ObjectiveTo investigate the adequate surgical procedures for well-differentiated thyroid cancer (WDTC) located in the isthmus.MethodsNineteen patients with WDTC located in the isthmus were identified with WDTC and managed by surgery in Department of General Surgery in Xuanwu Hospital of Capital University from Jun. 2013 to May. 2018.ResultsAmong the nineteen cases, fifteen patients had a solitary malignant nodule confined to the isthmus, four patients had malignant nodules located separately in the isthmus and unilateral lobe. One patient received extended isthmusectomy as well as relaryngeal and pretracheal lymphectomy; six patients received isthmusectomy with unilateral lobectomy and central compartment lymph node dissection of unilateral lobe; four patients received isthmusectomy with unilateral lobectomy and subtotal thyroidectomy on the other lobe as well as central compartment lymph node dissection of unilateral lobe; seven patients received total thyroidectomy or isthmusectomy with unilateral lobectomy and nearly total thyroidectomy on the other lobe, as well as central compartment lymph node dissection of both sides; one patient received total thyroidectomy and central compartment lymph node dissection of both sides, as well as lateral thyroid lymph node dissection of both sides. The median operative time was 126 minutes (67–313 minutes), the median intraoperative blood loss was 30 mL (10–85 mL), and the median hospital stay was 6 days (4–11 days). Hypocalcemia occurred in 12 patients. There were no complications of recurrent laryngeal nerve palsy or laryngeal nerve palsy occurred. All the nineteen patients were well followed. During the follow up period (14–69 months with median of 26 months), there were no complications of permanent hypoparathyroidism occurred, as well as the 5-year disease-specific survival rate and survival rate were both 100%.ConclusionsFor patients with well-differentiated thyroid cancer located in the isthmus with different diameters and sentinel node status, individualized surgical procedures should be adopted.
Objective To summarize the advanced researchs of autoimmune thyroid disease(ATD) complicated with differentiated thyroid cancer (DTC). Methods The related literatures about concurrent ATD and DTC were consulted and reviewed. Results Hashimoto diseas (HD) complicated with DTC at home and abroad were reported more and more, whether merging with HD or other ATD disease could affect the prognosis of papillary thyroid cancer (PTC) was a controversial topic. HD and DTC (mainly PTC) had some same epidemiological and molecular features. Conclusion Better understanding of clinical pathology and characteristic of DTC concurrent with ATD can provide some new insights to immunotherapy for DTC.
ObjectiveTo systematically evaluate the reliability and stability of transoral endoscopic thyroidectomy vestibular approach (TOETVA) and conventional open thyroidectomy (COT) in the treatment of differentiated thyroid cancer.MethodsThe clinical studies of TOETVA and COT in the treatment of differentiated thyroid cancer were retrieved from major databases including PubMed, Embase, Cochrane Library, Wanfang, and CNKI by computer. The search date ended on March 1, 2020. Two investigators screened the literatures strictly and extracted the data following the pre-defined inclusion and exclusion criteria, and then used RevMan 5.3 software for meta-analysis.ResultsA total of 7 studies including 1 465 patients were included in this meta-analysis. The results showed: compared with the COT group, the operation time of the TOETVA group was longer [WMD=35.18, P=0.000 1], and the number of lymph node dissections in the central area was larger [WMD=1.42, P=0.000 5]. But the intraoperative blood loss [WMD=–5.32, P=0.39], the length of hospital stay after operation [WMD=0.05, P=0.94], the incidences of transient recurrent laryngeal nerve palsy [OR=0.81, P=0.43], transient hypocalcemia [OR=0.55, P=0.35], permanent hypocalcemia [OR=0.39, P=0.22], permanent recurrent laryngeal nerve palsy [OR=1.34, P=0.73], and hematoma [OR=1.29, P=0.69] were not statistically significant between the two groups.ConclusionsTOETVA has a higher stability. Although the COT has a shorter operation time, the former has a higher central lymph node dissection rate, and there is no scar on the neck after surgery and no significant difference in the incidence of postoperative complications.
ObjectiveTo explore the significance of thyroglobulin in the evaluation of lymph node metastasis during the treatment and follow-up of differentiated thyroid carcinoma.MethodThe literatures about thyroid globulin evaluation of lymph node metastasis of differentiated thyroid carcinoma were collected through online database and summarized.ResultsThe determination of thyroglobulin played an important role in the perioperative evaluation of lymph node metastasis in patients with differentiated thyroid carcinoma, the guidance of postoperative radiotherapy for metastasis, and the monitoring of recurrence and metastasis, and thyroglobulin combined with imaging examination could improve its evaluation efficiency.ConclusionsThyroglobulin is an important marker for the evaluation of lymph node metastasis in the treatment and follow-up of differentiated thyroid carcinoma. Combination between thyroglobulin and imaging examination or other laboratory indicators to comprehensively explore its diagnostic threshold is a new idea, that can improve its value in the evaluation of lymph node metastasis.
ObjectiveIn order to improve the levels of clinical diagnosis and treatment of differentiated thyroid cancer, the research status and progress of blood markers of differentiated thyroid cancer in recent years were reviewed.MethodThe literatures about blood markers and liquid biopsy of differentiated thyroid cancer at home and abroad in recent years were searched and summarized.ResultsThyroglobulin and thyroglobulin antibody were the most commonly used for markers of differentiated thyroid cancer. The application value of blood markers such as microRNA and long non-coding RNA in the diagnosis, treatment and follow-up of differentiated thyroid cancer had also been found.ConclusionBecause of the advantages of high specificity, high sensitivity, and no-invasion, blood markers are useful indicators to help improve the diagnosis of thyroid cancer patients and monitor the disease progression and recurrence in the future.
Objective To analyze clinical features of reoperation patients with differentiated thyroid cancer, and to explore reason, surgical pattern and therapeutic effectiveness of reoperation. Method The clinical data of 80 patients with differentiated thyroid cancer underwent reoperation from January 2012 to June 2016 in Peking Union Medical College Hospital were analyzed retrospectively. Results ① Eighty (5.37%) patients with differentiated thyroid cancer underwent reoperation were identified from a total of 1 491 patients with thyroid cancer in our treatment team. Twenty-seven cases were males, 53 cases were females. The male to female ratio was 1∶1.96. The age was (44±13) years with a range from 14 to 66 years. The median time between reoperation and the first operation was 16.8 months with a range from 8 days to 17 years. ② Thirteen cases underwent reoperation because of uncertain frozen sections, and the reoperation style was residual lobectomy and selective lymph node dissection. Sixty-seven cases underwent reoperation because of local recurrence or metastasis, 15 of them accepted residual lobectomy and selective lymph node dissection while the other 52 accepted selective lymph node dissection. ③ The rate of residual in thyroid cancer confirmed by postoperative pathology was 18.8% (15/80). The rate of cervical lymph node metastasis was 63.8% (51/80). The temporary laryngeal recurrent nerve injury occured in 6 cases, the temporary hypocalcemia occured in 9 cases, and the lymphorrhagia occured in 2 cases. ④ The hospitalization time was (6.50±0.97) d with a range from 3 to10 d, the time of drainage tube remove was (2.41 ±0.95) d with a range from 2 to 7 d. Seventy-three cases were followed up from 3 to 58 months with (32±18) months, 4 of them underwent operation once again because of local recurrence, no distant metastasis or death happened. ⑤ The proportion of male patients in reoperation patients was significantly higher than that of the first operation patients (P<0.05). The proportion of patients aged <45 years, the average hospitalization time, the average time of drainage tube remove, and the postoperative complications rate had no significant differences between the patients with the first operation and the patients with reoperation (P>0.05). Conclusions For reoperation patients, proportion of male patients is higher. Reoperation is proper treatment for patients with residual lobe or local recurrence or metastasis for differentiated thyroid cancer. Serious complications could be avoided by suitable surgical pattern and careful dissection during operation. Residual lobectomy and selective lymph node dissection are suggested for reoperation.
In response to the “Healthy China 2030” strategy, the General Surgery Quality Control Center of Sichuan Province and the Thyroid Surgery Innovation and Transformation Branch of Sichuan Medical Science and Technology Innovation Association, jointly established 18 quality control (QC) nodes. This framework integrates evidence from many major domestic and international guidelines/consensus and regional clinical QC practices in Western China. The system encompasses three core dimensions: diagnostic logic accuracy (e.g., TQC-01 for targeted screening to avoid over diagnosis by specifying high-risk ultrasonography indications); evidence-based treatment hierarchy (e.g., TQC-06/TQC-08 standardizing staging protocols for surgical indications); treatment outcome optimization (e.g., TQC-17 for long-term quality-of-life tracking). A four-phase closed-loop management structure is implemented. Screening intervention: imaging restricted to high-risk populations. Standardized diagnosis: initial nodule evaluation with serological testing (TQC-02) and pathological verification (TQC-04). Treatment protocolization: stratified execution of surgery/ablation indications (TQC-10). Dynamic prognosis monitoring: 10-year survival tracking post-differentiated thyroid cancer surgery (TQC-17) and multidimensional ablation efficacy assessment (TQC-16). Under the collaborative governance of regional leading institutions, this framework has demonstrated significant impact: reduction of low-value care (e.g., avoidance of non-indicated biopsy for suspicious lesion <1 cm), elimination of critical process omissions (including mandatory TNM staging compliance), and advancement toward regional healthcare quality homogenization. These contributions establish a replicable paradigm for enhancing China’s national thyroid disease clinical quality ecosystem.
Objective To explore the progress of diagnosis and treatment for differentiated thyroid carcinoma （DTC） in pregnancy. Methods The literatures on studying the diagnosis and treatment of DTC in pregnancy were reviewed and analyzed retrospectively. Results Radionuclide scanning and radioiodine （131I） administration during pregnancy were contraindicated. Surgery during the second trimester was considered safe. Monitoring of pregnancy must be strict during each trimester if surgery was delayed until after delivery. Conclusions Pregnancy makes the diagnosis and treatment of DTC become more complicated，the diagnosis and treatment of DTC during pregnancy present a challenging situation for the endocrinologists，surgeon，and obstetrician.
Objective To explore the reoperative techniques of differentiated thyroid carcinoma. Methods Clinical data of 56 patients who treated in The First Affiliated Hospital of General Hospital of PLA and General Hospital of PLA from Feb. 2011 to Feb. 2013 were analyzed retrospectively. Results All performed surgeries were successful. Surgeries took 90-150 minutes with an average of 120 minutes. Bleeding during surgeries was 70-200 mL with an average of 120 mL. Postoperative drainage was 90-210 mL with an average of 100 mL. The pathological diagnosis of the second surgery in 44 cases were as the same as the first， but there were no malignant tumor tissues of dissected glands in 12 cases. All patients had no postoperative bleeding and bucking， but 8 patients experienced hand and foot numbness， and 5 patientsexperienced transient hoarseness. Fifty patients were followed-up for 6-30 months （average 10.8 months） from the reoper-taion and 18-66 months （average 45.2 months） from the first operation， and rate of postoperative followed-up was 89.3%（50/56）. During the followed-up， 1 patient with papillary thyroid carcinoma and 1 patient with follicular thyroid carcinoma died in 44 months and 38 months respectively， 3 patients suffered lymph node metastasis at non-Ⅵ region ofaffected side， no one suffered recurrence. Conclusions For differentiated thyroid carcinoma patients who are undergoingthe second surgery， thorough whole body condition analysis should be performed and appropriate type of surgery should be chosen. By using recurrent laryngeal nerve monitoring， carbon nanoparticles for lymph node clearance， and protecting parathyroid gland to lower the possibility of postoperative complication， to improve survival rate and life quality.
ObjectiveTo explore the application value of carbon nanoparticles during radical operation of differentiated thyroid cancer (DTC).MethodsThe DTC patients underwent total thyroidectomy plus neck lymph node (area Ⅳ) dissection from September 2017 to September 2019 in this hospital were retrospectively collected, who were divided into observation group and control group according to using carbon nanoparticles or not during the operation. The operation related informations [operation time, intraoperative blood loss, total drainage volume on day 3 after operation, postoperative hospitalization time, number of lymph nodes dissection (area Ⅳ), lymph node metastasis rate, and rate of parathyroid glands resected by mistake during operation] and blood calcium (Ca2+) level and parathyroid hormone (PTH) level before and after (24 h and 1 month) operation were compared between the two groups.ResultsA total of 134 patients with DTC were collected, including 76 patients in the observation group and 58 patients in the control group. There were no significant differences in baseline data such as gender, age, etc. between the two groups (P>0.05). Although there were no significant differences in terms of operation time, intraoperative blood loss, total drainage volume on day 3 after operation, postoperative hospitalization time, lymph node metastasis rate between the two groups (P>0.05), the numbers of lymph node dissection and metastasis (area Ⅳ) were more and rate of parathyroid glands resected by mistake during operation was lower in the observation group as compared with the control group (P<0.05). On hour 24 after operation, the levels of Ca2+ and PTH in the observation group were higher than those in the control group (P<0.05). On month 1 after operation, the PTH level in the observation group was still higher than that in the control group (P<0.05), but there was no significant difference in Ca2+ level between the two groups (P>0.05). ConclusionCarbon nanoparticles can better protect the function of parathyroid gland during radical operation of DTC and clean neck lymph nodes more thoroughly.