"Why isn't it a thyroglossal duct cyst?" Nie Yuan thought for a while and then asked: "This is the most likely misdiagnosis in clinical practice."
"Indeed, thyroglossal duct cyst, both in terms of location and the lack of pain when touched, is similar to the symptoms of ectopic thyroid." Tao Le said, with a confident light on his face:
"But Teacher Nie, don't try to lead me astray - thyroglossal duct cyst is a congenital disease caused by incomplete degeneration of the thyroglossal duct. It can easily cause infection, but it has nothing to do with hypothyroidism."
If just now, Nie Yuan's questions were still in the nature of a school exam, now he has developed a sense of competitiveness.
He majored in pediatric endocrinology and worked in clinics for many years, which gave him the clinical intuition he has today.
But how old is this little girl? How can she be able to study both Chinese and Western medicine, and have such a strong ability to combine theory with practice in the subject of endocrinology?
Naturally, he would not have guessed that just last weekend, Tao Le's understanding of children's endocrinology was only general.
But from Monday to Friday, four nights have passed. With her current superhuman memory and understanding, she had already completed the relevant knowledge and documents, and even he himself might not be able to match it just by speaking.
"Last question." Nie Yuan asked: "Assuming that the child just now has an ectopic thyroid gland, then this congenital disease should be present at birth. Why did the mass develop recently?"
Tao Le didn't even bother to answer this time. He only said three words and Nie Yuan shut up angrily.
These three words are: adolescence.
Most ectopic thyroid glands in the neck are located on the submental thyrohyoid bone. They generally have no clinical symptoms in early childhood. Most of them only increase in size during adolescence and are then discovered.
Nie Yuan actually felt a little sad in his heart.
When he was asked this question by his tutor, he was speechless, answered incorrectly, and was severely punished.
Speaking of which, he was studying for a master's degree at that time and was one year older than the little Tao in front of him.
He closed his mouth and shouted the number again with his head down.
What's going on with this patient? He'd been called long ago, but why didn't he come in so that the doctor could save him?
At around three o'clock in the afternoon, the grandfather and grandson came back.
Nie Yuan looked at the test results one by one, and then handed them to Tao Le to read one by one.
The results of the thyroid function test are as before. There is nothing to say. Hypothyroidism remains the same.
Pituitary MRI showed that the pituitary gland was plump and the peak value of the growth hormone challenge test was basically normal - this ruled out short stature caused by growth hormone deficiency.
The color ultrasound results of the superficial tumor showed that there were solid nodules in the muscle tissue layer of the anterior neck area, and the blood flow signal was abundant - this meant that the mass was probably a thyroid gland that had grown in the wrong position.
But there are several types of ectopic thyroid. The first type is that there is a thyroid gland in the orthotopic position, but another one grows somewhere else; the second type is that the ectopic thyroid gland itself is an extension of the orthotopic thyroid gland; and the third type is completely ectopic, that is, there is only an ectopic thyroid gland. .
The static ECT results of the thyroid gland showed that there was no thyroid growth at all on both sides of the child's trachea. However, nodular imaging agent distribution thickening was seen at the base of the tongue, which was considered to be ectopic thyroid tissue.
This proves that the mass caused by Xiao Meixin is a completely ectopic thyroid gland.
About 30% of patients with ectopic thyroid will develop symptoms of hypothyroidism.
So this is why static ECT must be done.
If it is an ectopic thyroid in the first two cases, the excess ectopic part can be removed surgically; but if the patient only has a single ectopic thyroid and it is removed hastily during the operation - that is an iatrogenic accident.
There were a lot of inspection reports, and Nie Yuan and Tao Lechuan took a long time to read them.
During this time, the grandmother was obviously a little restless.
She had naturally read all the results just now in advance.
Even though she didn't quite understand, she saw on the color ultrasound results that there was blood flow inside the mass.
If there is blood flowing inside the lump, it is definitely not a good thing. She had already learned about this common sense from the neighbor's aunt's popular science exchanges.
So at this moment, she was really worried.
It’s just that the total of the various inspections just done was close to 2,000 yuan.
And this is just a preliminary inspection. I don't know how much it would cost to have another surgery, hospitalization, and subsequent medication and care.
By the way, maybe there will be radiotherapy and chemotherapy.
She and her husband have pensions, which add up to more than 4,000 a month, and they have enough food and clothing to live in Yun City.
I really didn't expect that this child could get such a serious disease.
But no matter what, Meixin was raised by her own family, so no matter how much money was spent, she had to be treated.
The family still has more than 200,000 yuan in savings, which was originally used for the old couple to support themselves in retirement, but this time they have to take out all of it.
By the way, I have to tell my daughter quickly so that she and her husband can also raise money.
In such a short time, countless thoughts had gone through her mind.
"Doctor, do you think this thing is at what stage of development? Does it require immediate surgery?" she asked tremblingly.
Nie Yuan looked up at her and replied, "There is no need for surgery for this disease."
Isn't it unnecessary? If the only thyroid gland is removed, how can it be done?
Unexpectedly, such a simple sentence would make grandma's heart turn upside down again.
What does the doctor mean by this? It can't be what I thought. I don't even have the chance for surgery, right?
Just now I was worried about spending too much money, but now I am worried about not being able to do it. Xiao Meixin is so young, she shouldn't have no chance.
It's all my fault. I didn't take her seriously before. It would have been better if I had brought her to the hospital earlier.
Within a few seconds, grandma's eyes were red and tears were in her eyes.
Tao Le was shocked when he saw it.
"Auntie, don't get me wrong. Director Nie said that the disease is not serious and does not require surgery at all. It can be improved by taking some medicine."
Nie Yuan nodded helplessly. He could not have imagined that the brain circuitry of the aunt in front of him had already reached the advanced stage of tumor.
"It's not serious?" Grandma stood blankly and looked at her granddaughter again.
Ever since the test results came out, Meixin's child saw her grandmother's serious face and felt very uneasy.
At this moment, she heard the doctor personally say that it was not serious, and she finally released the breath she was holding tightly.
"The child has congenital hypothyroidism. The cause is thyroid ectopy." Nie Yuan said in his deep and trustworthy voice: "This is why the child is shorter than other children of the same age."
Grandma doesn’t know much about endocrinology. She was obsessed with the lump: "So this lump doesn't need to be cut?"
"That is the child's thyroid gland, but it cannot be cut." Nie Yuan said, "I will prescribe some medicine and take it for a while. It may shrink on its own."
He wrote the prescription, Tao Le typed it out and handed it to grandma.
"Come back in three weeks for a re-examination of the nail function. When the mass grows up, if it does not shrink and affect the appearance, you can choose to transplant it elsewhere." Nie Yuan instructed.
Grandma looked at the list in her hand. It was just one medicine, and she took one pill every morning.
"It's so simple? No need to be hospitalized, no need to put in a sling, just take some medicine?" Grandma was a little unbelievable.
The previous set of examinations was as fierce as a tiger, but when it came to treatment, it was just drizzle. She felt that all the energy she had held in for so long was in vain.
Tao Le showed a big smile: "Yes, as long as the previous examination is in place and the disease is diagnosed correctly, the treatment is sometimes that simple."
"Ah, okay, thank you, doctor!" Grandma happily took Xiao Meixin and went out to pay the fee.
"Twenty-seven dollars and eight cents."
"so cheap?"
Indeed, this kind of levothyroxine tablets is really not expensive, and a box of 100 tablets can last you a long time.
(End of chapter)
