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In recent years, the incidence of thyroid nodules has been on a steep rise, with a male-to-female incidence rate of about 1:4. The prevalence of thyroid nodules detected with the aid of high-resolution ultrasound reaches 20% to 76%, with malignant tumors accounting for 7% to 15%. However.Most thyroid nodules tend to be asymptomatic and are most often discovered during occasional physical exams by a doctor's palpation of the thyroid and thyroid ultrasound.

1. So, who is prone to thyroid nodules?

① History of head and neck radiation exposure or exposure to radiation contamination during childhood;

(ii) A history of systemic radiation therapy;

(iii) A past or family history of thyroid cancer;

④ Thyroid nodules can also be triggered or aggravated by pregnant women, breastfeeding, exposure to major trauma and mental stimulation, cold stimulation, infections, and periods of rapid growth and development;

⑤ Suffering from thyroid diseases such as simple goiter, thyroiditis, and thyroid tumors;

(vi) Iodine intake is too low and iodine deficiency can cause thyroid nodules;

(vii) Eat frequent and large amounts of goiter-causing substances, such as soybeans, cabbage, and radishes;

(8) Took goiter-causing drugs, such as p-amino acids, p-aminosalicylic acid, potassium perchlorate, and potassium thiocyanide;

9 A history of familial goiter can lead to thyroid nodules due to inherited defects in thyroid hormone synthesizing enzymes or deficiencies in hydrolyzing enzymes.

2. What should I do if I find a thyroid nodule?

In general, after ultrasonography it is judged to beBenign thyroid nodulesMost of them do not require treatment.follow-up observationThat's it. Specific follow-ups.The frequencies are as follows:

For benign thyroid nodules that are highly suspicious by ultrasonography, it is recommended that the ultrasonography be repeated every 6 to 12 months in the hospital; for those that are moderately or lowly suspicious, it is recommended that the ultrasonography be repeated every 12 to 24 months.

② If there is little change in the shape and size of the nodule after review, it can also be reviewed every 24 months, or 2 years.

in the event thatThyroid nodule judged to be malignant after ultrasonographyThe micro-medicine practitioner suggestsConsult head and neck surgery or thyroid specialist or general surgery as early as possible, and after evaluation by a specialist, a follow-up examination and treatment and follow-up plan will be formulated according to the individual's specific situation.

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Thyroid nodules are frequently detected during physical examinations of healthy people. Clinical figures show that 3-7% of the healthy population can palpate thyroid nodules on their own, the incidence of thyroid nodules on ultrasonography is as high as 20-76%, and the incidence of thyroid cancer among nodules is 5-15%.

What kind of people are susceptible to thyroid nodules.Epidemiologic investigations have shown:

• The prevalence was significantly higher in females than in males, with a significant difference in the comparison between males and females;
  

• The prevalence of thyroid nodules tends to increase significantly with age;
  
• The prevalence of thyroid nodules varies among different groups. Generally speaking, the prevalence of thyroid nodules is higher in occupational groups that are engaged in mental labor, highly competitive, feeling stressful, and in a state of prolonged mental tension, such as medical personnel engaged in high-risk occupations, with high responsibility, irregular life, and high stress, and the prevalence of thyroid nodules is significantly higher than that of other groups;
  
• In addition, thyroid nodules are more likely to occur in people with high blood pressure, diabetes, and high blood cholesterol than in the general population.

The vast majority of thyroid nodules are benign and have no adverse consequences, so if malignancy can be ruled out, common benign nodules are not cause for much concern.

From the current medical technology, the most important of the thyroid nodule characterizationNon-invasive meansIt's an ultrasound.In 2009, the American College of Radiology first proposed color ultrasound of the thyroid glandTI-RADS classificationThe diagnostic criteria are of greater importance in guiding the determination of the nature of the thyroid gland.

If you find a thyroid nodule during your physical examination, you can pay attention to the ultrasound report form that gives aTI-RADS classificationNumbers.TI-RADS classificationFor grades 2, 3, 4a, 4b, 4c, and 5, the comparisons to the actual malignancy rates are 0, 0.5%, 4.6%, 25%, 73%, and 94%, respectively. This means that grades 2 and 3 are basically fine, while grade 4 and above should be of high concern.

However, you should be aware that ultrasound can detect undesirable nodules, but it is not the final diagnosis, which is ultimately based on thepathological diagnosis, also known as a fine needle aspiration biopsy of a thyroid nodule.

Thyroid nodules, which are scattered lesions caused by abnormal localized growth of thyroid cells, are a frequent and common disease of the endocrine system.

The prevalence of thyroid nodules obtained by palpation ranges from 3% to 7%, and the prevalence of thyroid nodules obtained by high-resolution ultrasound ranges from 20% to 76%. The prevalence of thyroid cancer among thyroid nodules ranges from 5% to 15%, with the latter occurring in relation to age, gender, history of exposure to radioactive substances, and family history. The clinical management of benign and malignant thyroid nodules varies, with significant differences in the impact on the quality of patient survival and the health care costs involved.The key point in the evaluation of thyroid nodules is the differentiation between good and bad.

Most patients with thyroid nodules have no clinical symptoms. When combined with abnormal thyroid function, the corresponding clinical manifestations may occur. Some patients develop symptoms of compression such as hoarseness, feeling of pressure and difficulty in breathing/swallowing due to compression of the nodule on the surrounding tissues.

The following features suggest a high risk of thyroid cancer:

(1) History of radiation exposure to the head and neck in childhood or exposure to radioactive fallout;

② History of systemic radiation therapy;

(iii) A past or family history of differentiated thyroid cancer (DTC), medullary thyroid carcinoma (MTC) or multiple endocrine adenomatosis type 2 (MEN type 2), familial polyposis, or certain thyroid cancer syndromes;

④Male;

⑤ Nodules grow rapidly;

(vi) With persistent hoarseness and dysphonia, and vocal cord pathology (inflammation, polyps, etc.) can be excluded;

(vii) With dysphagia or dyspnea;

(8) Nodules are irregular in shape and fixed in adhesion to surrounding tissues;

9 with pathologic enlargement of the cervical lymph nodes.

What further tests should be done when a thyroid nodule is found?

• Serum TSH levels are checked at the initial evaluation of patients with thyroid nodules. If the TSH level is low, a nuclear scan with technetium or 123I should be performed.

Serum TSH levels should be checked when a thyroid nodule is found to be >1 cm in diameter or when an 18FDG-PET scan shows diffuse or limited thyroid uptake. If the serum TSH level is low, a nuclide scan should be performed on the nodule to determine whether the nodule is hyperfunctional (higher uptake than surrounding normal thyroid tissue), isofunctional or warm nodule (same uptake as surrounding tissue), or nonfunctional nodule (lower uptake than surrounding thyroid tissue). The rate of malignancy in high-functioning nodules is very low, so cytologic evaluation of such nodules may not be necessary. If the patient has significant or subclinical hyperthyroidism, the nodules need to be evaluated. If the serum TSH level is high, the nodule should be evaluated even if it is only at the upper limit of the reference value, as the rate of malignancy of the nodule is then higher.

There are quite a lot of people with thyroid nodules around, and as I have personally summarized, the people who are more likely to have thyroid nodules are probably the following:

1. People who are easily angered and angry

2. People who can't easily think things through, people who keep their misery in their heart

3. Women are more likely than men

4. Family history in the family

5. Stressful life and work

Not all thyroid nodules need to be treated; single nodules are more dangerous than multiple nodules, and it also depends on the size, location, and shape of the nodule, all together.

What are thyroid nodules? Are thyroid nodules a disease?

Thyroid nodules, as the name suggests, areIt is a lump within the thyroid gland. Strictly speaking thyroid nodules are not the name of a single type of disease, but rather a clinical symptom of a variety of thyroid disorders. ManyThyroid disorders can all causethyroid nodule，So when it turns out thatthyroid noduleWhen this is the case, it should be made as clear as possible what the cause is.

There is reliable evidence that thyroid disease, and indeed thyroid cancer, is on the rise globally. The available epidemiologic data on the causes of thyroid nodules suggest that they are related to several factors:

1, Environmental factors

The most common environmental factor is iodine deficiency. Iodine is a trace element closely related to the thyroid gland. If the body is chronically deficient in iodine, it can easily cause the thyroid gland to become overactive, leading to thyroid disease.

In order to combat iodine deficiency disorders, the World Health Organization (WHO) has implemented the salt iodization strategy globally, and at present, more than 120 countries and regions have implemented this policy, and countries such as the United States and Australia have even adopted the measure of adding iodine to bread to prevent iodine deficiency disorders.

In recent years, there has been a trend towards an increase in the number of thyroid nodules, with the prevalence of thyroid disease ranging from 3-7% when obtained by physician palpation to 20-76% when obtained by high-resolution ultrasound. There are no reliable studies to support the assertion that there has been a "rise in thyroid disease due to universal salt iodization" over the past few years. Currently, the increasing availability and accuracy of testing methods is a reliable reason for the increased detection of thyroid disease.

There is also reliable evidence that excessive iodine supplementation also predisposes to the development of thyroid nodules. Therefore, in China, in addition to iodized salt intake, the general population should be careful to avoid other iodine-fortified foods.

A daily intake of 150 micrograms of iodine is appropriate for a normal person.

2, autoimmune abnormalities

Thyroid disorders such as hypothyroidism and hyperthyroidism due to autoimmune abnormalities.

3, Genetic factors

Between 5% and 15% of thyroid nodules are malignant, or thyroid cancer. More fortunately, the technology for diagnosing and treating thyroid cancer is more mature and healing is generally better with treatment. Cancer survival data for the province released by the Liaoning CDC in January 2017 showed that thyroid cancer is the tumor with the highest chance of survival. Early detection, treatment and diagnosis are effective means of preventing thyroid cancer.

Other studies have shown that obesity is also associated with the development of many types of cancer, and that proper weight management can be positive for health.

【Tian Jing】National Level 2 Public Nutritionist

Participant of Wang Xingguo Nutritional Special Training Course No. 5.

References:

Guidelines for the diagnosis and treatment of thyroid nodules and differentiated thyroid cancer" Teng Weiping et al. 2012.10 Chinese Journal of Endocrinology and Metabolism

Dietary Care and Traditional Chinese Medicine Nutrition for Thyroid Diseases by Xingguo Wang and Changchuan Bai

Trends in global prevalence of thyroid nodules and thyroid cancer and analysis of their causes" Yan Yuqin 2013.5 Chinese Journal of Endemic Diseases

Thyroid nodules can present as symptomatic (uncommon) and most present as asymptomatic and are usually detected by palpation or during a physical examination with a thyroid ultrasound. More thyroid nodules can be detected by neck ultrasound or autopsy50% to 67%, and if it's by palpation then it's probably less likely to occur.The thyroid gland is located directly in front of the neck and is not normally seen or felt. If an abnormally growing mass is found in the thyroid, it can be detected by palpation or by thyroid ultrasound.

Who is susceptible to triggering thyroid nodules?

1. Genetic factors. The development of thyroid nodules and various types of thyroid cancer may be associated with mutations, activation, suppression, and deletion of certain oncogenes and oncogenes.

2. The gender factor, according to statisticsThe prevalence of goiter and thyroid nodules is significantly higher in women than in men.

3. Iodine intake, there is a significant effect of iodine intake on the prevalence of thyroid nodules.

4,radiological exposure history ，Ionizing radiation is an important risk factor for thyroid nodule formation and tumorigenesis. Medical radiation therapy, especially in the pediatric population, is extremely sensitive to the side effects produced by radiation. Therefore, it is recommended that people who are regularly exposed to these radioactive substances have an annual physical examination to check your thyroid for nodules.

5, other factors such as:Autoimmunity, smoking, and weight also play a role in the development of thyroid nodules.

Current tests related to thyroid nodules include blood draws for thyroid hormones and serum TG-Ab and TPO-Ab,Thyroid ultrasound, thyroid nuclear scan or thyroid X-ray. If needed, a puncture biopsy of the thyroid nodule and needle aspiration cytology can be done; this test is more significant in identifying benign and malignant.

Thyroid is highly prevalent, so it is important for everyone to change their poor lifestyle and have targeted thyroid checkups annually.

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A so-called thyroid nodule is a specific lump that grows on the thyroid gland.There are many causes of thyroid nodules. Thyroid tumors, thyroid cancer, thyroiditis, congenital hyperplasia, and hyperplasia of residual thyroid tissue after thyroid surgery or radioactive iodine 131 treatment can all manifest as thyroid nodules.

Thyroid nodules are very common in clinical practice. In our country alone, 32.4% of the population suffers from thyroid nodules, especially the following groups of people：

1. Had contact with radiation.People with a previous history of radiation exposure to the head and neck have a significantly higher incidence of thyroid nodules and even thyroid cancer.
   

2. Family history of thyroid disease.. There is a genetic predisposition to thyroid nodules, and if one relative has thyroid disease, the probability of others having it increases.
   

3. chronic high iodine diet. Although most thyroid nodules develop because of inadequate iodine intake, a prolonged high iodine diet can also stimulate thyroid tissue to proliferate and nodules to appear.
   

4. female. Statistically, women are more likely to develop thyroid nodules than men.
   

What are the symptoms of a thyroid nodule?

Most people with thyroid nodules have no significant physical discomfort or symptoms. They are first detected during a physical examination or during a visit to a doctor for another condition. A small number of people suspect a thyroid lesion because of the presence of symptoms.

In some people, symptoms of respiratory compression such as hoarseness and difficulty in breathing and swallowing may occur due to significant enlargement of the nodule and compression of the surrounding tissues;

When thyroid nodules complicate hyperthyroidism, patients may experience panic and palpitations, short temper and insomnia;

When thyroid nodules are complicated by hypothyroidism, patients may experience chills, fear of cold, and easy fatigue.

"Ask the doctor" tips: if you belong to the high incidence of thyroid nodules and the above discomfort, must promptly go to the hospital for thyroid ultrasound examination. According to the results of the examination to determine whether the need for treatment and treatment options.

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Thyroid nodules, refers to the occurrence of thyroid nodules, thyroid nodules are very common, according to statistics, in areas not deficient in iodine, the probability that can be detected by a doctor's hands palpation of thyroid nodules is roughly 5% among women and 1% among men, at present, the widespread use of thyroid ultrasound, high-resolution ultrasound in a random sample of the population to find thyroid nodules probability of 19%-68%, so the thyroid nodules are a very common condition, and among women, thyroid nodules are especially likely to be found.

The discovery of thyroid nodules, positive identification of its benign and malignant is the key to treatment, through the color ultrasound description of the thyroid morphology, boundaries is the initial judgment of the information, for the color ultrasound under the suspicion of malignant, but also need to carry out fine needle aspiration of the thyroid gland sent to the pathology of the examination, to clarify the benign and malignant.

A common terminology description of benign and malignant manifestations on color ultrasound:

1, the performance of benign nodules: cystic nodules;

2, Extremely suspicious with <3% probability of malignancy:K/L cystic solid generalized eccentric solid area; spongy; cystic solid without suspicious signs;

3. Moderately malignant with a 10-20% probability of malignancy: hypoechoic solid borders are regular; hyperechoic solid borders are regular;

4、Higher possibility of malignancy: hypoechoic nodule with microcalcification border irregularity; hypoechoic border irregularity; hypoechoic longitudinal/transverse ratio >1; hypoechoic border irregularity extra-glandular invasion; hypoechoic border calcification interruption accompanied by soft tissue extra-invasion; nodule with border irregularity, can be metastasized cervical lymph nodes significant.

In actual clinical work, the incidence of thyroid nodules is very common, many people who do thyroid ultrasound find nodules that cannot be sized, but most of the nodules are benign, and about 5-10% of the thyroid nodules are malignant and need surgical treatment, so it is of utmost importance to determine the benignity or malignancy of the nodules when they are found.

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Thyroid nodules are lumps within the thyroid gland and are the most common form of thyroid disease.

It can be caused by a variety of etiologies, such as too little or too much iodine intake, inflammatory changes in the thyroid gland itself, benign or malignant tumors of the thyroid gland, and degenerative changes of the thyroid gland can lead to the development of thyroid nodules. Thyroid nodules can be single or multiple, and multiple nodules are more prevalent than single nodules.

Who is susceptible to thyroid nodules?

1. History of childhood head and neck radiation exposure or radioactive fallout exposure;
2. History of systemic radiation therapy;
3. Previously had differentiated thyroid cancer, medullary thyroid carcinoma or multiple endocrine neoplasia type 2 (MEN2), familial polyposis, or a family member with one of these diseases;
4. Women.

Most patients with thyroid nodules have no obvious physical discomfort or clinical symptoms and may be detected during physical examination or other medical visits.

How do I screen for thyroid nodules?

Ultrasound is the first choice, as it can detect more than 99.9% of nodules.

Note that more expensive and more tests are not better.CT and MRI are not superior to ultrasound in identifying benign and malignant thyroid nodules and are not recommended as routine tests for evaluating thyroid nodules.

Yearly follow-up thyroid ultrasound is recommended for people with a high prevalence of thyroid nodules, not only to confirm the presence of nodules and to determine their size, number, location, texture (solid or cystic), shape, borders, calcification, blood supply, and relationship to the surrounding tissues, but also to assess the presence of lymph nodes in the neck region and the size of the lymph nodes.

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With the popularization of ultrasound, the detection rate of thyroid nodules has increased significantly, and the incidence of thyroid nodules in China is around 12-18%, with female patients accounting for the majority. However, only 5-15% of them are malignant nodules.

What kind of people are prone to thyroid nodules?

1. There is a relationship with gender. Thyroid nodules occur more often in women, and the prevalence of men is lower than that of women.

2. There is a relationship with age. As you get older, the older you are, the higher your chances of developing thyroid nodules.

3、It has something to do with diet, too much or too little iodine intake can cause thyroid nodules.

4. There is a relationship with certain diseases. People with high blood pressure, diabetes, high blood fat are more likely to develop thyroid nodules than the general population.

5. There is a relationship with the autoimmune system, especially in combination with thyroiditis and so on.

The discovery of a "thyroid nodule" is not something to be frightened of; nor is it something to be taken lightly and left unattended. In summary, the incidence of thyroid nodules is high and the majority are benign. It is important to evaluate the benign and malignant nature of the nodules. Most benign nodules require only regular follow-up and do not require specific treatment, and in some cases surgery may be an option.

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