甲状腺结节（thyroid nodule）良恶性鉴别治疗

    <P> western overview of thyroid nodules ( thyroid nodule ) is one of the most common diseases of thyroid gland, can manifest in a variety of thyroid disease, including thyroid degeneration, inflammatory, autoimmune thyroid disease, injury and new biological and other lesions. In recent years, more than half of adults demonstrate goiter associated with sarcoidosis, autopsy also found histologically non invasive micro malignant tumor incidence as high as 17%, while the clinical thyroid cancer incidence number is much less than this number. Therefore, emphasis should be placed on correct understanding of nodules, especially to distinguish benign from malignant nodules, on the. Benign and malignant most, less than 1%. On the basis of nodule etiology can be divided into: simple goiter, nodular goiter, inflammatory nodules, toxic multinodular goiter, thyroid cyst, thyroid adenoma, thyroid tumor. According to traditional Chinese medicine of clinical manifestations of the disease, such as neck masses, bilge frowsty, pharyngeal occlusion of the neck, or accompanied by hoarseness, belongs to traditional Chinese medicine " gall " disease category. Nodules are varied, be clinically distinguished nodules as benign or malignant, sometimes quite difficult. As a result of cancer incidence in a single nodular goiter than multinodular goiter is high. There are reports of up to approximately 10% of the single nodule for cancer, therefore, a single nodule who is, should be 杭州那家医院看甲状腺比较好to make preventive operation excision, in order to avoid missed diagnosis or delayed diagnosis in thyroid carcinoma. Also have opposite opinion, arguing that since benign nodules than malignant nodules found, shall first give inhibiting amount of thyroid stem preparation treatment, after some time, such as sarcoidosis does not significantly reduce, or continue to grow, making operation resection. Most scholars believe that this simple approach is not appropriate, should be based on the patient's specific circumstances, to make a specific analysis, and then according to the circumstances given different treatments, such as nodules hard, irregular, fast growth, significant for cancer manifestation, and early operation should be resected, the single " cold " nodules, cancer rate is higher, if the nodule is hard, fixed or thyroid hormone suppressive therapy without narrowing, instead of increasing, appropriate to operation therapy; single " hot " nodules, generally without cancer, should first make Department of internal medicine treatment. Clinical differential diagnosis of thyroid nodule, good, evil, the following points of reference: 1 age and sex, thyroid cancer can occur at any age, but is more common in older people, the incidence of more women than men; 2 of thyroid cancer incidence, far more than in a single nodule of thyroid nodular swollen see; 3 one is soft, smooth, movable nodules, mostly benign ( undifferentiated carcinoma such as necrosis or hemorrhage, which can be quite soft ). A rigid, fixed, painless nodule, when the chance of malignancy in ( but there are exceptions ); 4 calcified nodules, the possibility of carcinoma of small 杭州那个医院治疗甲减最好 (note! Medullary carcinoma occurring calcification ); 5 fast growing nodules suggestive for cancer, but the rapid growth with pain thyroid adenoma internal bleeding or acute thyroiditis, rather than the cancer. 6 thyroid goiter, while adjacent cervical lymph node enlargement, should be considered for cancer. By 7 enough thyroid stem agents inhibit treatment for 2 to 4 months, nodules without significantly reduced or increased, should be considered for cancer. 8 thyroid nodules caused significant compression symptoms or hoarseness, should make operation treatment. In 9 thyroid scan a single " hot " nodules, often benign concomitant with hyperthyroidism; " warm " nodules in benign tumors, but as a result of the imaging equipment resolution of the impact or the surface of a normal thyroid tissue cover. A very small, no oxygen iodine 131 functions of " cold " nodules, in imaging will sometimes display " temperature " nodules, resulting in a false impression, the analysis results, should pay attention to. The single " cold " nodules, a cancer may, but is not necessarily cancer. If the nodule occurring within the bleeding, cystic changes, but also for the " cold " nodules. Thyroid cancer is generally unlike normal thyroid tissue that can be concentrated 131 iodine thyroid scan, and often presents as low or no function of "warm " or " cold " nodules, but very few due to thyroid cancer can occur in high functional nodules, therefore, the presence of high functional nodules, and cannot completely except the probability of malignancy. 10 other special examination of serum calcitonin increased, common in medullary carcinoma; thyroglobulin and microsomal antibody titers increased resistance to the diagnosis of chronic lymphocytic thyroiditis, with relative specificity. The other is an ultrasonic imaging, carcinoma of the thyroid scintigraphy ( such as 201TL, 99mTc-V-DMSA ); serum 杭州那个医院治疗甲亢病最好 thyroglobulin ( thyroglobu-lin, TG ) RIA in the diagnosis of thyroid cancer metastasis has important reference value. 11 fine needle aspiration cytology of thyroid helps solitary and benign thyroid nodules, malignant differential, especially helpful for chronic lymphocytic thyroiditis. Surgical treatment for solitary nodule for solitary nodule, domestic and international most hospital claims operation treatment, is generally believed that the people should be treated early operation. Cyclophos phamide except cancer nodules;②fine needle aspiration cytological or histological examination revealed that the cancer cell or cancer tissue; the autonomy of high functional nodules;④compression symptoms; the latter the sternum; the diameter of more than 3cm cystic nodule; the recent rapid growth; with the whole body symptom. For the vast majority of solitary thyroid nodules diseases side row glandular lobe resection, the effect of good. For multiple nodules in the surgical treatment of thyroid nodules multiple goitre-endemic District, very few for multifocal adenocarcinoma or cancer nodules. For this kind of patient advocate follow-up observation, and taking the iodine and thyroid preparations from 6 months to 1 years. Only appears when the following conditions shall consider operation treatment. The compression of the trachea, esophagus or recurrent laryngeal nerve caused by clinical symptoms;②substernal goiter;③the progressive increase influence life and workers; the secondary hyperthyroidism;⑤suspected malignant transformation; the thyroid autoantibody positivity. For unilateral should be ill side lobe resection, bilateral underwent bilateral gland lobe resection. Should be resected without function or has lost its normal structure or deterioration of the nodules, but try to retain the normal thyroid tissue, preferably a residual thyroid tissue aggregates > 20g. </P>