131I的电离辐射对甲状腺功能早期影响的研究

目的探讨131I的电离辐射与甲状腺组织功能早期改变的关系,如血清TNF、IL-1β、IL-6、IL-8等细胞因子水平变化以及甲状腺组织本身的病理改变等.方法选用兔作动物实验(15只),分别在0、6、24、48、72h及1周时抽血做IL-1β、IL-8测定,并每次随机处死1～2只兔以做病理切片观察,1周时同时做甲功测定(TT3、TT4、FT3、FT4)并与0h比较.17例病情中及重度甲亢患者用治疗剂量的131I治疗(每人次用量146.2～469.9MBq,平均267.5MBq),治疗前和治疗后4～7天抽血做TNF、IL-1β、IL-6和IL-8测定.结果①使用131I6h后即可见兔血清IL-1β增高(P<0.05),IL-8于48h达高峰(P<0.01),两种细胞因子于1周时皆降低到0h水平(P>0.05).1周内兔血清甲状腺激素水平无明显变化(P>0.05).②甲亢患者131I治疗前后血清细胞因子的变化与兔有所不同,TNF无明显变化(P>0.05),IL-6和IL-8升高(P<0.05),而IL-1β反而降低,且差异显著(P<0.05).③摄取131I后兔甲状腺组织在不同时间内呈现不同的病理改变.结论①甲状腺组织摄取一定剂量的131I在不同时间内呈现不同的病理改变,但短期内甲状腺激素水平无明显变化.②某些细胞因子IL-1β、IL-6、IL-8等似可用作观察甲状腺组织对131I辐射效应反应的指标,但其临床价值有待于进一步探讨.     

Thyroid hormones,Sertoli cell proliferation and differentiation in progenies from carbamazepine-treated rat dams during pregnancy and lactation

Carbamazepine (CBZ) is used in the control of seizure and affective disorders, causing hypothyroidism. Thyroid hormones regulate the Sertoli cell proliferation and differentiation. Clinical aspects must be considered since epileptic fertile women need to continuously use CBZ during pregnancy and lactation. This study aimed to evaluate the effects of CBZ on testis development of rat offspring from dams treated during pregnancy/lactation. Rat dams received CBZ (20 mg kg⁻¹ day⁻¹) or vehicle by intra-peritoneal route during gestation and lactation. Progenies were euthanised at 4, 14, 41, 63 and 93-days post-partum (dpp) for the evaluation of T3, T4 and TSH plasma total levels. Testicular cross sections were submitted to anti-Ki67, anti-PCNA, anti-p27^kip1 and anti-transferrin immunolabelling for the evaluation of Sertoli cells. There was a significant reduction in p27^kip1-positive Sertoli cell numerical densities and an increase in TSH level at 14 dpp. CBZ exposure affected the volume density of transferrin-positive immunolabelling at 63 dpp. These results suggest that CBZ may cause a dysregulation of the controller system of thyroid hormones homeostasis leading to an increase in the proliferation rate at the neonatal phase and a differentiation delay of the Sertoli cell, culminating in an altered function at late puberty. The occurrence of hypothyroidism cannot be completely discarded.     

Investigation and management of the neck lump

A neck lump is a common presenting sign in both the paediatric and adult population and may represent a broad range of benign or malignant diagnoses. The appropriate initial assessment, investigation and management is key to delivering appropriate treatments and to avoid missing potentially serious diagnoses. There is a range of imaging modalities available to the treating clinician and huge variability in the appropriate surgical or non-surgical management of disease. In this article we discuss the approach to the assessment of patients with a neck lump, including the history and examinations which should take place. We discuss the imaging modalities which are most appropriate for each condition and the range of management options available. Both common and rarer diagnoses are discussed through the course of the review.     

Association between age and disease specific mortality in medullary thyroid cancer

BackgroundThe aim of this study was to evaluate the association between age and disease specific mortality (DSM) among adults diagnosed with medullary thyroid cancer (MTC).MethodSurveillance, Epidemiology, and End Results (SEER-18) was used to analyze adult MTC patients stratified by age (18–64, 65–79, ≥80 years). Associations between patient demographics, tumor size, nodal status, metastatic disease, and extent of surgery on DSM was assessed with multivariable Cox regression.ResultsAmong 1457 patients with MTC, 1008 (69.2%) were younger adults, 371 (25.5%) older adults, and 78 (5.4%) were super-elderly. A significantly higher proportion of older adults and super-elderly had less than the recommended operation for MTC. On multivariable analysis, older adults and super-elderly were 2.9 and 6.7 times more likely to have an increased DSM (HR:2.91, 95% CI: 1.83–4.63; p < 0.001 and HR: 6.70, 95%CI: 3.69–12.20; p < 0.001). Extent of surgery or lymphadenectomy did not affect DSM.ConclusionsIncreased age is an independent predictor of DSM in patients with MTC.     

2021年美国甲状腺学会《甲状腺未分化癌病人管理指南》更新解读

甲状腺未分化癌（ATC）发病率低、预后差,为指导临床医生和研究人员对其进行规范化诊断和治疗管理,美国甲状腺学会于2012年制定了第1版《甲状腺未分化癌病人管理指南》。随着分子检测和靶向治疗结果的不断积累,2021年美国甲状腺学会对该指南进行了更新。新版指南强调了BRAFV600E分子检测在诊断及靶向治疗中的作用,增加了靶向治疗的内容,对晚期无法切除的 ATC病人更加推荐靶向治疗,而化疗则被更多的用于过渡性治疗和最终治疗。此外,新版指南也对病人的人文关怀进行了丰富和完善。     

Macrofollicular Variant of Follicular Thyroid Carcinoma (MV-FTC) with a Somatic DICER1 Gene Mutation: Case Report and Review of the Literature

Benign thyroid lesions such as multinodular goiter and adenomatoid nodules are well-circumscribed lesions displaying a macrofollicular growth pattern and lack of nuclear atypia. The highly unusual macrofollicular variant of follicular thyroid carcinoma (MV-FTC) mirrors these attributes and is thereby misclassified by cytological examination of fine-needle aspiration biopsies. The MV-FTC diagnosis is instead suggested following histological investigation, in which malignant attributes, most commonly capsular invasion, are noted. The bulk of MV-FTCs described in the literature arise in younger female patients and carry an excellent prognosis. A recent coupling to mutations in the DICER1 tumor suppressor gene has been proposed, possibly indicating aberrancies in micro-RNA (miRNA) patterns as responsible of the tumorigenic process. We describe the cytological, histological and molecular phenotype of a 35 mm large MV-FTC arising in the right thyroid lobe of a 33-year-old female with a family history of multinodular goiter. The tumor was encapsulated and strikingly inconspicuous in terms of cellularity and atypia, but nevertheless displayed multiple foci with capsular invasion. A next-generation molecular screening of tumor DNA revealed missense variants in DICER1 (p. D1709N) and MET (p. T1010I), but no established fusion gene events. After sequencing of germline DNA, the DICER1 mutation was confirmed as somatic, while the MET variant was constitutional. The patient is alive and well, currently awaiting radioiodine treatment. This MV-FTC mirrors previous publications, suggesting that these tumors carry a favorable prognosis and predominantly arise in younger females. Moreover, DICER1 mutations should be considered a common driver event in the development of MV-FTCs.     

妊娠期甲状腺功能减退症孕妇不同时期治疗效果及妊娠结局

目的:探究妊娠期甲状腺功能减退症孕妇不同时期治疗效果及血清促甲状腺激素(TSH)、游离甲状腺激素(FT4)、甲状腺过氧化物酶抗体(TPOAb)水平和妊娠结局。方法:2017年6月30日-2018年5月30日本院产前检查孕妇中筛选患有甲状腺功能减退症者120例,选择60例为一般给药组,在孕8周前行L-T4替代治疗;60例为推迟给药组,在孕8周后行L-T4替代治疗;另选同期产前健康健康孕妇60例为对照组。检测不同妊娠期TSH、FT4、TT4及TPOAb水平。统计围生期结局。结果:治疗前,一般给药组与推迟给药组血清TSH、FT4、TT4及TPOAb水平与对照组存在差异(P<0.05),治疗后在孕30周时两给药组血清上述指标与对照组无差异(P>0.05)。一般给药组自然流产、妊娠期糖尿病、胎盘早剥比例低于延迟给药组(P<0.05),但与对照组没有差异(P>0.05);妊娠期高血压、低出生体重儿两给药组及与对照组均无差异(P>0.05);一般给药组子代6月龄、12月龄时Gesell量表评分高于推迟给药组(P<0.05),与对照组无差异(P>0.05)。结论:对甲状腺功能减退症孕妇妊娠早期及早干预,可有效降低围产期不良结局发生几率,保证新生儿的早期发育。     

The superior laryngeal nerve loop and its surgical implications

Summary Based upon findings from 60 cadavers (120 sides), the incidence of superior laryngeal nerve loop, connecting the cervical sympathetic chain and the superior laryngeal nerve and its branches, the external and internal laryngeal nerve, was 98.3% (118 out of 120 sides). In most cases the loop connected the sympathetic chain and the external laryngeal nerve. The external laryngeal nerve was looped, and not linear as traditionally thought. The loop could be divided into three categories, V-shaped, U-shaped and mixed, and subdivided into 5 types and 17 subtypes according to morphological variation. The loop without exception innervated not only the cricothyroid muscle, but also the thyroid gland. The loop is one of the origins of the thyroid nerve. It seems that for thyroid surgery the loop, when lower in position, should be carefully separated from the superior thyroid vessels before the latter are ligated, in order to preserve a normal nerve supply to the muscle as well as to the part of the gland that remains after surgery.

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L'anse du nerf larynge supérieur, étude anatomique et applications chirurgicales

Résumé La fréquence d'une anse du nerf laryngé supérieur réalisant une anastomose entre la chaine sympathique cervicale et le nerf laryngé supérieur et/ou ses branches (rameau laryngé externe et ingerne), est de 98,3 % (118/120). Ce résultat s'appuie sur l'étude de 60 cadavres. Dans la plupart des cas, l'anastomose se fait entre la chaine sympathique cervicale et le rameau laryngé externe. Ce rameau laryngé externe a un trajet curviligne et non linéaire conformément aux données classiques. Il existe trois catégories d'anses : en "V", en "U" et mixte ; on peut également les subdiviser en 5 types et 17 sous-types en fonction des variations morphologiques. Cette anse innerve constamment non seulement le muscle cricothyroïdien mais aussi la glande thyroïde dont elle fournit une partie de l'innervation. Lors de la chirurgie thyroïdienne, si l'anse est en position basse, les nerfs doivent être soigneusement disséqués et séparés des vaisseaux thyroïdiens supérieurs avant ligature de ces derniers de façon à conserver l'innervation normale du muscle et de la partie restante de la glande.

     

Presymptomatic genetic screening in families with multiple endocrine neoplasia type 2

Medullary thyroid carcinoma occurs sporadically or as a part of the inherited cancer syndrome multiple endocrine neoplasia (MEN) type 2. The MEN 2 gene has been identified as the RET proto-oncogene on chromosome 10. In MEN 2A, RET mutations are detectable in one of five cysteine codons within exons 10 and 11 and in MEN 2B in codon 918 (exon 16). Direct DNA testing for RET proto-oncogene mutations is the method of first choice in presymptomatic screening of MEN 2 families. Gene carriers should be offered prophylactic thyroidectomy. The process of DNA analysis for RET proto-oncogene mutations is demonstrated in one family with hereditary medullary thyroid carcinoma. RET mutations were detectable in five of the nine family members at risk.Abbreviations MEN Multiple endocrine neoplasia - MTC Medullary thyroid carcinoma - FMTC Familial medullary thyroid carcinoma - PCR Polymerase chain reaction - C-cells Calcitonin-producing parafollicular cells