Should thyroid nodules be punctured?

Written by Hu Jian Zhuo
Nephrology and Endocrinology
Updated on September 18, 2024
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Thyroid fine needle aspiration is a reliable and highly valuable diagnostic method we use to distinguish between benign and malignant thyroid nodules. Generally, thyroid nodules with a diameter >1 cm are considered for fine needle aspiration. Fine needle aspiration is not routinely considered in the following situations: (1) The nodule has already been evaluated with a nuclear scan indicating a hyperfunctioning adenoma due to hyperthyroidism; (2) The nodule is purely cystic; (3) The nodule is highly suspected to be highly malignant. In cases where the nodules grow rapidly and significantly enlarge, causing compression of the surrounding trachea and symptoms such as breathing difficulties and hoarseness, these thyroid nodules requiring surgery do not necessitate further fine needle aspiration treatment.

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Written by Hu Jian Zhuo
Nephrology and Endocrinology
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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.

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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.

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Written by Gan Jun
Endocrinology
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Can thyroid nodules heal themselves?

Thyroid nodules cannot heal on their own, but with appropriate treatment, good recovery can be achieved. Thyroid nodules are a common clinical disease, with many causes. Nodules can be either solitary or multiple, and the incidence of multiple nodules is relatively higher. Regardless of the cause, thyroid nodules are more common in middle-aged women, with the most common symptoms including thyroid enlargement, neck discomfort, and localized thyroid pain. When people are diagnosed with thyroid nodules, there is no need to be overly worried. If the color ultrasound and thyroid function tests show no abnormalities, it is possible to observe the condition dynamically, with a follow-up check about once a year. If there is a high suspicion of malignant nodules, it is advisable to opt for early surgical removal, which typically yields very satisfactory results.

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Written by Hu Jian Zhuo
Nephrology and Endocrinology
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Thyroid nodule examination checks what

Generally, when thyroid nodules are detected, one should visit the hospital's breast and thyroid surgery department or the endocrinology department. If you find a thyroid nodule, you can consult a doctor and undergo some relevant tests based on your specific situation. Typically, the following tests are conducted: 1. Thyroid ultrasound: This can determine the size, number, location, texture, shape, and edges of the nodules, including whether there is calcification. It also examines the blood supply within the thyroid nodule, the relationship with surrounding tissues, and assesses whether there are lymph nodes in the neck and the nature of these lymph nodes. 2. Blood tests are needed to measure thyroid function, particularly the level of Thyroid Stimulating Hormone (TSH). Higher levels of TSH indicate that the thyroid nodule is more likely to be proliferative, and thus, the risk of thyroid cancer increases. In addition, Thyroglobulin (Tg) can be measured. Another measure is Serum Calcitonin (Ct). If serum calcitonin is > 100 pg/mL, medullary thyroid cancer should be highly considered, as these cancer cells can secrete large amounts of serum calcitonin, causing this marker to significantly increase. Nuclear isotope imaging is also performed. If the nodule is large and TSH levels are low, a thyroid radionuclide scan is conducted to see if the nodule is a hyperfunctioning adenoma. When necessary, a Fine Needle Aspiration Biopsy (FNAB) is also performed. Fine needle aspiration is an invasive test, but it is currently an important and most efficient method to assess the benign or malignant nature of the nodule. It is generally performed under ultrasound guidance.

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Written by Hu Jian Zhuo
Nephrology and Endocrinology
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Thyroid nodule biopsy pros and cons

Currently, thyroid nodule puncture is performed under ultrasound guidance, so it is relatively safe. Fine needle aspiration causes minimal damage to the thyroid and almost no complications occur. Generally speaking, the following few adverse reactions may occur: One is bleeding, because the thyroid is a blood-rich organ, so bleeding may occur post-puncture. It can be controlled by applying local pressure immediately after the puncture. The second is pain, which is generally mild and can be relieved within 1-2 days. The third is skin infection, which is more likely in patients who are obese, have numerous skin folds, and sweat easily. In such cases, antibiotic treatment may be necessary. The fourth is injury to the trachea and nerves, although this is very unlikely and typically resolves on its own.