Serum thyroglobulin in differentiated thyroid carcinoma

Serum thyroglobulin (S-Tg) concentrations were measured in 262 patients with differentiated thyroid carcinoma. Analysis of S-Tg with respect to histology showed that the follicular variety of carcinoma had the highest S-Tg values preoperatively and postoperatively when metastases were found. The S-Tg levels during thyroxine treatment accurately predicted the results of 131-I total body scan in all but two cases. In another patient both S-Tg and total body iodine scan were negative at the time when metastases were discovered at X-ray examination. All but two patients with negative scan had S-Tg less than 10 micrograms/l, whereas patients with metastases had values between 11 and greater than 5000 micrograms/l. In patients with residual thyroid bed uptake the S-Tg range was from less than 2 to 84 micrograms/l. The authors conclude that determination of the S-Tg level can replace total body iodine scan in most patients who have undergone ablative therapy for differentiated thyroid carcinoma.     

Lymphadenectomy in well differentiated thyroid carcinoma

In this review, the authors analyze, in relation to the data collected in other literature, the indications and the type of surgical procedure to perform on the neck lymph nodes in cases of differentiated thyroid carcinoma. The authors stress the fact that the surgical procedure must be determined according to the stage in which the diagnosis and prognostic factors are formed and in relation to the natural history of these tumors.     

分化型甲状腺癌的治疗

目的　为探讨分化型甲状腺癌的治疗方法。方法　对 173例分化型甲状腺癌患者的临床资料特别是治疗方法进行分析总结。结果　 173例患者均行手术切除 ,按照临床分期选择不同术式。术后辅以内分泌治疗。手术后出现神经损伤及其他手术并发症 3 0例 ,无手术死亡。随访期 5a以上者 91例 ,无死亡病例 ,但发生颈淋巴结转移 4例 ,胸骨转移 2例 ,肺转移 1例。结论　分化型甲状腺癌采用手术切除加内分泌治疗疗效颇佳。     

分化型甲状腺癌的近期再手术治疗

分化型甲状腺癌属于低度恶性肿瘤,早期无特异性表现,影像学检查亦很难诊断,临床上误诊、误治时有发生,以致需要再次手术治疗。今将我们收治27例分化型甲状腺癌行近期再次手术,现分析报告如下。1资料与方法1.1对象男10例,女17例,年龄19~64岁,平均35·6岁。外院首次手术22例,其中16例术前诊断为甲状腺瘤行患侧甲状腺叶肿瘤局部除术,6例术前行细针穿刺细胞学检查诊断为甲状腺癌中4例行患侧甲状腺叶次全切除,2例行患侧甲状腺叶加峡部切除术。我院首次手术5例,术中冰冻切片检查,4例报告为甲状腺瘤行患侧甲状腺叶肿瘤局部切除术,1例报告为结节性甲…     

Surgical treatment of differentiated thyroid carcinoma

Being the excellent prognosis, the extension of the thyroidectomy in the surgical management of differentiated thyroid carcinomas is still controversial: some authors recommend total thyroidectomy for all patients, others suggest a conservative approach, that guarantee the same good prognosis but is associated with fewer complications. Even the cervical lymph node dissection is discussed, both regarding to the indications and the extension. The authors reported a retrospective review of their experience of the last 10 years on 75 patients operated for differentiated thyroid cancer, 61 for papillary carcinoma and 14 for follicular carcinoma; 18 of them were men and 57 females, with a mean age of 48.2 years. We performed a total of 85 operations: 60 total thyroidectomy, 15 lobus-isthmusectomies and 10 completion thyroidectomy. Lymphadenectomy was performed in 17 patients with clinically or intraoperative evidence of enlarged lymph nodes. There was no surgical mortality. Permanent hypoparathyroidism occurred in 5 patients (5.8%) and permanent accidental laryngeal recurrent nerve injury, both monolateral, occurred in 2 cases (2.35%). The mean follow up was 53 months (4.5 years): 71 patients are still alive (94.7%), 68 of them disease free (90.6%) and 3 with recurrent disease (4%). Our results suggest that total thyroidectomy still represent the choice procedure for the treatment of differentiated carcinomas and that modified radical neck dissection is necessary in these patients with pre or intraoperative evidence of palpable lymph nodes. Some patients go well even undergoing more conservative surgery (lobectomy) but most problem is the impossibility to preoperatively identify these patients.     

Radioiodine therapy for differentiated thyroid carcinoma

Radioiodine (iodine 131) is an effective form of adjuvant therapy that is frequently underutilized. A review of our recent experience was undertaken to assess the role of this treatment modality in the routine management of thyroid carcinoma. Over a 2-year period, 29 patients received adjuvant iodine 131 therapy. Ten of these patients (35 percent) were found to have local or distant metastasis by iodine-131 scan, and 7 (24 percent) had a metastatic lesion not suspected by operative findings or chest radiography. A complete response was obtained in 70 percent of the patients with metastatic disease. This study supports more frequent use of adjuvant radioiodine therapy in the management of differentiated thyroid carcinoma.     

分化性甲状腺癌的外科治疗

分化性甲状腺癌（包括乳头状癌、滤泡样癌、Hürthle细胞癌）约占甲状腺癌的90%。该类甲状腺癌肿有恶性程度低、发病缓慢、病程长的临床特点,通过适当的治疗,与其他甲状腺肿瘤相比．其治疗效果好,病人生存期长。所以,对分化性甲状腺癌病人的治疗可根据其所处的不同病期采取不同的手术方式．目的是在最大程度根治肿瘤的基础上,尽可能保留病人的甲状腺功能,提高其生存质量,     

Completion thyroidectomy for differentiated thyroid carcinoma

Completion thyroidectomy is performed because of a deferred diagnosis of differentiated carcinoma of the thyroid or a significant thyroid remnant after initial operation. During a period of 6 years, data from 40 patients with differentiated thyroid carcinoma undergoing completion thyroidectomy were retrospectively reviewed. There were 4 men and 36 women (1:9), and the average age was 39.6 ± 1.9 years (range, 20 to 62 years). The indications for the initial surgery were a solitary thyroid nodule in 36 (90%) patients, multinodular goiter in 3 (7.5%) patients, and Graves’ disease in 1 (2.5%) patient. Three patients underwent completion thyroidectomy during the same hospital stay. In the remaining 37 patients, completion thyroidectomy was performed 4 to 252 days (44.1 ± 7.8 days) after the initial operation. The length of hospital stay for the initial operation was not different from that for completion thyroidectomy (5.1 ± 0.3 days vs. 5.2 ± 0.3 days). The length of time needed to accomplish the initial operation was not different from that required for the completion thyroidectomy (122 ± 7.5 minutes vs. 110.8 ± 5.9 minutes). There was no 30-day perioperative mortality. The postoperative morbidity in completion thyroidectomy consisted of transient hypoparathyroidism in 3 (7.5%) patients, permanent hypoparathyroidism in 1 (2.5%) patient, transient recurrent laryngeal nerve palsy in 1 (2.5%) patient, and permanent recurrent laryngeal nerve palsy in 1 (2.5%) patient. On the other hand, one transient recurrent laryngeal nerve palsy and one transient hypoparathyroidism occurred at the initial operation. Completion thyroidectomy is a safe procedure to remove the thyroid remnant. (Otolaryngol Head Neck Surg 1998;118:896-9.)     

Laryngeal involvement by differentiated thyroid carcinoma

BACKGROUND: Invasion of the larynx by differentiated thyroid gland carcinoma is uncommon but causes serious morbidity and mortality when present. METHODS: The clinicopathologic characteristics of 5 patients in which a total laryngectomy had to be performed for differentiated thyroid carcinoma are analyzed. Special reference is paid to the histologic intralaryngeal tumor spread, which is evaluated on whole-organ section. RESULTS: All patients presented with hoarseness and/or dyspnea. Two patients are alive at 44 and 115 months. One patient died of intercurrent disease 2 months and 2 patients with disease 6 and 14 months after surgery. In all cases, intralaryngeal tumor spread was observed. Invasion of the larynx occurs by direct extension or by posterior tumor growth around the edge of the thyroid cartilage. CONCLUSION: In rare cases, differentiated thyroid carcinoma can widely infiltrate the larynx, making total laryngectomy unavoidable. The diagnosis of intralaryngeal tumor spread is done by imaging and endoscopy.     

Unilateral versus bilateral thyroid resection in differentiated thyroid carcinoma.

Risk-group definitions have been developed recently in an attempt to clarify which operation to do for whom in differentiated thyroid carcinoma. The authors attempted to confirm the validity of an age-based risk-group definition for identifying patients at high risk of death from thyroid carcinoma and to test whether the degree of surgical resection in either high- or low-risk groups affected patient survival. An age-based risk-group definition was used in the retrospective analysis of 161 patients with differentiated thyroid carcinoma seen at the Saskatoon Cancer Centre, University of Saskatchewan, between 1933 and 1964. A significant difference was found in the death rate between low- and high-risk groups (4.3% versus 47% respectively). This confirms the validity of such an age-based risk-group definition. Although a long-term survival benefit was suggested with the use of bilateral thyroid resection in high-risk patients, the difference was not significant. In low-risk patients, there was no difference in the survival rate between patients who underwent unilateral or bilateral thyroid resection, followed up for as long as 55 years.     

低分化甲状腺癌治疗策略探讨

目的:对低分化甲状腺癌（poorly differentiated thyroid carcinoma,PDTC）的治疗策略进行探讨。方法:回顾性分析电子科技大学医学院附属肿瘤医院头颈外科中心2010年3月至2019年11月收治的31例PDTC患者,比较不同治疗方式对PDTC生存时间的影响,所有患者均接受手术治疗,术后...     

Lymph node dissection in non-medullary differentiated thyroid carcinoma

Papillary and follicular thyroid carcinomas are the most common form of endocrine carcinomas. Lymph node involvement seems to be a low risk factor for death, but it increases the risk for loco-regional recurrences and distant metastasis. The limits and the key points of the cervical lymph node dissection are described. The sentinel lymph node is used to rarely, so it could limit the lymph dissection. Node-picking has to be avoided. Central lymph node resection is recommended for high-risk patients, as male, patients more than 45 or less than 21 years old, papillary carcinomas greater than 1 cm or follicular carcinoma more than 2 cm in diameter. Lateral lymph node resection is performed when the lymph nodes of the central compartment are involved, more than 3 cm in diameter, and bulked. Prophylactic lymphadenectomy is useless. When thyroid carcinoma is known postoperatively, re-operation depends of the cervical mass and of the results of the radioactive iodine treatment.     

Conservative surgical treatment in differentiated thyroid carcinoma]

BACKGROUND: Purpose of the present study was to compare survival of patients affected by differentiated thyroid carcinoma after total and partial thyroidectomy. METHODS: The study has been carried in a retrospective way; mean follow-up has been 160 months. Surgical setting has been the Institute of Emergency Surgery at the University of Catania, where about 80 thyroid surgical procedures are performed every year. Patients have been divided into two groups: the first included 65 patients who underwent total thyroidectomy, while the second group included 67 patients who underwent partial thyroidectomy. Ten patients affected by a T3-T4, N0-N1 tumor were ruled out of the study to allow better uniformity of data. Besides early postoperative complications (recurrent nerve lesion, hypoparathyroidism), patients have been followed by periodic clinical and instrumental examinations. RESULTS: Follow-up has shown similar survival between patients treated by total thyroidectomy and those who underwent partial thyroidectomy (respectively 92.3% and 92.5%). Postoperative complications were instead significantly less in group 2. CONCLUSIONS: For patients affected by differentiated thyroid carcinoma at early stages it is suggested to perform a partial thyroidectomy since, compared to total thyroidectomy, a similar survival rate and a lower incidence of postoperative complications are obtained. According to personal opinion, total thyroidectomy should be performed in cases of thyroid carcinoma with vascular involvement and metastases.     

分化型甲状腺癌中VEGF的表达及意义

目的探讨血管内皮生长因子（vascular endothelial growth factor,VEGF）在分化型甲状腺癌中的表达及其与甲状腺癌临床病理特征之间的关系。方法采用免疫组化SP法检测57例分化型甲状腺癌、45例甲状腺良性病变和19例正常组织标本中的VEGF表达。结果VEGF在分化型甲状腺癌、甲状腺良性病变和正常甲状腺组织中的阳性表达率分别为86．9％、17．8％和10．5％,甲状腺癌中VEGF阳性表达与良性病变及正常组织相比差异均有统计学意义（P〈0．05）;VEGF强阳性表达在T3／T4、预后不良及复发组甲状腺癌中有更高的比例,差异有统计学意义（P〈0．05）。VEGF表达与预后指数呈正相关（r=0．320,P=0．015）。结论甲状腺组织中VEGF过表达可作为分化型甲状腺癌的一个辅助诊断和预后判断的指标,有助于预后不良的分化型甲状腺癌的筛选和鉴别。     

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分化型甲状腺癌(乳头状癌、滤泡癌)约占甲状腺癌的80％，由于生长缓慢，病期长，病人无任何不适，常在无意中或体检中被发现，多延误治疗时机，导致肿瘤难以彻底切除或复发转移，以及严重并发症，为进一步治疗带来困难。尽管如此，仍有一部分病人获得较其他恶性肿瘤好的疗效。由于这些特殊的临床表现，临床医师很难确切掌握其真实的病情进展及不同的外科治疗方式后的动态变化情况，这些因素制约了其正确评价疗效，从而造成了多年来在外科治疗原则上存在着一些意见分歧。本文就此问题谈谈看法，供同道们讨论。     

Risk group-based management of differentiated thyroid carcinoma

A number of controversies exist in the treatment of differentiated thyroid carcinoma with respect to the extent of surgery, use of radioactive iodine and post-operative thyroxine suppression. Recent recognition of prognostic factors has helped to assign patients, based on their risk profile, as being at high risk of developing recurrence. This has facilitated the development of a selective approach to therapy, thus, avoiding unnecessary treatment and reducing morbidity without compromising treatment outcome. This review attempts to evaluate the current concepts of management of differentiated thyroid carcinoma in the light of these new developments.     

Diagnosis and treatment of differentiated thyroid carcinoma

Thyroid cancer is the most common endocrine malignancy. More than 90% of primary thyroid cancers are differentiated papillary or follicular types. The prognosis for patients with differentiated thyroid carcinomas is favorable. Female gender and younger age (<50 years) are good prognostic factors. The diagnosis of papillary thyroid cancer is not difficult with ultrasonography and fine-needle aspiration cytology under ultrasonography, whereas that of follicular cancer is difficult, especially of minimally invasive follicular carcinoma. The diagnosis of most follicular cancer is made by pathologic diagnosis postoperatively. The primary treatment of differentiated thyroid carcinoma is thyroid surgery with lymph node dissection. The extent of resection of the thyroid gland depends on size the of the thyroid cancer and area of invasion. If a patient has distant metastasis, total thyroideectomy and radioactive iodine ablation therapy, followed by L-thyroxine therapy, should be offered. The extent of initial surgery, indications for radioiodine ablation therapy, and the degree of thyroid-stimulating hormone (TSH) suppression are all issues that are still being debated. The aim of TSH-suppressive therapy is to restore euthyroidism and to decrease serum TSH levels to reduce the growth and progression of thyroid cancer.     

分化型甲状腺癌的术式选择

近年来,甲状腺癌的发病率增加,其中以分化型甲状腺癌患者的增加最明显。所谓分化型甲状腺癌包括乳头状腺癌和滤泡状腺癌,前者约占甲状腺癌总数的70％,后者约占15％。因其病程发展缓慢,手术治疗后多数患者预后均较好,并且我国尚无甲状腺癌诊治规范,故对甲状腺切除范围,如何掌握颈淋巴结清扫尚缺乏统一认识。现结合美国甲状腺学会制订的2006年版《甲状腺结节和分化型甲状腺癌诊治指南》和我国近年有代表性的文章对分化型甲状腺癌的手术治疗方式选择作简要介绍。。