Treating the "heart" of the elderly: Don't ignore small thyroid nodules

Most people who discover thyroid nodules during physical examinations think that if the nodules are relatively small, no treatment is required. So, can all small nodules really be ignored?

Recently, an elderly patient, Aunt Yang, with a 10-year history of diabetes, was admitted to the Endocrinology Department of our hospital due to poor blood sugar control. During the physical examination, a low-echo nodule of about 0.48×0.42 cm was found in the middle of the left lobe of the thyroid gland, close to the trachea. The nodule had unclear boundaries, an aspect ratio >1, and no blood flow signal was seen inside (TI-RADS 4b category).

After consultation with the Department of Thyroid and Breast Surgery, it was recommended to perform fine needle aspiration of the thyroid gland. Fine needle aspiration of the left thyroid gland tumor was performed under ultrasound guidance in the Ultrasound Imaging Department. The puncture results showed that the microscopic morphology of the (left thyroid gland) was consistent with thyroid papillary carcinoma. There were surgical indications, and after completing preoperative examinations and excluding surgical contraindications, surgical treatment was performed on the second day. During the operation, it was found that the nodule in the middle of the left thyroid gland had adhered to the trachea. Bilateral thyroidectomy + recurrent laryngeal nerve exploration + central neck lymph node dissection were performed. Postoperative pathological examination showed that the (left) thyroid micropapillary carcinoma (tumor size 0.4cm×0.3cm×0.3cm) had invaded the trachea. Subsequently, iodine-131 treatment was performed in the Nuclear Medicine Department of our hospital.

A nodule less than 0.5 cm in size develops into thyroid cancer and invades the trachea. If it is not treated surgically in time, the scope of invasion will gradually increase and there will even be a risk of metastasis.

Thyroid nodules refer to one or more lumps of abnormal tissue structure in the thyroid gland due to various reasons. They are rarely found by clinical palpation and are mostly discovered through physical examination and color Doppler ultrasound. In fact, the incidence of thyroid nodules and even thyroid cancer is still very high. According to the National Cancer Center of the United States, up to 50%-60% of healthy people have thyroid nodules, but 5%-15% of thyroid nodules are at risk of malignant tumors. The above cases tell us that not all small thyroid nodules can be followed up regularly, so what situations should we pay attention to when small nodules are combined with?

Thyroid nodules show 4 or more categories and are combined with the following: 1. Extremely low echo; 2. Aspect ratio > 1; 3. Irregular edges; 4. Microcalcification; 5. Close to the thyroid capsule, trachea (or surrounding tissue).

Whether the thyroid nodules are benign or malignant, the early symptoms are not obvious. Therefore, routine physical examinations of thyroid nodules cannot be ignored. Once thyroid nodules are found, especially those of type 4 or above, regardless of size, it is necessary to seek diagnosis and treatment from a specialist, conduct an individualized assessment, and carry out targeted management and treatment.