The most comprehensive thyroid knowledge question and answer? Everything you want to know about the thyroid gland is here.

Thyroid nodules are a common problem for doctors. It is estimated that about 4% of adults will develop thyroid nodules. There are benign and malignant thyroid nodules. Benign mainly includes nodular goiter and thyroid adenoma. Malignant thyroid nodules are mainly thyroid cancer, besides thyroid lymphoma and metastatic tumor. Although malignant lesions are not common, it is difficult to distinguish them before operation. The most important thing is how to avoid missed diagnosis of cancer. According to autopsy data, the incidence of thyroid micro-malignant tumor can be as high as 17%. Clinically, the incidence of thyroid cancer is 39 cases per million people every year (3.9/65438+ 10,000 people).

Nodular goiter is a kind of simple goiter, which evolved from diffuse goiter and belongs to simple goiter.

First, the causes of thyroid nodules mainly include the following aspects:

1, iodine deficiency: It is one of the main causes of endemic goiter. Iodine content in soil, water and food in epidemic areas is inversely proportional to the incidence of goiter, and iodized salt can prevent goiter. Facts can prove that iodine deficiency is an important cause of goiter.

In addition, the increased demand for thyroid hormone can cause relative iodine deficiency, such as growth and development, pregnancy, breastfeeding, cold, infection, trauma and mental stimulation, which can aggravate or induce goiter.

2, goiter-causing substances: radish foods contain thiourea goiter-causing substances, and soybeans and cabbage also have some substances that can prevent the synthesis of thyroid hormones, causing goiter. The contents of minerals such as calcium, magnesium and zinc in soil and drinking water are also related to the occurrence of goiter. In some endemic areas, besides iodine, these elements are also lacking. In some areas, the incidence of goiter is directly proportional to the hardness of drinking water. Drugs such as potassium thiocyanate, potassium perchlorate, p-aminosalicylic acid, thiourea pyrimidine, sulfonamides, phenylbutazone, colchicine, etc. , will hinder the synthesis and release of thyroxine, thus causing goiter.

3. Hormone synthesis disorder: The pathogenic cause of familial goiter lies in the defect of hereditary enzyme, which causes hormone synthesis disorder, such as the lack of peroxidase and deiodinase, which affects the synthesis of thyroxine, or the lack of hydrolase, which makes it difficult for thyroid hormone to be separated from thyroglobulin and released into the blood, which may lead to goiter. This congenital defect belongs to recessive inheritance.

4. High iodine: it is rare and can be distributed locally or sporadically. Its pathogenesis is that excessive intake of iodine leads to excessive occupation of TPO functional genes, which affects tyrosine iodization, the organic process of iodine is blocked, and the thyroid gland is compensatory.

5. Gene mutation: This abnormality includes point mutation of thyroglobulin gene exon 10.

Early simple goiter is characterized by diffuse mild or toxic hyperplasia, increased blood vessels and hypertrophy of glandular cells. When the disease continues or worsens repeatedly and relieves, the thyroid gland will proliferate or regenerate due to irregularity, and nodules will gradually appear, forming nodular goiter. With the development of the disease, due to the accumulation of a large number of colloid (glial goiter) in the acinus, huge acinus is formed, follicular epithelial cells are flat, and connective tissue and blood vessels between acinus are reduced. In the later stage, some glands may be necrotic, bleeding, cystic degeneration, fibrosis or calcification. At this time, the thyroid gland is not only obviously enlarged, but also has nodules with different sizes and textures. The heterogeneity of thyroid structure and function and a certain degree of functional autonomy are the characteristics of this disease in the later stage.

The incidence of nodular goiter in women is higher than that in men. It usually occurs in adolescence, and it often appears in school age in epidemic areas. Goiter varies in size and shape. Diffuse swelling at the initial stage, often bilateral symmetry; When nodules are formed in the later stage, the two sides are often asymmetrical. Nodular goiter may be accompanied by cystic changes. If accompanied by intracapsular hemorrhage, the nodule can rapidly enlarge in a short time and cause pain.

2. Nodular goiter generally does not show functional changes, and the basal metabolic rate of patients is normal; However, when the nodule is large, it can compress trachea, esophagus, blood vessels, nerves and so on. And lead to the following symptoms:

1) compression of trachea: more common. When compressed from one side, the trachea shifts or bends to the other side; Bilateral compression, tracheal stenosis, dyspnea, especially retrosternal goiter. Long-term compression of tracheal wall can lead to tracheal softening and asphyxia.

2) Compression of esophagus: rare. Only substernal goiter may compress the esophagus and cause discomfort when swallowing, but it will not cause obstructive symptoms.

3) Compression of deep jugular vein: It may make it difficult for blood to return to the head and neck. This situation is more common in giant goiter located at the upper thoracic opening, especially retrosternal goiter. The patient's face showed blue-purple edema, and the superficial veins in the neck and chest were obviously dilated.

4) Compression of recurrent laryngeal nerve: it can cause vocal cord paralysis (mostly on one side) and the patient's voice is hoarse. It is extremely rare that the compression of cervical sympathetic ganglia can cause Horner's syndrome.

Third, the diagnosis of thyroid nodules

The diagnosis of this disease is that thyroid nodules and thyroid function are basically normal. T4 is normal or slightly lower, but T3 can be slightly higher to maintain normal thyroid function. T3 inhibition test shows inhibition reaction. The determination of high-sensitivity TSH concentration in serum is the best index to evaluate thyroid function, and serum TSH is often normal.

It is not difficult to diagnose according to the characteristics that swallowing moves up and down with laryngotrachea. However, if there is inflammation or malignant transformation, goiter will adhere to the surrounding tissues, and this feature will no longer appear.

Patients with nodules should be differentiated from thyroid tumors and thyroiditis. Nodules or cysts located in the isthmus of thyroid gland can be misdiagnosed as thyroglossal duct cysts. It is sometimes difficult to distinguish retrosternal or intrathoracic goiter from mediastinal tumor. It is not difficult to distinguish it from aortic arch aneurysm, which often beats.

The goiter in adolescence can mostly subside by itself. Iodide is rarely used in goiter caused by iodine deficiency, but an appropriate amount of thyroid hormone preparation is used instead, so as to inhibit the excessive secretion of endogenous TSH, supplement the deficiency of endogenous thyroid hormone, and achieve the purpose of relieving thyroid hyperplasia. It is suitable for goiter caused by various reasons, especially colloidal goiter before the lesion occurs, and the effect is remarkable.

Fourth, the treatment of thyroid nodules

Precautions for thyroid nodules Too much iodide in high-risk population of thyroid nodules can lead to thyroid dysfunction. It is naturally very useful to find out the substances that cause goiter and avoid them.

1) thyroid hormone: The usual dose of dry thyroid preparation is 90- 180mg per day, and the course of treatment is usually 3-6 months. If there is still recurrence after stopping the drug, repeated treatment can be carried out to maintain the normal range of basal metabolic rate; L- thyroxine (Youjiale) can be used in the treatment of young patients daily 100ug in the early stage, and the added value in the second month is daily 150-200ug. Determination of serum TSH concentration can estimate the degree of thyroid inhibition. Elderly patients or patients with multinodular goiter for a long time should be tested for serum high-sensitivity TSH concentration or TRH excitation test before receiving levothyroxine treatment to determine whether there is obvious functional autonomy. If the basal TSH is extremely low or undetectable, and the response of TSH to TRH is low or nonexistent, it indicates that the function is autonomous and levothyroxine should not be used for inhibitory treatment. If functional autonomy can be ruled out, levothyroxine can be used for treatment, and the initial dose should not exceed 50ug per day. The response of nodular goiter to levothyroxine is not as good as that of diffuse goiter, but it can also inhibit its further increase to some extent.

2) Iodine supplementation: People who are simply deficient in iodine should be reasonably supplemented with iodine. After iodine supplementation, the thyroid gland can shrink to varying degrees. Optional preparations include compound iodine oral liquid (Lugo solution), potassium iodide, intramuscular injection of iodized oil, etc. It is rarely used at present.

3) Chinese medicine treatment: resolving phlegm and softening hardness: only those with thick neck and no special symptoms belong to the syndrome of qi stagnation and phlegm stagnation. It can be treated with seaweed, kelp, Fritillaria thunbergii, green tangerine peel, pumice and Pinellia ternata. In addition, appropriate consumption of kelp, jellyfish and other seafood or iodine-rich food.

4) indications for surgical treatment: clinical symptoms caused by compression of trachea, esophagus or recurrent laryngeal nerve; Retrosternal goiter; Huge goiter affects life and workers; Nodular goiter secondary to hyperthyroidism; Nodular goiter is suspected to be malignant.

Verb (abbreviation of verb) people with high incidence of thyroid nodules

1. Eat high-content Chinese herbal medicines or seaweed food for a long time: Eating some high-content Chinese herbal medicines can also cause thyroid nodules. Causes of thyroid nodules Although iodine deficiency may cause thyroid nodules, long-term consumption of seaweed food with high iodine content is very beneficial to health.

2, eating too much iodine, there will be nodules. The director believes that in coastal areas, people eat a lot of food with high iodine content for a long time, and there is no shortage of iodine. In addition, iodized salt is usually added to their diet, which may lead to iodine overdose. In recent years, outpatients can meet patients with thyroid nodules almost every day. He analyzed that this may be related to the excessive intake of iodine by the public. How can we prevent excessive intake of iodine? The director suggested that citizens might as well fry iodized salt with oil before cooking, so as to sublimate the iodine in it.

3. Insufficient iodine intake during development: Insufficient iodine intake during development is also a factor leading to female thyroid nodules. If you don't take enough vitamins in adolescence, which leads to iodine deficiency, it will lead to many diseases in your body, and thyroid nodules are one of them.

4. Malignant tumors are often related to tissue genetic abnormalities: in addition, the pathogenic factors of female thyroid nodules are related to genes, and people with family history of such diseases are more likely to suffer from this disease. Other patients are caused by childhood illness and exposure to radioactive external radiation. I believe that through the above introduction, everyone has an understanding of the reasons for the high incidence of female thyroid nodules!

Sixth, the dietary adjustment of thyroid nodules

Thyroid nodules have brought serious harm to our lives and threatened our health, so the director reminded that patients with thyroid nodules must be treated in time to avoid serious harm.

1, calories: Because of hyperthyroidism, the metabolic rate of the body will increase, so the daily calories required can increase.

Protein: You can increase the number of protein.

3, vitamins: because of the increase in calories, the demand for vitamin B family has also increased, so pay attention to supplement.

4. Iodine: It is a component of thyroxine. Taking iodine compounds to hyperthyroidism patients can increase the storage of thyroxine and reduce its release, but too much dose will affect the treatment of thyroxine.

5. Avoid irritating foods, such as tea, coffee, cigarettes and alcohol.

Seven, the daily care of thyroid nodules

1, patients with thyroid nodules should not eat spicy food, such as pepper, Chili oil, etc.

2, insist on doing aerobic (outdoor) exercise for 20-30 minutes every day, which can improve the endurance of the heart and lungs and enhance physical fitness, and it is not easy to get tired at work.

3. Patients with thyroid nodules should go to bed early every day to ensure adequate sleep.

Eight, thyroid nodules in the diet taboo is mainly manifested in the following aspects:

1, avoid the following foods

(1) Avoid greasy and fried foods.

(2) Avoid spicy and irritating foods, such as onions, peppers, peppers and cinnamon. This is one of the dietary taboos of thyroid nodules.

(3) Pay attention to thyroid nodules in diet: avoid smoking and drinking.

After hyperthyroidism is cured, we can't treat it lightly. Patients with hyperthyroidism should actively avoid incentives, which requires patients to develop good living habits, pay attention to rest, don't be overtired, and take part in some exercise properly. In addition, patients with hyperthyroidism should eat less iodine-containing foods, such as kelp, seaweed and seafood. Don't smoke or drink.

2. Eat the following foods.

(1) Eat more foods with high iodine content, such as kelp, laver, scallop, jellyfish, sea cucumber, lobster and turtle.

(2) It is also a common dietary taboo for thyroid nodules to eat more foods with the function of eliminating nodules and reducing swelling, including water chestnut, rape, mustard and kiwi fruit.

(3) Eat more foods that enhance immunity, such as mushrooms, fungus, walnuts, coix seed, red dates, yams and fresh fruits.

Nine, the harm of thyroid nodules to the human body

1. Damage to fertility and sexual function: Most female thyroid patients suffer from menstrual disorder, which leads to menopause, decreased sexual desire and more difficult pregnancy. Male thyroid patients are more likely to induce decreased libido, impotence, premature ejaculation and infertility.

2. Causing cardiovascular diseases: Thyroid hormone acts on the heart for a long time, which is more likely to lead to cardiac hypertrophy, atrial fibrillation, arrhythmia and even heart failure and death.

3. The patient's working ability will obviously decrease, and he often suffers from insomnia, inattention and memory loss, which will obviously reduce the working effect.

4. Patients with thyroid nodule exophthalmos will have diplopia symptoms.

5. Patients with tracheal compression have many symptoms. With the development of the disease, the nodule will become very large. Some patients will show compression of one trachea, which is a common injury of thyroid nodules. Some patients will show bilateral tracheal compression, causing dyspnea, and in severe cases, they will show suffocation.

6. The appearance of thyroid nodules is very harmful to people's lives. Patients will be upset, loud and angry, and easily argue with others, which seriously damages the connection between family and friends.

Ten, the correct treatment of thyroid nodules.

1, don't rely solely on western medicine. Western medicine will have certain side effects and harm, and it will make patients dependent and easy to relapse, and it has no radical effect.

2, you can't give up halfway, no matter which treatment method has a certain course of treatment, a considerable number of patients blindly stop taking drugs after the symptoms disappear, and then treat them when they get sick again, and they can't be cured repeatedly.

3, diet does not pay attention, patients with thyroid nodules should pay attention to diet, try to control the intake of spicy and irritating food, even in the painless period.

4. Choosing the correct treatment method, oral administration of traditional Chinese medicine and external application therapy can quickly eliminate thyroid nodules, thus restoring the normal health of the neck.

Eleven, thyroid nodule examination methods

1, radionuclide scanning: scanning is of little significance in differentiating benign and malignant lesions. Most benign and malignant solid nodules have lower function than the surrounding normal gland tissues, so it is found that cold nodules have almost no specificity, and the overlapping uptake of nuclides by the surrounding normal gland tissues will miss the diagnosis of small nodules. Many thyroid adenocarcinoma can absorb Tc, so there are still some cancer cases in hot nodules.

2. Serological examination of thyroid dysfunction can not rule out thyroid cancer, but it shows that it may be very small, accompanied by hyperthyroidism or TSH reduction, all of which suggest vegetative thyroid adenoma, nodule or toxic nodular goiter. The serum calcitonin level in patients with medullary thyroid carcinoma is increased, but it needs the stimulation of gastrin pentapeptide and calcium in the early stage of C cell proliferation.

3. Ultrasonic diagnosis Ultrasound is very reliable in the diagnosis of cystic lesions. It is of little value in distinguishing benign from malignant. However, it is of great significance to distinguish the size and location of nodules and guide puncture.

4. The coincidence rate of fine needle aspiration cytology (FNAC) of thyroid nodules with surgical and pathological results was 90%. Only 5% false negative rate and 5% false positive rate. Of course, the coincidence rate depends on the success rate of the operator and varies greatly.

5. Fine needle aspiration cytology is very helpful for the treatment of thyroid nodules. The wide application of this method greatly reduces unnecessary thyroid surgery, improves the detection rate of intraoperative malignant tumors and reduces the treatment cost of thyroid nodules. The accuracy of fine needle aspiration cytology is 70%-90%, which is related to the experience of puncture and cytological diagnosis.

6. Other radionuclide examinations Positron emission tomography (PET) can be used to examine nodular thyroid lesions and distinguish benign from malignant tumors. Proton magnetic resonance seems to be able to distinguish normal gland tissue from cancer tissue.