nodular goiter in children
Introduction
Introduction to children with nodular goiter Nodular goiter refers to a swollen thyroid tissue with single or multiple nodules (more than 2 nodules), most of which are adenomas, some of which can be malignant, and a few are thyroid cancer. basic knowledge The proportion of illness: 0.002% Susceptible people: children Mode of infection: non-infectious Complications: difficulty swallowing
Cause
Causes of nodular goiter in children
(1) Causes of the disease
Thyroid nodules are a common thyroid disease. Many thyroid diseases can be characterized as nodules. Thyroid nodules are divided into benign and malignant categories. The majority of benign people are less than 1% of malignant ones. Change, inflammation, autoimmunity and new organisms and other diseases, thyroid nodules can be single or multiple, multiple nodules are more common than single, while single nodules are compared with multiple nodules The incidence of thyroid cancer is higher.
According to the etiology of nodules can be divided into: nodular goiter, inflammatory nodules, toxic nodular goiter, thyroid cysts, thyroid tumors, early clinical understanding of the nature of thyroid nodules, especially distinguishing them as benign or It is a malignant lesion, which has important significance for the choice of treatment plan and prognosis.
1. solitary thyroid nodule (solitary goitre)
Individual swollen thyroid nodules should be carefully examined, and thyroid radionuclide examination, thyroid radionuclide examination, Na99mTcO4, according to the ability of thyroid nodules to concentrate radionuclide into cold or cold nodules (no functional nodules), warm nodules (functional nodules), hot nodules (high functional nodules).
(1) cold nodus (cold nodus): thyroid nodules concentrated radionuclide ability similar to extra-thyroid background radioactivity, such nodules are highly malignant.
(2) cool nodus (cool nodus): thyroid nodules concentrated radionuclide ability is lower than normal thyroid tissue, but higher than the extrathyroid background radioactivity.
(3) Warm nodus: The thyroid nodules have the same ability to concentrate radionuclides as normal thyroid tissue, so such nodules are generally benign and less likely to develop malignant transformation.
(4) Hot nodus: The ability of thyroid nodules to concentrate radionuclides beyond normal thyroid tissue is characteristic of nodular functional adenomas.
2. multiple nodi goiter (multiple nodi goiter)
The thyroid gland is unevenly enlarged, and it can reach more than 2 nodules. The soft and hard features of the nodules vary depending on the cause. Nodular goiter often occurs in endemic goiter areas, thyroid nodules. The formation of thyroid hormone synthesis in the region of iodine deficiency, feedback TSH secretion increased, TSH stimulated thyroid tissue repeated proliferation, degradation results.
(two) pathogenesis
Most of the structures in the thyroid nodules are gelatinous follicles, and the epithelial cells of the follicles are cuboidal (partially flat). The cytological examination of the fine needles of the thyroid gland is characterized by a large amount of gel after the special staining. Less or moderate amount of cubic epithelial cells dispersed in the cytoplasm, the cell volume is larger than normal thyroid epithelial cells, and the staining is uniform, a few multiple nodules or scattered single nodules, most of which are adenomas, and have a complete package Membrane, divided into 3 types:
Follicular adenoma
The adenomas are composed of follicles of different sizes and different gum masses. The follicular epithelium has different degrees of hyperplasia, usually the texture is hard and the capsule is intact.
2. papillary adenoma
The follicular epithelium is increased in the shape of a nipple-like nipple. Most of the pedicle is connective tissue. Sometimes the soft part of the nodule is cystic, and the sac is a viscous fluid or an old bloody fluid.
3. Mixed adenoma
The structures of the above two nodules are present in such tumors, that is, both follicular epithelial cells and papillary epithelial cells are visible.
Thyroid tumors have intact fibrous capsules ranging in size from a few millimeters to more than 10 cm, single or multiple nodular round masses, adenoma follicles of normal size, full of glial cells, well-differentiated cells, multicellular follicular adenomas including Fetal adenomas, composed of microfollicles; Hürthle cell adenomas containing solid eosinophils; embryonic adenomas consisting of poorly differentiated cells with few follicles.
Prevention
Pediatric nodular goiter prevention
Thyroid nodules are a common thyroid disease. Many thyroid diseases can manifest as nodules, such as thyroid degeneration, inflammation, autoimmunity, and new diseases.
1. Prevention of iodine deficiency
Caused by iodine deficiency, such as the need for collective prevention and treatment of residents in endemic goiter areas, the most effective and convenient to iodized salt, the concentration is generally 1:10000, iodized oil intramuscular injection for infants and young children, iodine can be formed after intramuscular injection The library is very slow to absorb, and the effect is better than iodized salt.
2. Prevent excessive iodine
Excessive iodine supplementation is not beneficial, too much iodine can cause goiter; other such as hard water, cobalt poisoning, chromium poisoning and industrial waste pollution can cause goiter.
3. Avoid head and neck X-ray
X-ray irradiation can cause goiter, 20% to 30% of materials exposed to head and neck, and nodular goiter in the future, and 80% of children with thyroid cancer have a history of radiation exposure.
4. Prevent infection
It is believed that bacterial or viral infections are associated with thyroiditis.
Complication
Pediatric nodular goiter complications Complications, difficulty swallowing
Large nodules may have symptoms of compression, difficulty in swallowing, difficulty breathing, occasional dumbness; may be associated with hyperthyroidism or malignant transformation. There is also significant pain in contact. Patients with thyroiditis will show symptoms such as excitement, fear of heat, palpitation, tremors and excessive sweating. Others may present symptoms such as constipation and drowsiness, which seriously affect the normal life of the patient and cause certain harm to the patient.
Symptom
Symptoms of nodular goiter in children Common symptoms Nodules and difficulty breathing
Occasionally, the thyroid gland is swollen and can touch single or multiple round nodules. The surface is smooth, rarely adhered, and there is no tenderness. Radionuclide radionuclide examination should be performed.
1. Solitary goiter (solitary goiter) should be carefully examined for a single enlarged thyroid nodule, check the thyroid texture, adhesion to the surrounding, fixed, pay attention to whether the neck lymph nodes are swollen or sticky, whether the trachea has Compression, larger nodules may have symptoms of compression, difficulty swallowing, difficulty breathing, occasional dumbness, such as intratumor hemorrhage, can cause sudden growth of the tumor, thyroid tumor can cause hyperthyroidism or malignant transformation, clinically caused by corresponding performance.
2. Multiple nodi goitre The thyroid gland is unevenly enlarged. It can reach more than 2 nodules. The soft and hard features of the nodules vary depending on the cause.
Examine
Examination of nodular goiter in children
Thyroid function test
Toxic nodules can show hyperthyroidism. Most of the early subacute thyroiditis also has hyperthyroidism. Chronic lymphocytic thyroiditis has normal thyroid function, but many patients have reduced or hyperthyroidism, and other diseases cause thyroid nodules. Most of the thyroid function is normal.
2. Needle biopsy and cytology
Needle aspiration biopsy can obtain cells or fluids from thyroid nodules, with 22 to 27 needles, simple and safe to operate, help with nodular goiter, chronic or subacute thyroiditis, diagnosis of papillary or undifferentiated carcinoma This method can reduce the operative rate of thyroid nodules, but it is still difficult to identify follicular adenomas or adenocarcinomas. The latter also needs to observe the histological changes of the capsule or blood vessels.
3. Thyroid nuclides imaging
Radionuclide (131I or 99mTc) can reflect the location, size, morphology and functional status of the thyroid and its nodules. According to the nodule's ability to ingest 131I, it can be "hot nodules", functional nodules and "cold" Nodules, a single "cold nodule" is relatively likely to be malignant, the incidence of cancer is 20% to 30%; functional nodules and multiple "cold nodules" are mostly benign adenomas or nodules, The incidence of cancer is small; the "hot nodules" are almost benign, the "hot" nodules are functionally autonomous thyroid nodules; if they are functional or "cold" nodules, they are non-functionally autonomous thyroids. Nodule.
Thyroid scan, the application of 123I examination is generally a hot nodule, not a special diagnosis, must be combined with other conditions for analysis, at present, there is no scan can distinguish between benign or malignant nodules, if there is a possibility of cold nodules.
4. Ultrasound examination
B-mode ultrasonography of the thyroid gland can show the solidity of the thyroid nodules, the cystic or cystic solid mixed lesions, can accurately diagnose the number and size of the glands, the accuracy rate can reach more than 90%.
Individual solid nodules have more chances of malignant transformation. As with solid mixed nodules and solid nodules, there is also the possibility of malignancy, and cystic nodules are rarely malignant lesions.
5. X-ray inspection
X-ray images of the neck, such as fine-point or sand-like calcification, may be sand-like bodies of papillary carcinoma, large irregular calcification can be seen in degenerative nodular goiter or thyroid cancer, in the trachea image See if there is infiltration or deformation, and more suggestive of malignant lesions.
Diagnosis
Diagnosis and diagnosis of nodular goiter in children
diagnosis
The history of exposure to ionizing radiation can help to consider the possibility of malignant transformation. The serum thyroxine levels are mostly normal. Some patients have hyperthyroidism, only serum T3 is elevated, and some patients have elevated serum T4 and T3.
1. Thyroid biopsy: Fine needle aspiration biopsy, 94% to 97% of nodules can get satisfactory aspiration, which provides valuable help for the diagnosis and treatment of thyroid nodules.
2. Thyroid hormone inhibition test: It has been reported in the literature that taking thyroid hormone for several months can inhibit the growth of thyroid nodules and distinguish between benign or malignant according to the dependence of thyroid nodules on TSH.
Differential diagnosis
Thyroid tumors are of great significance in the differential diagnosis of thyroid masses: it includes benign thyroid tumors and malignant thyroid cancer. Thyroid papillary carcinoma accounts for 60% to 80% of thyroid cancer. It occurs mostly in young women, and the tumor is mostly multiple. Focality, easy to metastasize, even if lymph node metastasis, the prognosis is still good, thyroid follicular cancer accounts for 15% to 20% of thyroid cancer, more common in 50-year-old women, easy to distant metastasis, 50% of patients have been diagnosed Metastasis, medullary thyroid carcinoma accounted for 5% to 10%, calcitonin determination is helpful for diagnosis, thyroid undifferentiated cancer accounts for 5% to 10%, poor prognosis, tumor growth rate, size and infiltration (including hoarseness, Drinking water, dyspnea, etc.) contribute to the identification of benign and malignant properties. In addition, laboratory tests include thyroid function tests (T3, T4 free triiodothyronine, free thyroxine, ultrasensitive thyroid stimulating hormone) ), thyroid autoantibody assay, calcitonin determination, thyroid B ultrasound, thyroid radionuclide imaging and fine needle aspiration cytology combined to facilitate differential diagnosis.
Neck teratoma is often located in the thyroid gland. Some tumors are mistaken for the thyroid gland, or replace the thyroid gland, or located near the thyroid gland, accounting for 3% of neonatal and childhood teratomas. 50% of cervical teratoma is in the newborn. In childhood, it was found that the amniotic fluid in the fetal period was too much, and the trachea and esophagus were compressed. 20% of the newborns could rapidly enlarge the postpartum mass, compress the trachea, and have respiratory distress. The neonatal period needs immediate intubation and surgical treatment, and even leads to Bleeding and other complications.
