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Hu Jian Zhuo
Nephrology and Endocrinology
About me
Hu Jianzhuo, associate chief physician and master supervisor. Deputy director of the Diabetes Specialty Committee of the Hunan Integrated Traditional Chinese and Western Medicine Association, and deputy director of the Endocrinology Specialty Committee of the Hunan Traditional Chinese Medicine Association. Expert in the technical guidance expert group for comprehensive prevention and control demonstration zones for chronic non-communicable diseases in Hunan Province. Leading one provincial-level project, participating in seven department-level research projects. Published over ten academic papers in national publications and contributed to two professional books. Specializes in integrated traditional Chinese and Western medicine treatment of diabetes and thyroid diseases.
Proficient in diseases
Combining traditional Chinese and Western medicine to treat diabetes and thyroid disorders
Voices
Effects after thyroid nodule removal
Thyroid surgery often leads to postoperative bleeding as a common complication. Bleeding may compress the trachea, causing difficulty in breathing. If a patient exhibits severe breathing difficulties along with significant bleeding from the drainage tube post-surgery, emergency hemostasis should be performed. Secondly, tracheomalacia. Long-term compression from the mass softens the tracheal wall, leading to a collapse due to inadequate support from surrounding tissues. Thus, after removing thyroid nodules, the thyroid and adjacent tissues fail to support the softened trachea, resulting in breathing difficulties. Thirdly, pharyngeal edema. During surgery, inflammatory stimulation can cause edema in the surrounding tissues, which may lead to difficulty in breathing. Therefore, after ruling out possibilities of postoperative bleeding, tracheomalacia, or vocal cord paralysis, pharyngeal edema should be considered. Nebulization therapy can be administered. Fourthly, vocal cord paralysis is common due to accidental damage to the recurrent laryngeal nerve during surgery, causing hoarseness. Generally, patients may gradually recover over three to six months, and symptoms can improve. The fifth effect is damage to the parathyroid glands. If the parathyroid glands are damaged, it may lead to abnormal blood calcium levels and symptoms of hypocalcemia, such as tetany and spasms. Most cases are due to vascular damage to the parathyroid glands resulting in temporary hypofunction, which often recovers shortly. The sixth possible outcome is a thyroid storm. Some patients with hyperthyroidism may experience a sudden release of large amounts of thyroid hormone into the bloodstream post-surgery, causing high fever, irregular heart rate, restlessness, nausea, vomiting, coma, and even death. The seventh effect is that removal of the thyroid gland leads to a deficiency in thyroid hormones, resulting in symptoms of hypothyroidism.
What is a thyroid nodule?
The thyroid is an endocrine gland located in the neck of the human body. If some abnormal nodules appear in it, they are referred to as thyroid nodules. Based on histological classification, they can be divided into follicular type, papillary type, and mixed type. A common characteristic of these types is that they generally appear as solitary nodules with a relatively complete capsule; the tumor cells differ from the surrounding thyroid tissue; and the cellular structure inside the tumor is relatively consistent. Generally speaking, middle-aged women are the demographic most prone to developing thyroid nodules.
Thyroid Nodule Classification Standard
To standardize the diagnosis of thyroid diseases, we have categorized thyroid nodules into six levels, with the severity and the likelihood of malignancy increasing with each level: Grade 1 refers to normal thyroid tissue; Grade 2 indicates benign changes in the thyroid, with the risk of malignancy increasing over time. For example, simple thyroid cysts, which require an ultrasound check every 1-2 years; Grade 3 refers to the presence of nodules in the thyroid with a malignancy possibility of
Do thyroid nodules require surgery?
Whether thyroid nodules require treatment generally depends on medical guidelines. Thyroid nodules larger than 1cm with malignant features typically require biopsy. The decision for a biopsy should be made by a professional ultrasonographer after examination. Therefore, upon detecting a nodule, it is crucial to visit a specialized hospital for further ultrasound examination. If the nodule is malignant, we recommend surgical removal. If it is benign, close observation is advisable. However, treatment is necessary under the following conditions: First, if the nodule is too large and compresses other organs, causing breathing difficulties, localized swelling, pain, or other discomforts. Second, if the nodule grows quickly, increasing in volume by more than 50% within six months, the possibility of malignancy should be considered and treatment is needed. Third, if the thyroid nodule is located behind the sternum, which is called an ectopic thyroid nodule, surgical treatment is necessary. If the thyroid nodule is large enough to affect the aesthetics of the neck, surgical treatment may also be considered.
Differentiation between benign and malignant thyroid nodules
Generally speaking, whether benign or malignant, thyroid nodules show blood flow signals. For benign nodules, blood flow signals can be seen around the perimeter, with internal blood flow no different from normal thyroid tissue. In such cases, the nodules are typically diagnosed as thyroid adenomas, and they usually appear round or oval in shape with a uniformly echoic internal substance. If liquefaction occurs, mixed or cystic changes can appear; the tumor’s capsule tends to be intact, with clear boundaries. If a nodule has abundant internal blood flow with disorganized vessel distribution and high flow velocity, showing a high-resistance flow pattern, and has relatively less peripheral blood flow, it generally needs to be assessed for thyroid cancer. These nodules are often hypoechoic with irregular shapes, and the ratio of their longitudinal to transverse diameter is greater than 1. They have unclear boundaries, lack a capsule, and have no halo. In typical cases, microcalcifications like sand grains can also be observed. From the above analysis, we can see that the blood flow signals in thyroid nodules are complicated and reflect the extent of the nodular pathology. These signals can help in differentiating benign from malignant nodules, but when a rich and disorganized blood flow is observed, the nodule is more likely to be malignant.
How to treat thyroid nodules?
Clinically, if a thyroid nodule is confirmed to be a benign tumor, generally speaking, if thyroid function is normal and the nodule is not large, urgent treatment is not necessary, and regular follow-up is sufficient. If the thyroid nodule significantly enlarges, causing compression of the trachea or nerves, surgery should be considered. Furthermore, for ectopic growth of thyroid tissue behind the sternum, surgical removal is also considered necessary. Another scenario that requires special mention is if a thyroid nodule grows rapidly in a short period and ultrasound suggests calcification or bleeding within the cyst, thyroid cancer should be suspected. In this case, it's advisable to have the nodule surgically removed.