Where to do acupuncture for thyroid nodules?

Written by Lin Xiang Dong
Endocrinology
Updated on September 25, 2024
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Thyroid nodules do not require acupuncture treatment. The vast majority of thyroid nodules are benign, with only a small portion, about 5%, being malignant. We generally determine the treatment approach based on whether the nodule is benign or malignant. For benign nodules, we typically follow up with observation, while malignant nodules require surgical treatment and oral medication, or Iodine-131 radiotherapy. The primary evaluation for distinguishing between benign and malignant nodules relies on the results of color Doppler ultrasound and the pathology results from thyroid fine-needle aspiration.

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Written by Zhang Jun Jun
Endocrinology
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"Malignant thyroid nodules" means what?

Thyroid nodules are assessed under ultrasound with a grading system, and if rated at level three or higher, they tend to be more likely to be malignant. The most common malignancy in thyroid nodules is thyroid cancer. Among all types of tumors, thyroid cancer tends to grow slowly and is relatively less malignant. Therefore, if an ultrasound suggests a high likelihood of malignancy in a thyroid nodule, further examinations should be conducted. This can include a fine needle aspiration biopsy, thyroid contrast-enhanced ultrasound, or even direct surgical removal of the malignant nodule for further pathological examination to determine whether it is benign or malignant. Since the degree of malignancy of thyroid nodules is relatively low compared to other malignant tumors, a high grading score on a thyroid nodule should not be overly worrying. It is advisable to proceed with formal medical checks and regular follow-ups, as the five-year survival rate is quite high, exceeding 80%.

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Written by Hu Jian Zhuo
Nephrology and Endocrinology
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Is thyroid nodule ablation a good treatment?

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 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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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.