无锡地区人群甲状腺结节流行状况调查

目的研究无锡地区人群中甲状腺结节的患病情况。方法2005年5月至8月采用分层随机整体抽样方法,抽取无锡地区16岁以上常住居民807人,进行甲状腺B超和血清促甲状腺素检测。结果完成调查750人。调查人群中甲状腺结节患病率为22.53%,女性患病率显著高于男性(27.10%对16.82%),且男女患病率都随年龄增长而增加。男性和女性结节大小和数量构成比及结节体积比较差异均无统计学意义。有结节组和超声正常组甲状腺功能差异无统计学意义。女性群体中,有结节组甲状腺体积虽较超声正常组稍大,但差异无统计学意义。结论无锡地区人群中甲状腺结节发病率较高,应积极采用超声检查和甲状腺细针穿刺,早期发现和干预甲状腺结节。     

721例中老年体检者原发性甲状腺功能减退状况调查

目的了解目前中老年人群甲状腺功能减退（甲减）的患病率和相应的甲状腺形态学改变。方法参加我院体检的40～79岁的中老年721例为研究对象。电化学发光法检测血清促甲状腺激素（TSH）、游离甲状腺素（FT4）、甲状腺过氧化物酶抗体（A—TPO）和甲状腺球蛋白抗体（A—TG）。全部行甲状腺高灵敏度超声探查。结果筛查出原发性临床甲减患者17例,原发性亚临床甲减患者64例。老年组与中年组临床甲减患病率之比为1．27：1;亚临床甲减患病率之比为2．26：l。其中,老年组女性亚临床甲减患病率较中年组女性患病率明显升高,差异有统计学意义（P〈0．05）;老年组亚临床甲减总患病率高达11．50％,较中年组明显升高（P〈0．05）。甲减患者甲状腺抗体阳性的患病率、临床甲减和亚临床甲减患者甲状腺结节的患病率均较高。结论与中年人群相比,老年人群具有更高的原发性甲减患病率;甲减患者的甲状腺抗体阳性率和甲状腺结节患病率均明显升高。应加强对老年人甲减和甲状腺结节的筛查。     

探讨甲状腺小结节的径线特征及其对结节定性诊断的价值

目的探讨甲状腺小结节(结节长径≤10 mm)的径线特征及其与结节良、恶性的关系,提高高频超声对甲状腺小结节定性诊断的准确性。方法对病理诊断的353例患者的665个甲状腺小结节(结节长径≤10 mm)的前后径与横径进行分析比较,观察超声声像图特征。结果恶性结节对于前后径≥横径的敏感性及特异性都很高(93.6%、97.4%),良、恶性结节相比有显著差异性(P<0.05);不规则边界、不完整晕环、微钙化、穿入血流,恶性结节的敏感性及阳性预测值都很低;恶性结节对于低回声的敏感性高(89.2%),特异性低(19.1%)。结论根据小结节的径线特征利于甲状腺微小癌的早期诊断。     

Molecular pathogenesis of thyroid nodules and cancer

Tumours derived from the thyroid follicular epithelium represent an informative model for understanding the molecular pathogenesis of multistage tumourigenesis, which is the prevailing theory on cancer development and progression nowadays. The early stages of thyroid tumour development appear to be the consequence of the activation or 'de novo' expression of several proto-oncogenes or growth factor receptors, such as ras, ret, NTRK, met, gsp and the thyrotropin (TSH) receptor. Alterations in the expression pattern of these genes are associated with the development of differentiated neoplasms, ranging from benign toxic adenomas (gsp and TSH receptor), to follicular (ras) and papillary (ret/PTC, NTRK, met) carcinomas. They may all be considered to be early events of thyroid cell transformation and, for some, experimental evidence derived from gene transfer studies supports this hypothesis. Alterations in tumour suppressor genes (p53, Rb) are associated instead with the most aggressive and poorly differentiated forms of thyroid cancer, indicating that, in the thyroid tumourigenic process, they represent late genetic events. Specific environmental factors (iodine deficiency, ionizing radiations) have been shown to play a crucial role in promoting the development of thyroid cancer, influencing both its genotypic and phenotypic features. Interestingly, a high percentage of genetic lesions causing thyroid cancer originate from gene rearrangements and chromosomal translocations (ret/PTC, NTRK, Pax-8/PPARgamma) a finding which, being a rare event in most epithelial tumours, makes the molecular pathogenesis of thyroid cancer unique. The uninterrupted flow of information on the molecular genetics of thyroid nodules and cancer will broaden the correlation between genotype and phenotype and will also provide important information for the development of more accurate preoperative diagnostic tools and more efficient treatment choices for the different forms of thyroid cancer.     

Ultrasound guided microwave ablation of thyroid nodular goiter and cystadenoma: A single center,large cohort study

Thyroid nodules are one of the most common entities that affect the thyroid gland. Traditionally, their treatment was surgery. Currently, ablation combination with percutaneous procedure became a good option.To analyze safety, efficacy, and describe our experience in microwave-ablation using ultrasound-guidance for benign thyroid nodules.A total of 304 patients with 1180 thyroid nodules (thyroid cystadenoma and nodular goiter) were studied retrospectively. Two hundred sixty-seven patients who underwent microwave-ablation successfully in our hospital were enrolled in this study. The baseline, follow-up nodule volume, thyroid function tests, thyroid antibodies, and posttherapy complications were analyzed. The informed written consent was obtained from patients or guardians. The study was approved by the ethics committee of our hospital.The average age was 50.1 ± 11.7 (21–83 years), 214 were women (80.1%) and 53 (19.9%) were men. The average number of nodules per patient was 4.02 ± 1.8 (1–8), 9.86%, 6.13%, and 84% located in the right thyroid lobe, left lobe, and bilateral, respectively. The average size of the nodules was 5.28 cm² ± 3.63 (0.09–23.45 cm²). The average ablation time was 11 minutes ± 5.36 (3–20 minutes). The hospitalization period was 24 hours ± 10.16 (7–48 hours). Eighteen complications were reported. Postablation volume reduction rate was 54.74% and 93.3% at 3 and 12 months follow-up respectively (P < .05). The thyroid function tests, pre and postablation showed no significant changes (P > .05).Ultrasound-guided microwave-ablation of thyroid nodules is safe and effective. More clinical trials are needed to define the true use of microwave-ablation.     

The associated factors for spontaneous intranodular hemorrhage of partially cystic thyroid nodules: A retrospective study of 101 thyroid nodules

Spontaneous intranodular hemorrhaging in benign partially cystic thyroid nodules was reported to cause neck swelling, difficulty swallowing, and other oppressive symptoms attributed to their growing progressively at high rates. In our study, the risk factors for hemorrhaging in these nodules were investigated.We retrospectively analyzed benign partial cystic thyroid nodules from September 2017 to December 2019, and divided them into 2 groups according to the occurrence of intranodular hemorrhage. Age, gender, follow-up time nodules initial maximum diameter, blood supply, spongiform content, nodules solid components, and internal solid portion were compared between the 2 groups at the first ultrasound examination. Chi-Squared and multivariate analysis were performed to evaluate the association of hemorrhage with clinical and ultrasonographic characteristics. ROC analysis was performed to evaluate the utility of factors in predicting hemorrhage.There were 59 occurrences of intranodular hemorrhage, which were associated with abundant blood supply, spongiform contents, and unsmooth margin of the internal solid portion. After multivariate analysis, abundant blood supply, and spongiform content were independent predictors for hemorrhage. In ROC analysis integrating these predictors, the sensitivity was 62.7% and specificity was 95.2% with the AUC 0.881.Partially cystic thyroid nodules with abundant blood supply, non-smooth margin of the internal solid portion and a spongiform internal content were apt to spontaneous intranodular hemorrhaging, which can be recognized as soon as possible by ultrasound.     

Radiofrequency ablation for the management of thyroid nodules: A critical appraisal of the literature

The majority of benign thyroid nodules are asymptomatic, remain stable in size and do not require treatment. However, a minority of patients with growing nodules may have local symptoms or cosmetic concerns, and thus demand surgical therapy. The timely use of ultrasound‐guided, minimally invasive thermal therapies has changed the natural history of benign, enlarging thyroid nodules (TNs). These procedures produce persistent shrinkage of TNs and an improvement of local symptoms. Among the various procedures, percutaneous ethanol injection represents the first‐line treatment for thyroid cysts, while in solid cold nodules, laser and radiofrequency ablation (RFA) have proven to be very effective and safe techniques in producing significant volume reduction that remains stable over several years. In particular, RFA seems to be suited for the management of small and medium nodules, while larger nodules may require repeated RFA treatments, and could be difficult to treat if they extend into the chest. RFA is performed in outpatient clinics and has a lower risk of complications compared to surgery. However, to date, there is still no unanimous consensus on the percutaneous treatment of benign nodules using such minimally invasive thermal techniques. In this review, we critically revise the literature to identify patients who are more likely to benefit from RFA treatment as an alternative to surgery.     

Effect of Chinese herbal medicine for patients with benign thyroid nodules in adults: A protocol for systematic review and meta-analysis

Background:Thyroid nodules (TN) are discrete lesions within the thyroid gland and are a common clinical problem detected in 19% to 68% of people. TN are more common as age increases and occur more frequently in women. TN can cause pressure symptoms, cosmetic complaints, and thyroid dysfunction. Treatment for benign thyroid nodules includes thyroid hormone therapy, surgery, radioiodine treatment, percutaneous ethanol injection therapy, and laser or radiofrequency treatment to shrink nodules. In China and many other countries, doctors use Chinese herbal medicines (CHM) to treat TN. However, systematic review and meta-analysis has not been found to assess the effects and safety of CHM in curing TN at present. Hence, the systematic review is conducted to scientifically and methodically evaluate the value of its effectiveness and safety of CHM on TN.Methods:Literatures related to CHM for TN from the establishment of the database to November 2020 will be retrieved from the following databases: PubMed, Excerpta Medica Database (EMBASE), MEDLINE, Web of Science, Cochrane Library, SpringerLink, WHO International Clinical Trials Registry Platform (ICTRP), Wanfang Database, China National Knowledge Infrastructure (CNKI), Chinese Biomedical Literature Database (CBM), and Chinese Scientific Journal Database (VIP). There are no language restrictions for retrieving literatures. Case reports, animal studies, editorials, expert opinions, reviews without original data, and studies on pediatric population were excluded. Eligible randomized clinical trials (RCTs) evaluating the effectiveness and safety of CHM in TN patients will be put in the study including nodule volume reduction ≥50%, pressure symptoms, cosmetic complaints, quality of life, and adverse events. By scanning the titles, abstracts and full texts, 2 reviewers will independently select studies, extract data, and assess the quality of study. Meta-analysis of RCTs will be conducted using Review Manager 5.1 software. The results will be presented as risk ratio for dichotomous data, and standardized or weighted mean difference for continuous data.Result:This study will provide high-quality available evidence for the treatment of TN with CHM based on nodule volume reduction ≥50%, pressure symptoms, cosmetic complaints, quality of life, and adverse events.Conclusion:The systematic review will to evaluate the efficacy of CHM in treating benign thyroid nodules in adults and provide evidence for clinicians.INPLASY registration number:INPLASY2020120093.     

解读美国甲状腺协会2009年甲状腺结节和分化型甲状腺癌诊治指南

近期,美国甲状腺协会发表了第3版甲状腺结节和分化型甲状腺癌的临床诊治指南,总共提出了80项指南性的参考建议.指南强调了细针穿刺细胞学检查对鉴别甲状腺结节良、恶性的意义.提出了甲状腺癌手术方式以及是否进行淋巴结清扫的具体操作方案,并详细介绍了分化型甲状腺癌131I治疗的适应证、整个操作过程、不良反应、131I扫描联合甲状腺球蛋白测定的判读等.此外,指南还提出了甲状腺癌危险度三等级的判断标准.     

2020欧洲甲状腺学会《影像引导下良性甲状腺结节热消融治疗临床实践指南》解读

热消融是甲状腺结节治疗领域颇受关注的新技术,目前已逐步得到应用。2020年欧洲甲状腺学会发布了《影像引导下良性甲状腺结节热消融治疗临床实践指南》,为临床相关人员提供了良性甲状腺结节热消融(TA)治疗方面详细、可靠的指导。熟悉该指南中介绍的TA技术、操作标准及甲状腺结节的治疗选择,对于合理应用TA具有现实意义。