Thyroid tumor
Introduction
Introduction to thyroid tumors Thyroid tumors are divided into two types, benign and malignant. Benign tumors can be divided into thyroid adenomas and cysts. More than 95% of malignant tumors are primary thyroid cancer, and very few may have malignant lymphoma and metastases. 60% of thyroid cancer is papillary carcinoma, mostly in young people, more women than men, low degree of malignancy, slow growth, mainly lymph node metastasis, after surgery, the survival time is better. Another 15% are undifferentiated cancers, mostly in older patients. The degree of malignancy is high, and lymphatic and blood transport can occur in the early stage. Because of the obvious symptoms, patients can usually see a doctor in time. basic knowledge Sickness ratio: 0.01%-20% Susceptible people: no special people Mode of infection: non-infectious Complications: superior vena cava compression syndrome in the elderly
Cause
Thyroid tumor cause
Benign thyroid tumors:
Chinese medicine believes that the disease occurs in a state of unsatisfactory emotions, inappropriate living conditions, and a close relationship between evil and evil.
1. Unsatisfactory emotions: sorrow, thinking, depression, anger, causing liver qi stagnation, liver loss, liver and wood, then the spleen is not healthy, phlegm stays in the body; or liver stagnation, fire, refining Burn the body fluid into a sputum. Turbid gas, dampness condensed in the neck; liver qi stagnation, blood meridian loss in harmony, qi stagnation and blood stasis, meridian obstruction, upper knot in the neck into a tumor.
2, the place is not suitable: long time in the mountains, plateaus, water quality is too biased, long-lasting air machine operation is abnormal, water wet inside stop, sputum mutual knot, the formation of tumor.
3, the imaginary evil spirits: righteousness and weakness, sinister poisoning by virtual invasion, so that the meridian obstruction, blood stasis in the neck before the formation of sputum; congenital deficiency, physical weakness, imaginary body by the evil poison, evil fire stagnation in the neck.
In short, the occurrence of this disease is closely related to the liver and spleen. Under the influence of many factors, the gas, blood and phlegm condense with each other, and qi stagnation, blood, phlegm, phlegm and phlegm are formed, and the neck is formed. It is better to treat this disease with pure Chinese medicine, treat both the symptoms and the roots, and treat with traditional Chinese medicine. The treatment effect is stable, ideal and without any side effects, and does not recur after healing. According to the dialectical treatment of patients' syndromes, TCM formulates treatment plans, controls the disease, relieves symptoms, and gradually recovers the patients. Patients should pay attention to health care in their lives.
Thyroid malignancy:
The pathogenesis of thyroid malignancy is not clear, but its related factors include many aspects, mainly in the following categories:
1. Oncogenes and growth factors: Modern studies have shown that the occurrence of many animal and human tumors is associated with overexpression, mutation or deletion of protooncogene sequences.
2. Ionizing radiation: It has been found that external radiation of the head and neck is an important carcinogenic factor of the thyroid gland.
3, genetic factors: some medullary thyroid carcinoma is an autosomal dominant disease; in some patients with thyroid cancer, often ask family history
4. Iodine deficiency: As early as the beginning of the 20th century, it has been suggested that iodine deficiency can lead to thyroid tumors.
5. Estrogen: In recent years, studies have suggested that estrogen can affect the growth of the thyroid mainly by promoting the release of TSH from the pituitary and acting on the thyroid gland, because the level of TSH increases as the level of estrogen in the plasma increases. It is not clear whether estrogen acts directly on the thyroid gland.
Prevention
Thyroid tumor prevention
1. Instruct patients to establish a regular lifestyle, ensure good rest and adequate sleep, reasonable diet, reasonable work and rest, and strive to maintain a balance of mind.
2, strengthen outdoor activities, such as walking, jogging, Qigong, Tai Chi, a variety of aerobics, etc., to promote the body's blood circulation, promote metabolism, enhance the body's immunity, prevent colds and other respiratory infections. When you are active, you should pay attention to choosing non-competitive projects to avoid unpleasant things.
3. Thyroid cancer is a group of diseases in which the benign and malignant are extremely uneven and the prognosis is very different. Therefore, after surgical resection, comprehensive treatment should be actively carried out. The thyroxine should be treated with long-term use after surgery, and 131I should be used in patients with distant metastasis. Explain to patients and their families that as long as they follow the doctor's advice, maintain a good psychological state, have a reasonable diet, make reasonable meals, and strengthen self-care, most patients can survive for a long time, so that patients can enhance their confidence in fighting diseases.
4. For undifferentiated or poorly differentiated thyroid cancer with high degree of malignancy, the necessary radiotherapy and chemotherapy should be instructed regularly to prolong life and improve the quality of life. What are the care items for advanced thyroid cancer?
5, follow the doctor's advice to conduct regular follow-up visits. Differentiated thyroid cancer should be reviewed regularly for thyroglobulin and 151I; medullary carcinoma should be reviewed regularly for calcitonin and carcinoembryonic antigen (CEA). Undifferentiated cancer or differentiated cancer without iodine should be regularly examined by B-mode ultrasound, CT, MRI or radionuclide (TI) to detect recurrence and metastases in time.
6, strengthen self-observation, patients should pay close attention to their own subtle changes, especially the thyroid site and surrounding masses, nodules, pain, hoarseness, difficulty in swallowing and abnormal feelings in other parts of the body, etc., abnormalities should be promptly treated.
Complication
Thyroid tumor complications Complications of the elderly superior vena cava compression syndrome
Post-sternal thyroid tumors may cause dyspnea and superior vena cava compression after compression of the trachea and large blood vessels.
Symptom
Thyroid tumor symptoms Common symptoms Progressive neck mass jugular vein anger sound hoarseness neck lymph node enlargement dysphagia dyspnea dysfunction
Benign thyroid tumors:
Benign tumors of the thyroid gland are common, and in the neck mass, thyroid tumors account for about 50%. Generally, there are no obvious symptoms. When the tumor is large, it may cause difficulty in breathing, difficulty in swallowing, hoarseness and other symptoms due to compression of the trachea, esophagus, and nerves. When the tumor merges with hemorrhage and rapidly increases, local pain will occur. Because of the malignant transformation of benign thyroid tumors, some of them are benign, but they are "hot nodules" (ie, highly functional), so active treatment is needed. Common benign tumors: thyroid adenoma, nodular goiter, thyroglossal cyst, subacute thyroiditis.
Thyroid malignancy:
The most common thyroid malignancy is Thyroid carcinoma. Very few can have malignant lymphoma and metastases. Thyroid cancer accounts for 1% of systemic malignancies. Except for medullary carcinoma, most thyroid cancers originate from follicular epithelial cells. The incidence of thyroid cancer has a certain relationship with the region, race, and gender.
Papillary carcinoma and follicular carcinoma have no obvious symptoms at the beginning, and the former may sometimes seek medical treatment due to swelling of the cervical lymph nodes. As the disease progresses, the mass gradually increases, the mass is hard, and the degree of movement of the mass is reduced when swallowing. The above symptoms of undifferentiated cancer develop rapidly and invade surrounding tissues. Late stage can produce hoarseness, difficulty breathing, and difficulty swallowing. The cervical sympathetic ganglia is compressed and can produce Horner syndrome. When the shallow branch of the cervical plexus is violated, the patient may have pain in the ear, pillow, shoulder, etc. There may be cervical lymph node metastasis and distant organ metastasis (lung, bone, central nervous system, etc.).
In addition to cervical lumps, medullary carcinoma can cause diarrhea, palpitations, flushing of the face, and decreased blood calcium due to serotonin and calcitonin. For patients with a family history, attention should be paid to the possibility of multiple endocrine neoplasia syndrome type II (MEN-II).
Examine
Thyroid tumor examination
1, thyroid function test: mainly the determination of thyroid stimulating hormone (TSH). The high functional hot nodules reduced by TSH are less malignant, so it is more important to treat hyperthyroidism. A normal or elevated thyroid nodule with TSH and a cold nodule or warm nodule with a reduced TSH should be further evaluated (eg, a biopsy, etc.).
2. Radionuclide scanning: The isotope scan of radioactive iodine or strontium (ECT) is an important means of determining the functional size of thyroid nodules. The American Thyroid Society noted: "The results of the ECT examination include high functionality (higher intake rate than surrounding normal thyroid tissue), functional or warm nodules (same rate as surrounding tissue) or no functional nodules (near surrounding Thyroid tissue uptake rate is low. High-function nodule malignant rate is very low, if the patient has obvious or subclinical hyperthyroidism, the nodule needs to be evaluated. If the serum TSH level is high, even if it is only at the highest limit of the reference value The nodule should be evaluated because the malignant rate of the nodule is higher at this time." However, ECT is often not displayed for nodules or microscopic cancers less than 1 cm, so ECT examination should not be used for such nodules.
3, B-ultrasound: Ultrasound is an important means to find thyroid nodules, and initially judge its benign and malignant, is the criterion for the implementation of fine needle aspiration biopsy (FNA), and is the most effective means of examination. All European and American guidelines refer to suspected malignant signs under ultrasound, including: hypoechoic nodules, microcalcifications, abundant blood flow signals, unclear boundaries, nodular height greater than width, solid nodules, and lack of halos . Some people in China have analyzed and evaluated the nodules in terms of nodule morphology, boundary, aspect ratio, peripheral sonic halo, internal echo, calcification, and cervical lymph node. The postoperative pathological results were compared and the nodule morphology was obtained. Calcification and internal echo are more relevant in the benign and malignant identification of thyroid nodules, and this feature can be emphasized (only for papillary carcinoma).
4, needle smear cytology examination: needle aspiration biopsy includes fine needle aspiration biopsy and thick needle biopsy, the former is cytological examination, the latter is histological examination. For the suspected malignant thyroid nodules found by B-ultrasound, this method can be used to confirm the diagnosis. At present, a fine needle biopsy is generally used, and the patient is supine when operating, and the neck is overextended. Local anesthesia should be used. Emphasize the importance of multi-directional puncture, at least 6 times to ensure that enough specimens are obtained. When puncture, fix the nodule with the middle finger of the left hand, hold the syringe with the right hand, and return the needle to generate the negative pressure. At the same time, slowly pull out the needle 2mm, then puncture it. After repeated several times, see the cell debris inside the needle. Stop the suction, remove the negative pressure, pull out the needle, disengage the syringe, inhale a few milliliters of air into the syringe, attach the needle, and discharge the specimen inside the needle onto the slide, requiring 1-2 drops of orange-red liquid. There are cell debris inside. Then smear check.
Diagnosis
Diagnosis and diagnosis of thyroid tumor
Diagnosis can be made based on medical history and laboratory tests.
