How big a thyroid nodule needs surgery? Malignant lesions require surgery

Thyroid nodules can be single or multiple. The incidence of multiple nodules is higher than that of single nodules, but the incidence of thyroid cancer in single nodules is higher. Thyroid nodules are complicated by various thyroid diseases, such as simple goiter, thyroiditis, thyroid tumors, etc. The nodules can be single or multiple, and can be clinically divided into benign and malignant. Benign thyroid nodules mainly include nodular goiter and thyroid adenoma; malignant thyroid nodules are mainly thyroid cancer, and also include thyroid lymphoma, metastatic tumors, etc.

1. How big a thyroid nodule is required for surgery?

If the thyroid nodule is benign, then surgical treatment is not required. If it can be confirmed to be a malignant mass after some examinations, then surgery is required no matter how small it is. The key is to look at the nature of the nodule. A thyroid iodine uptake rate test and a thyroid radionuclide development can be done to check the iodine uptake rate and metabolic rate.

2. Surgical treatment

Surgical treatment of thyroid cancer includes surgery on the thyroid gland itself and removal of the neck lymph nodes.

There is still disagreement on the extent of thyroid resection, and there is a lack of basis for the results of prospective randomized controlled trials. However, complete tumor resection is very important, and meta-analysis data suggest that whether the tumor is completely resected is an independent prognostic factor. In addition, the advantage of extensive surgery is a lower rate of local recurrence, and the main disadvantage is an increase in short-term or long-term complications after surgery. For patients in the high-risk group, it is appropriate to adopt near-total or subtotal resection of the affected lobe and the contralateral lobe. The operation can also be designed according to the clinical characteristics of the tumor: ?Lobectomy + isthmus resection is suitable for low-risk patients with tumors less than 1 cm in diameter and clearly confined to one lobe of the thyroid gland; ?Total thyroidectomy + isthmus resection + near-total thyroidectomy on the contralateral side is suitable for patients with tumors greater than 1 cm in diameter, more extensive unilateral papillary carcinoma with lymph node metastasis; ?Total thyroidectomy is suitable for highly invasive papillary and follicular carcinomas with obvious multifocality, enlarged lymph nodes on both sides, tumor invasion of surrounding neck tissues or distant metastasis. In cases under 15 years old or over 45 years old, the lymph node metastasis rate is high, reaching 90%. Total thyroidectomy should be considered for this group of cases.

The decision to perform prophylactic neck dissection is currently made with great caution. Especially for patients in the low-risk group, if no enlarged lymph nodes are felt during surgery, cervical lymph node dissection may not be performed. If enlarged lymph nodes are found, central neck lymph node dissection or modified neck lymph node dissection can be performed. Because central zone lymph node dissection during a second operation can easily damage the recurrent laryngeal nerve and parathyroid glands, some people advocate performing central zone dissection even if no enlarged lymph nodes are found during the first operation. For high-risk patients, those with visible cervical lymph node metastasis, tumor invasion outside the capsule, and those over 60 years old, modified cervical lymph node dissection should be performed. If the disease stage is late and the cervical lymph nodes are widely invaded, traditional lymph node dissection should be performed.

3. Diet for thyroid nodules

You should eat more foods that have the function of eliminating swelling, including water chestnuts, rapeseed, mustard, kiwi, etc.; it is best to eat more foods that can enhance immunity, such as shiitake mushrooms, mushrooms, fungus, walnuts, coix seeds, red dates, yam and fresh fruits. Eat more foods high in iodine, such as kelp, seaweed, hairy shellfish, scallops, jellyfish, sea cucumber, lobster, turtle, etc.