甲状腺结节怎样治疗方法

甲状腺结节如何治疗方法配图，仅供参考

Benign nodules
Benign thyroid nodules requiring treatment are rare. The most common are hyperfunctioning nodules and nodules whose growth is associated with compression of vital structures like the trachea or esophagus,general neck discomfort,and/or cosmetic problems—all of which can negatively impact quality of life. Surgery is an option in these cases,but there are also several nonsurgical,minimally invasive alternatives. These include US-guided ablation procedures involving percutaneous ethanol injection (the traditional method and currently the least expensive) or the application of heat in the form of laser,radiofrequency,high-intensity focused US,or microwave energy. Radiofrequency and laser ablations can significantly reduce nodule volumes ). As shown in [Table 2](https://ncbi.nlm.nih.gov/pmc/articles/PMC7365695/table/T2/) ),these techniques differ in terms of their indications,adverse effects,and associated costs. Hyperfunctioning nodules can also be treated with radioiodine.
High-intensity focused US is a newer needle-free technique that is producing promising results ),but it requires further clinical validation. More evidence and experience are also needed before microwave ablation is used on a large-scale basis. The use of these techniques for the treatment for symptomatic benign nodules has been addressed by several groups of experts ). In general,consensus statements by these groups list US-guided aspiration as the first-line treatment for cystic or predominantly cystic nodules. Ethanol injection can be used for recurrences,and thermal ablation techniques are reserved for cases in which symptoms persist after ethanol. Thermal ablation can be used for nodules that are predominantly solid and/or growing,but only after the benign nature of the lesion has been confirmed with 2 serial FNABs and serum calcitonin assessment. For nodules with lower risk features on US or autonomously functioning lesions,a single aspirate with benign cytology is sufficient ). The clinical and US-based follow-up of benign nodules that undergo treatment require expert clinical and US evaluation,because the morphologic features may change over time. If regrowth occurs,a new cytological assessment is indicated.
When surgery is indicated,decisions on the extent of resection will depend on multiple factors,including symptoms,the presence of contralateral nodules,thyroid functional status,comorbidities,family history,surgical risk,and patient preferences ). Common reasons for surgery are large goiters,local compressive symptoms or progressive nodule or thyroid enlargement,or large toxic multinodular goiters. In most patients with multiple nodules,both lobes of the gland are involved and total thyroidectomy is necessary. Consensus is lacking on the procedure of choice for patients with an asymmetric nodular goiter. In some cases,lobectomy can be considered as a safer alternative to total thyroidectomy. However,it requires long-term follow-up,is associated with nodule recurrence risk ),and may subsequently require a second operation ).","department":"