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The occurrence and progression of thyroid cancer are related to a series of molecular changes and the activation of signaling pathways, which is the basis of targeted therapy. For inoperable locally advanced, metastatic and refractory thyroid cancer, especially anaplastic thyroid cancer, the efficacy of targeted therapies, particularly tyrosine kinase inhibitors (TKIs) , has been demonstrated in clinical trials. TKIs can relieve clinical symptoms, improve patients’quality of life, prolong the progress free survival, and even create opportunities for radical operation or reoperation. This article reviews and summarizes the key molecular events in tumorigenesis and progression of thyroid cancer, and analyzes the results of clinical studies on the efficacy and safety of different TKIs in refractory advanced thyroid cancer, in order to provide reference and assistance for individualized targeted therapy of patients.
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Objective:To analyze the relationship between surgical resection range and prognosis of medullary thyroid carcinoma.Methods:Clinical data of 39 patients with medullary thyroid carcinoma treated in Shanghai Sixth People′s Hospital from Jan 2017 to Mar 2020 were retrospectively analyzed.Results:There were 13 males and 26 females, age ranging from 26 to 72 years old. Preoperative calcitonin levels increased from 21.5 to 20 000 ng/L. Tumor stage: stage Ⅰ was 35.9%, stage Ⅱ 23.1%, stage Ⅲ 25.6%, stage Ⅳ 15.4%. The proportion of lymph node metastasis in central region was 53.8% (21/39). The proportion of lateral cervical lymph node metastasis was 43.6% (17/39), which was statistically related with the preoperative calcitonin level ≥200 ng/L. The median follow-up was 10 months, and the biochemical and anatomical cure rates were 66.7% and 33.3% respectively. Transient recurrent laryngeal nerve palsy, temporary and permanent hypothyroidism were 2.6%, 23% and 2.6%, respectively. There was no postoperative hemorrhage, infection, lymphatic leak or death.Conclusions:Bilateral total thyroidectomy, and at least ispilateral central lymph node dissection were advocated for patients with MTC. When preoperative calcitonin level ≥200 ng/L, lateral cervical lymph node dissection is advised.
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Hypercalcemic crisis (HC) is a rare but critical electrolyte disorder, which may result in death if rapid correct management is not given due to the injury of the neurologic, cardiovascular and renal systems. Severe primary hyperthyroidism (PHPT) is listed as the most common cause of hypercalcemic crisis. Prompt surgical removal of the parathyroid glands is the most effective cure for HC. Nevertheless, hypercalcemic crisis after a successful parathyroidectomy is infrequent. Now, we report a case admitted to the Department of General Surgery of the Shanghai Jiao Tong University Affiliated Sixth People’s Hospital about a successful therapy of hypercalcemic crisis postparathyroidectomy in Sep. 2019, aiming to remind clinicians of the individualized program of calcium supplement after surgery of hyperparathyroidism and emphasize the value of renal dialysis in HC.
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Objective To discuss the feasibility of totally transoral video-assisted thyroidectomy (TO-VAT).Methods Data of 30 hyperthyroidism patients treated with TOVAT from Jan.2014 to Dec.2016 were retrospectively analyzed.Index such as operative time,intraoperative blood loss,hospital stay,complication were recorded.Results No neck scar was found,and patients were satisfied with the cosmetic effects.The average surgical time was (97.3±13.4) min,blood loss 24.0(12.3～28.3)ml,hospital stay (2.0±0.5)d,cosmetic score 8.2± 0.3.No hoarse voice,drinking cough,bleeding,convulsion,or parathyroid injury happened.Two patients had swelling in the anterior cervicaarea,2 patients showed lower jaw numbness and 1 patient showed temporary hypoparathyroidism.During the follow up of 1 to 35 months,all were subjected to symptomatic management and recovered.Conclusion TOVAT is a safe and effective technique with the advantages of minor iniury,quicker recovery,fewer complications and good cosmetic effect.
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Objective To analyze whether preoperative serum thyroglobulin (Tg) can be the indicator for predicting malignancy in follicular thyroid tumors (FTC).Methods A retrospective analysis was done for 125 patients with FTC who had been diagnosed by pathology in our hospital.The patients were grouped into benign group and malignant group.Sex,age,tumor size and preoperative serum Tg concentration were analyzed.Results There were 62 patients in benign group (23 male and 39 female).The mean age was 49 years old,ranging from 19 to 78 years,and the mean diameter of tumors was (3.4±1.374) cm,ranging from 0.1 to 5.5 cm.There were 63 patients in malignant group (13 male and 50 female).The mean age was 46 years old,ranging from 15 to 79 years,and the mean diameter of tumors was (3.14±1.143) cm,ranging from 0.3 to 7 cm.The mean preoperative serum Tg concentration was (299.73± 495.02) ng/ml in malignant group and(48.20 ±43.68)ng/ml in the benign group.Through comparing the two groups,we found age and tumors diameter had no statistical difference between the two groups (P＞0.05),while sex and Tg had statistical difference (P＜0.05).When the cutoff of Tg was 100 ng/ml,the sensitivity and specificity for the diagnosis of malignancy was 48.7％ and 90％ respectively.Conclusions Tg can be used as auxiliary diagnosis index of thyroid FTC.High preoperative Tg levels should be highly suspected the possibility of FTC.
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Thyroid cancer is one of the most common malignant tumors.Advanced thyroid cancer usually invades encroachs nerves,blood vessels,trachea,esophagus,and other organs,and needs muhidisciplinary team for better effect.The disease center of diagnosis and treatment provides a good platform for multidisciplinary treatment of advanced thyroid cancer.
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Objective To investigate the application of carotid artery resection and reconstruction in surgical management of thyroid carcinoma with carotid artery involvement.Methods We conducted a retrospective cohort study involving 10 patients whose common carotid arteries were invaded by thyroid carcinoma.All patients underwent tumor en bloc resection and carotid arteries reconstruction.Patients were evaluated by muhidisciplinary team and surgeries were cooperated by general surgeons,orthopedists and vascular surgeons.The perioperative complications and surgical outcomes were also recorded and analyzed.Results No patient had complications of central nervous system.One patient suffered Horner syndrome and one presented hoarseness postoperative.Two patients had wound infection,two patients presented carcinoma recurrence and two patients presented distant metastasis during the follow-up.Conclusion En bloc resection of tumor and carotid artery reconstruction is a feasible modality in treatment of thyroid carcinoma with carotid artery invasion.
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Objective To investigate the curative effect of endoscopic thyroidectomy via breast areola approach.Methods The clinical data of 28 cases of endoscopic thyroidectomy via breast areola approach were retrospectively summarized.Results The mean diameter ofthe tumor Was 2.9(1.7～4.2)cm.The mean operative time Was 128(95～165) min.Pathologic data:adenoma in 15 cases,nodular goitar in 12 csses,papillary carcinoma indicated intraoperatively by frozen section in 1 case.One case occurred temporary hoarseness.No intraoperative and postoperative hemorrhea and convulsion after operation.Minor pain and discomfort in anterior chest continued for 7～19d in 18 cases,all without taking painkillers,satisfaction rate of beauty was 90 percent.Condusions Endoscopic thyroidectomy via breast areola approach is safe and feasible for patients with thyroid diseases,and has excellent cosmetic results.