Thirty patients with heperthyroidism were investigated for triiodothyronine (T3), thyroxine (T4), thyroid stimulating hormone (TSH), thyromicrosome antibody (TMA), thyroglobulin antibody (TGA) and hydrocortisone before and after operation. The levels of serum T3, T4, TGA, TMA were markedly decreased after operation, and the level of hydrocortisone farther decreased from the preoperative low level. But only a little decrease in TSH level was found as compared with that before operation. The assay of these hormones and antibodies has very important clinical significance for judgement of the effect of operation and prevention of crisis of hyperthyroidism.
Objective To investigate the possible interaction between the ras and p53 genes overexpression in thyroid carcinoma, and whether there is correlation between the ras and p53 overexpression and clinico-pathological criteria. Methods Thyroid lesions from eighty patients were examined for expression of ras and p53 genes by the LSAB immunohistochemistic method. Of these patients, 54 were diagnosed as malignant lesions and 26 benign nodular thyroid disorders. Results The positive immunostain rate for ras and p53 genes was 90.7%, 23.0% and 55.5%, 30.7% in carcinoma and benign lesions respectively with statistically significance between thyroid carcinomas and benign disorders (Ｐ＜0.05). Both ras and p53 overexpressions coexisted in 30 thyroid carcinomas and follow-up showed that 3 of them died and 5 of them had recurrence within 4 years.Conclusion Activation of ras gene and inactivation of p53 gene are cooperatively associated in thyroid tumorigenesis. The concurrent overexpression of ras and p53 could result in a poor prognosis.
Objective To summarize the progress in the diagnosis and treatment of thyroid cancer related genes. Methods By using the method of literature review, The literatures of thyroid cancer related gene were reviewed on the study of emerging diagnosis and treatment strategy. Results Combined detection of BRAF oncogene, RAS oncogene, RET/PTC rearrangement, PAX8-PPARγ fusion gene and its related genes, can effectively improve the prediction accuracy of the malignant thyroid nodule form benign, and has become a basis of targeted drug therapy. Conclusion In preoperative thyroid cancer, Joint detection of related gene can provide a molecular basis for the patients to guide the operation and drug treatment.
Objective To evaluate the markers which contribute to diagnosis and prognosis of thyroid neoplasm. Methods The references about thyroid markers in recent years were reviewed. Results CD26 and galectin-3 could be regarded as a simple, potent markers to differentiate thyroid carcinoma in preoperative diagnosis, CD97 was a specific marker for undifferentiated thyroid carcinoma and its metastasis, CD15 and telomerase could be used in fine-needle aspirate biopsy (FNAB) of thyroid mass, and to improve its diagnostic evaluation, RET/PTC was mainly expressed in thyroid medullary carcinoma, oncofetal fibronectin (oncFN) was specific to papillary and anaplastic carcinoma, thyroid peroxidase was used to identify benign and malignant thyroid tumor. Conclusion Although there are a lot of markers for thyroid neoplasm, but there is no marker which are completely specific to certain histotype of thyroid neoplasm at present.
Some Chinese traditional medicines were found to inhibit rejection of graft. The antirejection effects of chuanxiong, LCH and HXI in thyroid allografts of rabbits were studied for selecting an immune depressor from Chinese traditional medicine with efficient and less sideeffect. The rabbits were divided into 5 groups in the study, with 7 in each group. Group I: The control group, no drug was used. Group II: dexamethason 0.25mg/kg/day, intramuscularly. Group III: chuanxiong water solution, 5g/kg/day, orally. Group Ⅳ： LCH water solution, 10g/kg/day, orally. Group Ⅴ： HXI water solution, 6g/kg/day, orally. The medication was given for 28 days. The grafted thyroids were removed for histopathological examination on the 28th day postoperatively and were scored and classified. The rejection and the survival of grafts were scored and classfied according to the La Rosa and Warrens criterion. The histopathological findings were as following: in Group I, follicles were badly damaged with much lymphocytes infiltration and fibrosis; in Gracup Ⅱ， two rabbits died, the other three showed damaged of the thyroid tissue and much lymphocytes infiltration; in group Ⅲ and Ⅴ, three cases showed damage of thyroid tissue, however, better revascularization was evident in Group Ⅲ; in Group Ⅳ, there was one case with much lymphocytes infiltration. It seemed that the degree of damage of grafts in the experimental groups was better than that in the control group, and had less lymphocytes infiltration, especially in Group Ⅳ. It was suggested that chuanxiong, LCH, HXI and dexamethason could protect the grafted thyroid, but the sideeffect of dexamethason was more than the other three. The antirejection of LCH was the best of the three. It was worth doing more research. HXI.
ObjectiveTo review the recent progress of the molecular targeted therapy for thyroid cancer. MethodsThe literatures of molecular etiology for thyroid cancer, mechanism and evaluation of targeted therapy via Medline and CHKD database were reviewed. ResultsSo far, four molecular targeted drugs (Sorafenib, Lenvatinib, Vandetanib, and Cabozantinib) have been approved for treatment of advanced thyroid cancer by FDA. They can mainly improve the patient's progression-free survival. Besides, several new molecular targeted drugs have accomplishedⅠphase or Ⅱ phase clinical trials. These drugs may be new options for treatment of advanced thyroid cancer in the future. ConclusionsMolecular targeted drugs have been the main therapeutic method for advanced thyroid cancer. However, we should invent more effective new drugs and investigate the drug combination to improve the therapeutic effect.
ObjectiveTo summarize and analyze the clinical characteristics of patients with thyroiditis who would be misdiagnosed with thyroid tumor easily. MethodThe clinical data of 19 patients with thyroiditis who were misdiag-nosed with thyroid tumor in our department from 2009 to 2012 were analyzed retrospectively. ResultsAll of 19 patients underwent surgery, among which 8 cases were diagnosed with chronic lymphocytic thyroiditis after operation, 10 cases diagnosed with subacute thyroiditis, and 1 case diagnosed with suppurative thyroiditis.Different surgery program such as the biopsy or wedge resection was adopted to the subacute thyroiditis and the chronic lymphocytic thyroiditis respec-tively. ConclusionSometimes, it is very difficult to distinguish atypical thyroiditis from thyroid tumor so that we must pay attention to the patients who had nontumorous characteristics in order to decrease the misdiagnosis.
ObjectiveTo investigate the diagnosis, treatment, classification, and epidemiology of thyroid tuberculosis. MethodsA retrospective study of 5 cases of thyroid tuberculosis and a review of the literatures were analyzed, which related to the clinical characteristics, the gist of the diagnosis and treatment, the causes of misdiagnosis and the methods of operation. ResultsAll of the cases were misdiagnosed before operation. Two cases were diagnosed by the frozen sections during the operations and three cases were diagnosed by postoperative pathology. Subtotal resection or lobectomy and local excision (3 cases) were performed respectively. Debidement and anti-tuberculosis medicine were given locally in 2 unresectable cases. All patients underwent standard chemotherapy for 6－8 months after operations and recovered finally. Four cases were caseous necrosis, 1 case was hyperplasia, all of which were chronic infections thyroid tuberculosis, and no acute thyroid tuberculosis be found. No recurrence was found in the 2－15 years of follow-up. ConclusionsUsually, it is difficult to establish a definite preoperative diagnosis for thyroid tuberculosis. Treatment, such as resection, debridement with local medication or systemic chemotherapy, shall be taken individually according to pathology types, focal features, and comorbidities. For hyperplasia cases, surgical resection shall be the best choice, while, for caseous necrosis cases, sometime difficult to remove, debridement with local medication may be suitable.
Objective To sum up experiences in diagnosis and treatment for thyroid malignancy. Methods Clinical records of 8 patients diagnosed as Hashimoto’s disease associated with thyroid malignancy by histologic examination at our hospital from Jan. 1998 to Dec. 1998 were analyzed. Results There were 1 male and 7 females with average age of 37.6 years. The incidence of Hashimoto’s disease associated with thyroid cancer and malignant lymphoma were 7.7% and 2.6%, respectively. No operative mortality and complication was found. Conclusion Hashimoto’s disease is not uncommon. The combined thyroid cancer is small with papillary carcinoma predominance and the prognosis is good. If it is complicated with malignant lymphoma, the thyroid is rapidly enlarged with pain and dyspnea.
Objective To explore the feasibility and safety of endoscopic thyroidectomy via chest-breast approachand summarize the operation skill. Method The clinical data of 40 cases performed endoscopic thyroidectomy via chest-breast approach from August 2010 to August 2012 in this hospital were analyzed retrospectively. Results The endoscopic thyroidectomies via chest-breast approach were successfully performed in all 40 patients without conversion to open surgery， massive haemorrhage， hypercapnia， severe subcutaneous emphysema， cutaneous necrosis on chest，permanent impairment of recurrent laryngeal nerve， and permanent hypoparathyroidism. One case of hoarseness was found on 2d after operation， who returned to normal after symptomatic treatment. One case of numbness in the extremitieshappened on day 2 after operation and the symptom was relieved through intravenous and oral administration of calcium treatment in 3d. One case of cutaneous tightness on chest happened， and it was spontaneous remission in a month. The operation time was （102±28.4） min （55-182 min）， intraoperative bleeding was （46±16.6） mL （30-106 mL）， and the drainage tube was removed postoperative 2-7d with an average （4±2.2） d， the postoperative hospitalization was 3-8 d with an average （4±1.1） d. All of the cases were followed-up after operation without low calcium， low parathyroid hormone， hoarseness， and local goiter recurrence. Two cases of hypoparathyroidism returned to normal after oral thyroxine dose adjustment. All the patients were satisfied with the cosmetic results. Conclusions The endoscopic thyroidectomy via chest-breast approach is safe and feasible with good cosmetic results. The subcutaneous Y tunnel， the “upper yellow middle white lower red” appearance on the chest， and the landmark of inverse trapezium on the neck are the key points for creation of operation compartment. Sufficient exposure， stepwise procedure， blunt dissection combined with sharp dissection in the precise gap are the surgical skills for endoscopic thyroidectomy.