Are thyroid nodules serious?

Written by Hu Jian Zhuo
Nephrology and Endocrinology
Updated on September 29, 2024
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The severity of thyroid nodules needs to be assessed based on their nature, size, function, and location. Generally, they can be classified into benign and malignant, with malignant nodules being thyroid cancer, which requires timely treatment. Surgical treatment is the main method for treating thyroid cancer, whereas most benign nodules do not require special handling. Regarding the size of the thyroid nodules, if the nodules are too large and compress surrounding tissues such as the trachea, esophagus, and nerves, surgical treatment is recommended. For common benign nodules, regular observation is sufficient. Functionally, some thyroid nodules may affect thyroid function, such as in Hashimoto's thyroiditis, which can present with diffuse multiple nodules, leading to either hyperthyroidism or hypothyroidism. In such cases, appropriate medication treatment is needed. From a positional perspective, ectopic growth of thyroid nodules, if located at areas like the base of the ear, pharynx, neck, esophagus, or thoracic cavity, is a rare congenital developmental anomaly. If such a nodule significantly enlarges and compresses surrounding tissues, surgical treatment is advised.

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Written by Hu Jian Zhuo
Nephrology and Endocrinology
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Are thyroid nodules serious?

The severity of thyroid nodules needs to be assessed based on their nature, size, function, and location. Generally, they can be classified into benign and malignant, with malignant nodules being thyroid cancer, which requires timely treatment. Surgical treatment is the main method for treating thyroid cancer, whereas most benign nodules do not require special handling. Regarding the size of the thyroid nodules, if the nodules are too large and compress surrounding tissues such as the trachea, esophagus, and nerves, surgical treatment is recommended. For common benign nodules, regular observation is sufficient. Functionally, some thyroid nodules may affect thyroid function, such as in Hashimoto's thyroiditis, which can present with diffuse multiple nodules, leading to either hyperthyroidism or hypothyroidism. In such cases, appropriate medication treatment is needed. From a positional perspective, ectopic growth of thyroid nodules, if located at areas like the base of the ear, pharynx, neck, esophagus, or thoracic cavity, is a rare congenital developmental anomaly. If such a nodule significantly enlarges and compresses surrounding tissues, surgical treatment is advised.

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Written by Hu Jian Zhuo
Nephrology and Endocrinology
1min 32sec home-news-image

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

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Written by Hu Jian Zhuo
Nephrology and Endocrinology
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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.

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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.

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What should I eat for thyroid nodules to dissipate?

Traditional Chinese Medicine (TCM) believes that thyroid nodules are mainly caused by emotional distress, dietary imbalances, and environmental maladjustment. Long-term emotions such as anger and depression can lead to stagnation of qi (vital energy), resulting in liver qi dysfunction and the formation of phlegm. Qi stagnation and phlegm accumulation in the front of the neck lead to the formation of this goiter. Therefore, the treatment for this condition often involves the use of foods or medications that soften hardness, disperse nodules, reduce swelling, and resolve stasis. For example, purslane, loofah, plums, and dried figs are some of the foods that can clear heat, facilitate diuresis, reduce swelling, and disperse nodules. Appropriate consumption of these foods can be beneficial in slowing the progression of the disease. However, it is generally difficult to dissolve nodules through diet alone, and active treatment is still necessary.