"Why not a thyroglossal duct cyst?" Nie Yuan thought for a while, and then asked, "The most likely misdiagnosis in clinical practice is this." ”

"Indeed, thyroglossal duct cysts, both in location and painlessness when touched, are similar to ectopic thyroid symptoms." Tao Le said, with a confident light on his face:

"But Mr. Nie, don't try to lead me astray - thyroid tongue duct cyst, it is a congenital disease caused by the degeneration of the thyroglossal duct, which can easily cause infection, but it has nothing to do with hypothyroidism."

If it was said that Nie Yuan's question just now was still of the nature of the school examination, a trace of competitiveness had already arisen at this time.

He studied pediatric endocrinology and worked in the clinic for many years, which is why he has today's clinical intuition.

But how old is this little girl, how can she do both Chinese and Western medicine, and in this endocrinology, the ability to combine theory with practice is so strong?

Naturally, he couldn't guess 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 comprehension, she has already completed the relevant knowledge and literature, and if she just relies on her mouth, she is afraid that he may not be able to catch up with herself.

"One last question." Nie Yuan asked: "Assuming that the child just now is really an ectopic thyroid gland, then this congenital disease should have been born at birth, why did it only grow a lump recently?" ”

Tao Le didn't bother to answer this time, and only said three words, which made Nie Yuan stop his mouth in a daze.

These three words are: adolescence.

The ectopic thyroid gland in the neck is mostly located on the submental thyrohyoid bone, and is generally asymptomatic in early childhood, and most of them are enlarged during adolescence and then discovered.

In Nie Yuan's heart, he was actually a little sad.

When he was tested by his tutor to this question, he was stammered and answered the wrong question, and was severely criticized.

Speaking of which, he was studying for a master's degree at that time, and he was one year older than Xiao Tao in front of him.

He closed his mouth and shouted the trumpet again with his head shut.

What's the matter with this patient, why didn't he come in all the time, so he could save Dr. Ben?

At about three o'clock in the afternoon, the pair of grandparents returned.

Nie Yuan looked at the inspection results one by one, and then handed them to Tao Le one by one.

The results of the thyroid test are the same as before, there is nothing to say, or the hypothyroidism is still the same.

MRI of the pituitary gland shows full pituitary morphology and a generally normal peak growth hormone provocation test—which excludes short stature due to growth hormone deficiency.

The superficial mass was reported by ultrasound results, and there was a solid nodule in the musculature layer of the anterior cervical region, and the blood flow signal was abundant—which meant that the mass was likely to be the thyroid gland in the wrong place.

But there are several types of ectopic thyroids. The first is the presence of the thyroid gland in the anteroposterior position, and as a result, another one grows elsewhere; The second type of ectopic thyroid gland itself is an extension of the orthotopic thyroid gland; The third type is completely ectopic, i.e., only ectopic thyroid.

The results of quiescent ECT of the thyroid gland reflect that the thyroid gland is not growing at all on both sides of the trachea; At the base of the tongue, nodular imaging agent distribution is enriched, which is considered to be ectopic thyroid tissue.

This proves that the mass born by Xiao Meixin is a completely ectopic thyroid gland.

About 30% of patients with an ectopic thyroid gland will have symptoms of hypothyroidism.

So that's why it's necessary to do static ECT.

In the case of the first two cases of the ectopic thyroid gland, the excess ectopic part can be surgically removed; However, if the patient has only one ectopic thyroid gland and is hastily removed during surgery – it is an iatrogenic accident.

There are a lot of inspection reports, and the time for Nie Yuan and Tao Le to read them is not short.

In the middle of this, the grandmother was obviously a little restless.

She naturally saw the results just now.

Even if she didn't understand it very well, she also saw that there was blood flow inside the lump as the results of the color ultrasound said.

If there is blood flowing in the lump, it can't be a good thing. This kind of common sense, she has long understood in the neighbor's aunt's popular science exchange.

So at this moment, she was really a little worried.

It's just that the tests just done add up to nearly 2,000 yuan.

And that's just a preliminary check. If I think about it, if I have surgery and hospitalization, plus the later medication and maintenance, I don't know how much it will cost.

By the way, maybe there will be chemoradiotherapy.

She and her husband have a pension, which adds up to more than 4,000 a month, and they are well fed and clothed in this cloud city.

I really didn't expect this child to have such a serious illness.

But no matter what, Mei Xin grew up watching her own family, and no matter how much money she spends, she has to be treated.

There are more than 200,000 savings at home, which were originally used by their old couple for the elderly, but they have to be taken out this time.

By the way, I have to tell my daughter quickly so that she and her husband can also raise money.

After a while, countless thoughts had already turned through her mind.

"Doctor, look at this thing, what stage is it progressing, and it needs to be operated on immediately, right?" She asked tremblingly.

Nie Yuan glanced up at her and replied, "This disease, there is no need for surgery." ”

Isn't it useless, if you cut this only thyroid gland for someone else, then how can it work?

Unexpectedly, such a simple sentence made my grandmother's heart turn over again.

What does the doctor mean by that? It can't be what I thought, and I don't even have a chance to operate, right?

Just now, I was worried about spending a lot of money, but now I'm afraid I won't be able to do it. How old is Xiao Meixin, there shouldn't be no chance.

It's all my fault, I didn't take it seriously before, if only I had brought her to the hospital earlier

After a few seconds, my grandmother's eyes turned red and tears were in her eyes.

When Tao Le saw it, he was immediately startled.

"Auntie, don't get me wrong. Director Nie said that this disease is not serious, there is no need for surgery at all, and it can be improved by taking some medicine. ”

Nie Yuan nodded helplessly. He couldn't imagine that the brain circuit of the aunt in front of him had turned to the advanced stage of the tumor.

"Not serious?" Grandma stood dumbfounded, and looked at her granddaughter again.

Since the results of the examination came out, Meixin's children saw their grandmother's serious face, and they were also very uneasy.

At this time, I heard the doctor say that it was not serious, and she let out a breath of tightness.

"The child was born with hypothyroidism. The cause is an ectopic thyroid. Nie Yuan said in his deep and credible voice, "This is the reason why the child is shorter than children of the same age. ”

My grandmother didn't know much about endocrinology. She was obsessed with the lump: "Then this lump, don't you need to cut it?" ”

"That's the child's thyroid gland, you can't cut it." Nie Yuan said: "I'll prescribe some medicine and take it for a while, maybe it will shrink on its own." ”

He gave a prescription, and Tao Le typed it out and handed it to his grandmother.

"I'll come back in three weeks to check my nail skills. That lump, when it grows up, if it does not atrophy and affects the appearance, you can choose to transplant it elsewhere at that time. Nie Yuan instructed.

Grandma looked at the list in her hand, just a medicine, and took one tablet every morning.

"It's that simple? You don't need to be hospitalized, you don't need to hang a bottle, just take some medicine? "Grandma was a little incredulous.

The previous set of examinations was as fierce as a tiger, and it fell into the drizzle of treatment. She felt that the strength she had held back for so long was all in vain.

Tao Le showed a big smile: "Yes, as long as the previous examination is in place and the symptoms are judged correctly, the treatment is sometimes so simple." ”

"Ah, well, thank you, doctor!" Grandma happily took Xiao Meixin and went out to pay the fee.

"Twenty-seven dollars and eight anise."

"So cheap?"

Indeed, this levothyroxine sodium tablet is really inexpensive, and a box of 100 tablets can be eaten for a long time.

(End of chapter)