nodular goiter
Introduction
Introduction to nodular goiter Nodular goiter, also known as adenoma-like goiter, actually refers to multiple nodules formed by endemic goiter and sporadic goiter. The incidence rate is very high, and it has been reported to reach 4% of the population. basic knowledge The proportion of illness: 0.001% Susceptible people: no special people Mode of infection: non-infectious Complications: thyroid adenoma thyroid cancer thyroid nodules
Cause
Cause of nodular goiter
(1) Causes of the disease
The pathogenesis and etiology of thyroid nodules are still unclear, and may be caused by multiple factors, such as genetics, radiation, immunity, geographical factors, goiter factors, iodine deficiency, chemical stimulation and endocrine changes. Caused by stimulation.
Thyroid-causing substances include certain foods, drugs, water pollution, soil pollution and environmental pollution; thyroid-deficient areas have goiter with nodular goiter, radioactive damage can cause cancer, but after decades of experience with 131I treatment and Statistics show that the main side effect of radioactive 131I treatment is not carcinogenic, but hypothyroidism, especially long-term dysfunction. In some patients with multinodular goiter, the positive rate of 54.7% is found in TGA and TMA. The positive rate of nodule was 16.9%. Patients with nodular goiter had congenital metabolic defects, which led to excessive compensatory hyperplasia of thyroid gland, lack of selenium, fluoride, calcium, chlorine and magnesium in the environment. In short, the pathogenesis of nodular goiter is more complicated, and it is still not clear and remains to be studied.
(two) pathogenesis
The pathogenesis and etiology of thyroid nodules are still unclear, and may be caused by multiple factors, such as genetics, radiation, immunity, geographical factors, goiter factors, iodine deficiency, chemical stimulation and endocrine changes. Caused by stimulation, in recent years, there are also close relationship between the mutations of new biological tumor genes involved in thyroid tissue. Some people have proposed the theory of trigger factor-promoting factor, which is caused by the thyroid itself caused by thyroid mass and radiation damage or carcinogens. Changes in the DNA properties of thyroid tissue cells, causing mutations in TSH or other immunoglobulin substances, which are constantly evolving and changing, can lead to thyroid tissue hyperplasia and even canceration. Before the autonomic function changes occur in the early stage, the treatment can be effective and proliferative. Thyroid nodules can resolve. In the late stage, due to the formation of autonomous functional nodules or other changes, it is difficult to use drugs for treatment. It is necessary to remove the nodules surgically.
In short, the pathogenesis of nodular goiter is more complicated, and it is still inaccurate before and remains to be studied.
Prevention
Nodular goiter prevention
1. Try to avoid multiple times of radioactive examination and irradiation of the neck.
2. Regularly check the thyroid function and nodule nature every year, early detection, early treatment.
3. Those who have had a history of thyroid nodule surgery should also be reviewed regularly to avoid recurrence.
4. Thyroid nodules taking thyroid hormone therapy, if the effect is not good, should seek early surgical treatment to prevent deterioration.
5. Regardless of thyroid nodules, multiple nodules, hot nodules, warm nodules or cold nodules, surgical treatment is more active and safe to prevent missed diagnosis of malignant nodules.
Complication
Nodular goiter complications Complications thyroid adenoma thyroid cancer thyroid nodules
This disease is generally uncomplicated.
Symptom
Symptoms of nodular goiter Common symptoms Dysphagia, thyroid enlargement, chest tightness, dyspnea, fatigue, edema, hoarseness, irritability, multiple nodules, shortness of breath
1. The patient has a history of long-term simple goiter, the age of onset is generally greater than 30 years old, more women than men, the degree of thyroid enlargement is different, more asymmetry, the number and size of nodules are different, generally multiple nodules, There may be only one nodule in the early stage. The nodule is soft or slightly hard, smooth, no tenderness, sometimes the nodule is unclear, and there is only irregular or lobulated sensation on the surface of the thyroid gland. The disease progresses slowly and most patients are asymptomatic. Large nodular goiter can cause compression symptoms, difficulty breathing, difficulty swallowing and hoarseness. Acute hemorrhage in the nodules can cause sudden enlargement and pain of the tumor. Symptoms can resolve within a few days. The mass can be reduced in a few weeks or longer.
2. When the nodular goiter is hyperthyroidism (Plummer disease), the patient has fatigue, weight loss, palpitations, arrhythmia, fear of heat and sweating, irritability and other symptoms, but the thyroid is free of vascular murmurs and tremors. Eyes are rare, and finger tremors are rare. Older patients are often atypical.
3. Whether the patient has a history of radiology, oral medication history and family history, whether the patient is from the region is endemic goiter, etc., general nodular goiter has a long history, no compression symptoms, no symptoms of hyperthyroidism, patients I don't care, I accidentally found thyroid nodules and came to see a doctor.
4. If the heat nodules are also called toxic nodules, the patients are more than 40 to 50 years old, the nodular nature is moderate hardness, there are symptoms of hyperthyroidism, and even atrial fibrillation and other arrhythmia manifestations, such as bleeding There may be pain, even fever, and symptoms of compression may occur when the nodules are large, such as dysphonia, poor breathing, chest tightness, shortness of breath, and irritating cough.
5. For patients with nodular goiter from iodine-deficient areas, their thyroid function may be low, clinically, heart rate may be slowed down, edema and rough skin and anemia, etc., a small number of patients may also be cancerous, nodular properties For warm nodules are more common, can be treated with thyroid preparations, swollen glands can be reduced, cold nodules are relatively rare, there are clinical hypothyroidism can be treated with thyroid preparations, but often require surgery.
Examine
Nodular goiter examination
Thyroid Hormone Determination: General laboratory tests do not help much in determining nodular goiter, because thyroid hormone levels are usually normal and therefore cannot be used as markers, but thyroid function tests such as T3, T4, FT3 should be performed. FT4, TSH, PBI and serum thyroglobulin, some patients with malignant thyroid nodules may have altered thyroid function, and more often have hypothyroidism in the late stage. Some benign lesions may have elevated thyroglobulin levels, such as Graves' disease. Non-toxic goiter, Hashimoto's disease or subacute thyroiditis, for thyroid nodules, the determination of thyroglobulin is not much, but if it is autonomous functional toxic adenoma, its thyroid function can be elevated There was hyperthyroidism, TRH stimulation test, and its TSH level did not respond to TRH.
1. Thyroid ultrasonography in the thyroid B-ultrasound can confirm the thyroid nodules as substantial or cystic, the diagnosis rate is 95%, the thyroid nodules with cysts are mostly benign nodules, can be used to cure or reduce the nodules Patients with substantial nodules should also undergo thyroid scan or puncture pathology. High-resolution ultrasound imaging can analyze nodules to 1mm lesions. Clinically, single nodules are often found as multiple nodules. At autopsy, most cyst lesions are not truly cystic, but have solid tissue lesions and can show mixed echo groups.
2. Radionuclide imaging examination commonly used thyroid scan with radionuclide 131I and 99mTc 131 iodine scan 99 scan, thyroid nodules have different iodine uptake ability, the image is different and classified, 99mTc can be ingested by thyroid like iodine However, it can not be transformed, malignant nodules can not take iodine, and the sparse area will have sparse sparse areas. According to its iodine-taking ability, it can be divided into non-functional cold nodules, normal functional warm nodules and high-function hot nodules. The disadvantage of radionuclide or 99mTc scan is that it can not completely distinguish between benign or malignant nodules, but only a preliminary judgment analysis. It is reported that 22 patients with radionuclide scans, regardless of their thyroid function, all undergo surgery, the results are Cold nodules accounted for 84%, warm nodules 10.5%, hot nodules 5.5%, of which 16% of cold nodules, 9% of warm nodules and 4% of hot nodules were malignant nodules, therefore, cold nodules The most malignant, but most of them are still benign nodular lesions, although the malignant degree of hot nodules is small, but there are also malignant nodular lesions. In recent years, the thyroid gland using 75 selenium-selenomethionine as a tracer has also been developed. Positive phase sweep Compared with normal thyroid tissue, there are more cell divisions in the malignant nodular lesions, higher cell density, positive phase images at the lesions, and cold nodules with 131I or 99mTc scans. The selenium-selenomethionine scan showed normal phase development, and the possibility of malignant nodular lesions was more than 50%. The Americium-241 fluorescence scanning technique was used to identify benign nodules and malignant nodules by indirect measurement of iodine volume, which is better than 131I. The 99mTc scan is more sensitive and effective, but it also has false positives. In addition, there are still NMR, dry X-ray radiography, electron radiography and temperature recorders, which are still to be further applied.
3. Thyroid puncture histopathological examination using fine needle aspiration biopsy examination, has a certain value for the diagnosis of thyroid nodules, relatively safe, puncture results are helpful for surgical treatment indications, and its cytological accuracy is 50% to 97% However, there may be errors in sampling, especially those with cystic changes and small nodules. For lesions less than 1 cm, the accuracy of puncture may be difficult, fine needle biopsy cannot be determined, and needle biopsy may be used. The results may be more accurate, but after the needle enters the malignant nodular cancer, the cancer cells can be spread to its harmfulness. Special attention should be paid. In order to confirm the nature of the nodule before surgery, an open thyroid tissue biopsy can also be used for comprehensive analysis. .
Diagnosis
Diagnosis and diagnosis of nodular goiter
Thyroid nodules are mostly benign nodules, which can be single or multiple, some have endocrine function, clinically known as nodular hyperthyroidism, and some have no endocrine function, which is general nodular hyperthyroidism, and some have hypofunction. Considering the possibility of thyroid tumor, simple nodular goiter is generally difficult to diagnose, has a long history, and has no symptoms of compression. The general clinical manifestations are normal. The thyroid tissue can be reduced to different degrees when the thyroid preparation is used for treatment. It should rely on pathological examination to determine the nature of thyroid nodules. Only relying on general medical history, physical examination, laboratory tests or radionuclide examinations can not make 100% judgment and diagnosis of malignant nodules.
Differential diagnosis
1. Thyroid adenoma is especially distinguished from multiple adenomas. Patients with nodular goiter are older and have a longer history. The goiter is lobulated or has multiple nodules of different sizes. The boundary is unclear. Thyroid hormone Treatment, gland symmetry reduction, multiple thyroid adenoma thyroid enlargement asymmetry, can reach multiple solitary nodules, such as combined with simple goiter, adenoma nodules border is also clear, the texture is slightly tougher than the surrounding tissue Thyroid hormone therapy, glandular tissue shrinkage, nodules more prominent.
2. Nodular goiter with hyperthyroidism and Graves disease. The former endemic goiter is more common in the epidemic area. The age is generally larger, more than 40 years old, often in the onset of nodules many years after the onset, hyperthyroidism symptoms Lighter and less typical, the age of onset of Graves disease is 20-40 years old, the thyroid gland is diffuse and swollen, the eyeball is prominent, the finger tremors, the thyroid gland can touch the tremor and hear the vascular murmur, and the thyroid scan finds one or several "hot" Nodule."
3. Other
(1) Thyroid cyst: The thyroid scan is a "cold nodule", the B-ultrasound is a cystic nodule, and the fine needle aspiration is clearly diagnosed.
(2) thyroid adenoma: most of them are single-shot, slow-growing, asymptomatic, thyroid scan is "warm nodule", if the toxic adenoma shows "hot nodules", adenoma can also occur bleeding, necrosis liquefaction "Cold nodule".
(3) thyroid cancer: thyroid cancer in addition to thyroid nodules in addition to any symptoms, this time with the nodular goiter identification is difficult, can do acupuncture biopsy, especially the diagnosis of thick needle acupuncture is very significant.
(4) toxic nodular goiter: more common in the elderly, no exophthalmos, abnormal heart, thyroid scan can be seen multiple iodine-enhanced nodules, irregular irregular light development area.
(5) thyroid neoplasms: follicular thyroid cancer secretion of thyroid hormone causes hyperthyroidism, local sputum and mass, radionuclide scanning, ultrasonography and fine needle aspiration cytology can help diagnose.
