Risk Assessment And Study Of The Tranditional Chinese Medicine Syndrome About Thyroid Nodules In Adults

ObjectiveThe incidence of thyroid nodules,mainly given priority to with clinical follow-up and surgical treatment with an unsatisfactory prognosis,is increasing year by year.The standard management in patients with thyroid nodules is to assess the risk of malignancy,based on sex,age,clinical history,symptoms,biochemical indexes,patterns of ultrasound image and TCM syndromes,et al,which is also lack of an unified and valid criterion.Our study attempts to determine the effect of factors above on malignant risk of patients with thyroid nodules,and validate and improve the Adamczewski' s scoring system,which is do good to make a comprehensive and individualized integrated therapy.MethodsA cross-sectional survey was conducted to investigate the relationship between sex,age,clinical history,symptoms,laboratory indexes,patterns of ultrasound image,TCM syndromes and pathology of 313 thyroid nodules patient,using data from Traditional Chinese Medicine Hospital of Guangdong Province(including the institute and the 3 branches in Guangzhou)on inpatients matched the inclusion and exclusion during Jan 2013 to June 2014.Clinical datas were collected to establish database and processed in SPSS 17.0 software.ResultsThyroid nodules are more likely to occur in women with a male-to-female ratio of approximately 2:5,and the average age was 47.37±12.706 years.Radiation exposure,both family and personal history of malignant tumor and thyroid diseases,diabetes suggest the possibility of malignancy,so do irritating cough and voice changes.A high normal range TSH level and present of raised thyroid antibodies,that is TGAb and TPOAb,also prompt the risk of carcinomas.The corresponding ultrasound images of each lesion-performed in the course of preoperative diagnostics-were evaluated for the presence of ten different features,suggesting a malignant character of lesion,viz.a presence of pathologically altered lymph nodes(L),microcalcifications(C1),"taller-than-wide" orientation(0),the increased intranodular vascularity(V),hypoechogenicity(E),irregular margin(M),absence of halo(H),solid composition(C2),large size(a diameter longer than 3.0 cm,D),and multinodular(N).Phlegm is a vital component of nodules.Qi deficiency syndrome is more often appeared in the nonmalignant nodules,while Qi stagnation syndrome and blood stasis syndrome are more oft'en in male,while blood stasis syndrome is more often appeared in the malignant.Our study evaluated the Adamczewski' s scoring system,which can be also applied to better assessment of patients in our hospital,with a total score ranging from 0<2.5 points??2.5<3.5 points and ?3.5 points suggest a low,intermediate and high risk respectively.Accordingly,we establish a logistic regression equation help with clinical assessment of malignancy,which is "logit(P)=-2.842+1.749(family history of malignancy tumor)+3.300(personal history of malignant thyroid disease)+1.892(diabetes)+1.379(irritating cough)+0.945(voice changes)+0.483(TSH)-1.008(Qi deficiency syndrome)-1.213(N)+1.571(C2)+2.019(V)+2.817(M)+2.558(C2)-2.167(D)”with an accuracy of 87.9%.In Qi-deficiency-syndrome?Qi-Stagnation-syndrome?blood-stasis syndrome,the equations are logit(P)=31.928+3.190(TSH)-1.213(N)+37.762(V)+36.925(C2),logit(P)=-18.815+36.802(V)+72.321(C2)and logit(P)=-257.087+389.157(TSH)-311.72(N)+78.123(0)+633.755(V)-362.303(D)respectively.Among nodules of Qi stagnation syndrome,voice change was more than others.And a hig range level TSH was obvious in the blood-stasis and Qi stagnation.In ultrasound images,V is less appeared in the Qi deficiency,as well as C2.In Qi Stagnation,C1?V?E?M?H?C2 are commom,and V?E?C2?solitary nodules were more often seen in the blood stasis.TCM syndromes are associated with the Adamczewski' s scores.The Adamczewski' s score of the Qi deficiency is low while the Qi stagnation and the blood stasis are high.ConclusionFamily history of maligiant tumor,personal history of maligiant thyroid disease,diabetes,irritating cough,voice changes,a high normal range TSH level,patterns of ultrasound image,including C1,V,M,and C2,while Qi deficiency syndrome,multinodular and large size(a diameter longer than 3.0 cm)show protection.The logistic regression equation,taking TCM syndrome into consideration,makes an attempt of integrated traditional and Western medicine to assess the risk of malignancy.Comprehensive application of Adamczewski' s scoring system and logistic regression equation can help to develop optimal clinical decisions as regards the selection of treatment strategy,avoiding over-or undertreatment.