Is thyroid nodule ablation a good treatment?

Written by Hu Jian Zhuo
Nephrology and Endocrinology
Updated on September 29, 2024
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Thyroid nodule ablation has its advantages over traditional surgery, but it also has its shortcomings. The advantages include minimal trauma, less bleeding, and less pain for the patient. Ablation involves inserting an ablation needle through the skin of the patient's neck, directly into the tumor to perform the ablation with the goal of eliminating the nodule. Since it does not require cutting, it reduces damage to surrounding tissues and bleeding, allowing the patient to resume activities earlier and reduce suffering. However, the drawback is that ablation is effective for smaller benign thyroid masses, but for complex or malignant thyroid nodules, the treatment effectiveness is poor, and its use is not advocated.

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Written by Hu Jian Zhuo
Nephrology and Endocrinology
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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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Written by Zhang Peng
General Surgery
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Thyroid nodule surgery risks

The hazards of thyroid surgery actually refer to the risks involved in thyroid surgery. Thyroid surgery is now a common treatment method. The main risks of thyroid surgery include anesthesia on one hand, and postoperative bleeding on the other. There might be a need for a second incision for decompression. The most common complications are choking while drinking water and hoarseness of voice, mainly due to the involvement or damage to relevant nerves during the surgery. Generally, these complications resolve after a period of adjustment, and most people can recover normally.

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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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Written by Hu Jian Zhuo
Nephrology and Endocrinology
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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.

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Written by Chen Xie
Endocrinology
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The difference between thyroid enlargement and thyroid nodules

Thyroid enlargement generally refers to simple thyroid enlargement, which is typically diffuse thyroid enlargement, mainly caused by iodine deficiency, commonly seen in endemic goiter and physiological thyroid enlargement. Thyroid nodules, on the other hand, are nodular hyperplasia of the thyroid caused by certain physical and chemical factors. Thyroid nodules can manifest as benign hyperplasia or malignant hyperplasia. Therefore, the risks associated with thyroid nodules are relatively greater than those of thyroid enlargement. However, some patients with thyroid enlargement, as the disease progresses, can develop nodular hyperplasia of the thyroid. These are the differences between the two.