteroids, etc.,
②FT3, FT4
FT3 (free triiodothyroid thyroidine), FT4 (free thyroxine) can more accurately reflect the thyroid function status. If both raises at the same time, it is often prompted that hyperthyroidism ; decreases at the same time, it is prompted that reduces .
Clinically, it is often combined with the three indicators of TSH, FT3 and FT4 to confirm hyperthyroidism or hypothyroidism, and to track the efficacy of the drug.
③TT3 (total triiodothyroidogenine)
Secondary TT3 levels are related to age, with higher infants and lower elderly people. is elevated is commonly seen in hyperthyroidism; is reduced is commonly seen in hypothyroidism, or hypoT3 syndrome (T3 is reduced, but there are no symptoms of hypothyroidism, which can be seen in pernicious anemia, cirrhosis, chronic wasting diseases, etc.).
④TT4 (total thyroxine)
elevation is commonly found in hyperthyroidism, hyperthyroid binding globulinemia, acute or subacute thyroiditis, acute hepatitis, etc.; decreases is commonly found in hypothyroidism, total pituitary hypofunction, etc.
thyroid autobodythyroid autoantibodies abnormal , indicating that there is autoimmune disorder , which can cause thyroid damage.
◎Thyrotropin receptor antibody (TRAb): If the result is abnormal, it may cause both hyperthyroidism and hypothyroidism.It is mainly used for the diagnosis, differentiation and later prediction of Graves disease (viral diffuse goiter).
◎Thyroglobulin antibody (TGAb): If the result is abnormal, it can cause hypothyroidism. It is mainly used for monitoring the efficacy of drugs and can also be used as an auxiliary indicator for monitoring thyroid cancer.
◎Thyroid Peroxidase Antibody (TPOAb): If the result is abnormal, it can cause hypothyroidism. It is the gold standard for Hashimoto's thyroiditis . If TPOAb is positive, it can be confirmed as autoimmune thyroid disease .
The thyroid gland has lesions, which may cause abnormalities in multiple indicators. How to identify the type of lesions in ? You may wish to refer to the following table:
2. Thyroid ultrasound
Important means to discover and judge nodules
thyroid ultrasound, usually including thyroid + neck lymph node examination. It can determine whether there are abnormalities in the structure and location of the thyroid, the size and number of nodules and lumps; find tiny lesions of 1 to 2 mm; and even assist in judging the benign and malignant tumors, etc.
So today we will focus on interpreting the issue about thyroid nodules. There are many different versions of the thyroid nodules. Currently, thyroid imaging and data system (TI-RADS) is generally used to guide the diagnosis of thyroid nodules. As follows:
◎1: is normal, ultrasound shows that the gland size and echo are normal, and there are no nodules, cysts or calcifications;
◎2: examination shows benign, the edge boundaries are clear, solid is the main, the echo is uneven, and isoecho-hyperecho can have eggshell-like calcification or crude calcification. The risk of malignant tumor is 0, and clinical follow-up is required;
◎3: is likely to be benign, the probability of malignancy does not exceed 3%, and it needs to be reviewed once 6 months later. If there is any significant change, further puncture biopsy is required.
◎4: The possible proportion of malignant is 5%~85% (4A malignant 5%~10%, 4B malignant 10%~50%, 4C malignant 50%~85%, malignant predictive value is for reference only, and further examination is required);
◎5: indicates that the possibility of cancer is very high, greater than 85%;
◎6: cytology examination confirmed cancer.
[Note] The diagnosis of html below grade 43 is highly likely to be benign. For patients without clinical symptoms, they can observe regularly and have a color ultrasound after 3 to 6 months. Level 4 has the possibility of malignancy, and the puncture is certain; surgical treatment is usually recommended for grades 5 and 6.
Generally speaking, most of the thyroid nodules of are benign , which may be cysts, inflammation, degenerative changes, etc. If the ultrasound indicates good condition, and there is no pain, no itching, no compression and other symptoms, you can consider regular observation or supplemented with certain medications.
, but about 5% to 15% of the nodules are malignant tumors. If the following words appear on the thyroid report, you need to be alert to thyroid cancer.
① solid nodules;
② extremely low echo, uneven echo;
③ irregular shape and blurred edges;
④ vertical growth (aspect ratio > 1);
⑤ microcalcification, or fine sand-like calcification.
Generally speaking, a single ultrasound feature is not enough to determine the benign and malignant nature of thyroid nodules. In the end, the doctor needs to make a judgment. The next step is to follow-up, other examinations or surgery, etc.
. Can it be cured if you have thyroid disease?
If thyroid disease is unfortunately detected, the most concerned question for many people is "can it be cured". Different diseases have different answers.
,
Hyperthyroidism: Multiple cure
Most hyperthyroidism is caused by toxic diffuse goiter (Graves disease). It can be cured through standardized oral drug treatment; a small number of hyperthyroidism are caused by toxic polynodular goiter and thyroid adenoma , which can be cured by surgery or iodine 131. If all the patients with hyperthyroidism meet the following conditions, they can basically stop taking anti- thyroid hormone drugs (such as propionerthouracil, methimazole): the symptoms completely disappear; the thyroid function returns to normal; the thyroid stimulating hormone receptor antibody TRAb drops to normal, and 2 to 3 consecutive re-examinations are still normal; the course of medication is 1.5 to 2 years.
, hypothyroidism: Most of them cannot be cured
Most hypothyroidism is incurable , and requires lifelong medication , such as Hashimoto thyroiditis, iodine 131 treatment, thyroid surgery, etc....
Hypothyroidism caused by iodine deficiency and some drugs (such as oral medication for treating hyperthyroidism, amiodarone, etc.) can only be cured.
Therefore, after taking the medication, even if the thyroid function returns to normal, it does not mean that it is cured and you need to continue taking the medication. Once the medication is stopped or reduced without authorization, the thyroid function will be abnormal again.
It should also be noted that patients with hypothyroidism need to undergo a review of every 3 to 12 months, and adjust the dosage of medication in a timely manner according to the recovery of thyroid function and the level of thyroid stimulating hormone.
, thyroid cancer: Most of them can be cured, but they may also be critical
thyroid cancer has different types, and most of them have a high cure rate, but some scholars believe that has the best treatment effect, and thyroid cancer has the worst treatment effect.
pipette cancer
pipette cancer is the most common thyroid cancer of , accounting for about 80~90%, especially tiny cancers of less than 1cm are more common. Its has a very low mortality rate , and most can be closely monitored by without removing .
However, if the micro-cancer increases by 3mm in one year, or new lesions and lymph node metastasis appear, and symptoms such as hoarseness and difficulty breathing may indicate highly malignant papillary cancer and require surgical treatment. After the operation of
, follow-up treatments such as thyroid hormone, iodine 131 internal radiation should be strictly followed in accordance with the doctor's instructions to inhibit the thyroid stimulating hormone levels in the body, adjust living and eating habits, and regularly reviews can greatly extend life.
②Undifferentiated cancer: It may be more severe than advanced pancreatic cancer
The incidence of undifferentiated cancer of the thyroid gland is very low, accounting for about 31% to 7.5% of , but it is the most serious type of thyroid cancer.
It can metastasize from lymph and blood, is highly malignant, has extensive infiltration, is difficult to operate, and has a poor survival rate of . Some people even believe that it is more critical than advanced pancreatic cancer, with a 5-year survival rate of less than 10%.
Undifferentiated thyroid carcinoma may be caused by sudden local enlargement and degeneration of the thyroid nodules that have existed and have been observed for many years. Therefore, we should pay more attention to regular physical examination and follow-up.
4. Protect the thyroid gland and do 4 things well
In the face of high incidence of thyroid diseases, it is particularly important to actively protect the thyroid gland. In daily life, in addition to maintaining good living and eating habits, moderate exercise, and avoiding excessive fatigue, you must do 4 things well:
,
aval unnecessary ionizing radiation
Scientific research shows that ionizing radiation is a clear risk factor for thyroid nodules and thyroid cancer .
Usually, try to avoid unnecessary ionizing radiation , , for example, do not over-exhaust X-ray, CT, bone scans, etc. (but what should be done still); do not rush to move in to a new house to avoid excessive exposure to radioactive substances such as radon.
, Maintaining estrogen levels normal
Abnormal estrogen levels are an important cause of thyroid disease, which is also one of the reasons why there are more patients with thyroid disease in women than men.
There is a large amount of data and studies that have confirmed that estrogen can affect the growth of the thyroid gland, which will act on the thyroid gland by prompting the pituitary gland to release thyroid stimulating hormone (TSH) .
Therefore, in daily life, , on the one hand, , should avoid inadvertent intake of estrogen, such as some unqualified cosmetics, diet, etc.; , on the other hand, , , , , , , , for people who need estrogen supplements, must do it under the guidance of a doctor, to avoid abnormalities.
In addition, a more important point is that balances estrogen . In daily life, you can appropriately increase the intake of beans in . Among them, isoflavones can regulate estrogen levels in both directions , helping the thyroid health.
, Scientific selenium supplementation
For the good and bad of the thyroid gland, many people focus on iodine. In fact, Selenium is the second essential trace element of the thyroid gland , which participates in the synthesis, secretion and metabolism of thyroid hormones. Research has found that proper selenium supplementation can help maintain thyroid hormone balance and reduce inflammatory activity in patients with autoimmune thyroiditis, thereby reducing thyroid disease.
Animal liver, lean meat, quail eggs, sesame, mushrooms, etc. are all foods containing selenium and can be added in moderation in daily diet. If selenium deficiency has occurred, you can also take selenium supplements scientifically.
, strengthen the spleen and replenish qi, relieve liver and relieve depression
Long-term mental stress, bad mood , etc. are also risk factors for thyroid diseases. Traditional Chinese medicine believes that the thyroid gland is located in front of the neck, and the front of the neck is the part where the foot Taiyin spleen meridian and the foot Jueyin liver meridian are circulating. Therefore, strengthening the spleen and replenishing qi, relieving liver and relieving depression can also help alleviate thyroid diseases.
splenishing spleen and relieve liver tea
