World Thyroid Day | As the saying goes, “Anger harms the body”, are thyroid nodules really caused by anger?

□ Gao Hongkai

May 25th is World Thyroid Day. The thyroid gland is an important endocrine organ in the human body, responsible for secreting thyroid hormones and regulating the growth, development, metabolism, nervous system and other aspects of the human body. In recent years, everyone may have a thyroid ultrasound examination during a physical examination, and more and more people have been diagnosed with thyroid nodules.

Thyroid nodules refer to abnormal growth areas inside the thyroid gland. They can be benign or malignant, i.e., thyroid cancer. Therefore, thyroid nodules are not completely equivalent to thyroid cancer. Most thyroid nodules are benign, and only a small number of them will develop into thyroid cancer. Therefore, when you are diagnosed with thyroid nodules, you don’t need to panic too much, but you can’t take it lightly either. Just seek medical attention in time.

Laser 3D illustration of thyroid nodules (copyright image from the gallery, reprinting may cause copyright disputes)

Can ultrasound examination determine whether thyroid nodules are benign or malignant?

Thyroid ultrasound is the most commonly used non-invasive examination method for evaluating thyroid nodules. For thyroid nodules, our physical examination reports generally mark the TI-RADS classification. TI-RADS stands for Thyroid Imaging Reporting and Data System, which is a tool used to assess the risk level of thyroid nodules. Different TI-RADS levels correspond to different probabilities of malignancy. According to the 2020 Chinese version of TI-RADS, thyroid nodules are divided into grades 0-6. The higher the grade, the greater the possibility of malignancy of the thyroid nodules. Understanding the different clinical significance of ultrasound examination grades can help us better understand the doctor's diagnosis and advice.

Level 0: The results of this examination are meaningless and require re-examination or other examinations;

Level 1: The thyroid gland is in a normal state, with no obvious nodules, cysts, calcifications, etc.;

Grade 2: The thyroid nodules are benign, with solid, equal-echoic or high-echoic appearance, and no risk of malignancy;

Grade 3: The thyroid nodules are hypoechoic and are basically benign nodules with a very low risk of malignancy;

Grade 4: Usually, it can be divided into three different grades: 4a, 4b and 4c. The higher the grade, the greater the possibility of malignancy. Usually, the risk of malignancy for 4a is 5%-10%, 4b is 10%-70%, and 4c is more than 75%;

Level 5: Ultrasound examination basically believes that the thyroid nodule is malignant and the possibility of benign is very small;

Grade 6: Malignant thyroid nodules confirmed by pathology.

How to treat thyroid nodules

Generally, there are three treatment options for thyroid nodules: the first is follow-up observation. For small and asymptomatic benign nodules, regular follow-up examinations are recommended to observe changes in the nodules. The second is drug treatment. If the patient with thyroid nodules has thyroid dysfunction, drug treatment may be needed to adjust thyroid hormone levels. The third is surgical treatment. When the patient's nodules are large and compress surrounding tissues to cause symptoms, or are confirmed to be malignant by fine needle aspiration biopsy, surgical treatment is generally required. The determination of the surgical treatment plan requires comprehensive consideration of the patient's overall health, the pathological results of the thyroid nodules, and the patient's personal wishes.

In addition, ultrasound-guided puncture biopsy can show the location of the lesion very clearly, intuitively and accurately. After the location is clear, puncture biopsy can be performed. Puncture biopsy is basically the gold standard for diagnosis. The most accurate diagnosis is to completely remove the lesion through surgery and do gross pathology. However, ultrasound-guided puncture biopsy can avoid unnecessary surgery. If the biopsy pathology proves to be benign, or tends to be benign, it can be observed first.

Thyroid nodules are caused by a combination of factors

Generally speaking, both thyroid nodules and thyroid diseases are caused by a combination of factors. Although emotional fluctuations do not directly lead to thyroid nodules, long-term negative emotions, such as anger, anxiety, or depression, may indirectly affect the metabolism of the thyroid gland, especially for people who already have thyroid diseases. Negative emotions may become a factor that exacerbates the development of the disease. Therefore, patients with thyroid nodules should learn to manage their emotions and avoid excessive stress and negative emotions.

In daily life, patients with thyroid nodules should pay attention to the following points in their diet: First, iodine intake. Iodine is an important element for the synthesis of thyroid hormones. Appropriate iodine intake is essential for thyroid health, and excessive or insufficient iodine intake should be avoided; second, avoid irritating foods. Spicy, fried and other irritating foods may increase the burden on the thyroid gland and should be controlled in moderation; third, eat a balanced diet. Maintaining a balanced diet ensures that the body gets enough nutrition, which helps maintain the health of the thyroid gland.

Having thyroid nodules is not terrible, and it does not necessarily mean cancer. Therefore, we need to understand the relevant knowledge about thyroid nodules and maintain a healthy lifestyle. Through scientific examinations and reasonable treatment, most patients with thyroid nodules can be effectively managed and treated.

(The author is an associate chief physician of general surgery at the Third Medical Center of PLA General Hospital)