Effects after thyroid nodule removal

Written by Hu Jian Zhuo
Nephrology and Endocrinology
Updated on September 13, 2024
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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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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.

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Written by Zhang Peng
General Surgery
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How long does thyroid nodule surgery take?

This depends on individual circumstances. Generally, when performing thyroid surgery, there are two methods: open and minimally invasive, though the treatment procedures are largely similar. For nodules, we first need to determine their nature. If they are benign, then removal within a certain range during surgery may suffice. However, if intraoperative freezing suggests malignancy, then we face the issue of lymph node dissection, which could significantly prolong the duration of the surgery.

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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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Should thyroid nodules be punctured?

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 Li Jin Quan
General Surgery
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How to Treat Calcification of Thyroid Nodules

In the treatment of thyroid nodule calcification, we generally decide based on the size of the calcification. Usually, larger calcifications have a lower malignancy rate. Such calcifications can continue to be observed. Depending on specific circumstances, a fine needle aspiration cytology test may be chosen. Depending on the results of the pathological examination after the aspiration, we decide the next treatment approach, whether to continue observation or proceed with surgery. The second type involves smaller calcifications, which relatively have a higher malignancy rate. Our preferred treatment is surgery. During the surgery, based on the medical examination results, if the nodule is malignant, we need to further devise other treatment plans, including expanded surgery, radiotherapy, etc.