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Objective To investigate the diagnosis and treatment. Of primary hyperthyroidism and concurrent thyroid microcarcinoma. Methods A retrospective analysis of 32 cases of primary hyperthyroidism and concurrent thyroid microcacinoma proved by postoperative pathology and were admilted between January 1994 and December 2002.Resulth The morbidity was 1.07%.No case had been diagnosed before operation.All of 32 cases underwent bilateral subtotal thyroidectomy.All cases showed diffase goiter and 11 cases showed small thyroid nodules at operation. There was no evidence of lymph node metastasis. No case had reoperation. No case of recurrent hyperthyroidism nor cancer was found during the 1 to 10 (mean5.5)years follow up. Conclusion The clinical diagnosis of primary hyperthyroidism and concurrent thyroid microcarcinoma is difficult and chiefly depends on postoperative pathology. Surgical treatment gives good results and has a better prognosis ,but long term follow up is still needed.
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1 cm or tumor penetrating through the thyroid capsule(P1 cm or tumor penetrate through the thyroid capsule.
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Objective To analyze the clinical characteristics,diagnosis and treatment of thyroid micro-carcinoma.Methods The clinical data of 52 cases of thyroid micro-carcinoma operated from 2003 to 2008 were analyzed retrospectively.Results All of the 52 cases were confirmed as thyroid micro-carcinoma by postoperative pathologic exam;30 cases(57.7%) were discovered by intraoperative frozen section and 22 cases were not.Micro-calcification ratio on ultrasound was 35.19%.11 cases were diagnosed as malignant tumor on ultrasound scan preoperatively.Lobectomy of involved lobe with subtotal thyroidectomy of contra-lateral lobe was performed in 38 cases,3 cases of bilateral total thyroidectomy,3 cases of unilateral lobectomy and isthmectomy,5 cases of ipsilateral subtotal lobectomy and 3 cases of ipsilateral lobectomy with isthmectomy were performed.Combined central region lymph nodes dissection was adopted in 27 cases(positive 11/27,40.74%).Follow-up rate was 96.2%,with time ranging from 3 months to 5 years.No recurrence or mortality was discovered.Conclusions(1)B type ultrasound is the first choice for preoperative screening.(2) lpsilateral thyroid lobectomy with contralateral subtotal thyroidectomy combined with central region lymph node dissection is advocated.
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0.05).Seventy patients were followed up from 3 months to 8 years post-operatively,with tumor-free survival in 67 cases,and cervical lymph nodes metastasis in 3 cases.No permanent hypo-parathyroidism or paralysis of recurrent laryngeal nerves occurred.Conclusions Total thyroidectomy is advised for bilateral thyroid carcinoma.It is necessary to emphasize the importance of resection of the central region lymph nodes.
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Objective To study the optimum incision and reasonable extension of functional cervical dissection in well differentiated thyroid cancer. Methods The dissected specimens of 182 patients with well differentiated thyroid cancer treated by functional dissection(197 times), including therapeutic and selective dissection, from 1986 to 1998 were divided into 4 anatomical divisions(cervical inferior, media and superior area and subparotid gland area), and calculated the number of cervical lymph nodes that had been invaded by thyroid cancer in each area. Results The best incision was located in the area from the mastoid to downward and bakcward curvilinear to the surface and behind the anterior border of trapezium muscle 2～3?cm, then downward along the median of acromioclavicular joint to 5?cm below the midpoint of the clavicle. In therapeutic dissection group, among 61 patients with neck metastases, the metastases rate in the cervical superior area was 83.61%, but only one case in subparotid area. In selective dissection group, lymph nodes metastases was found in cervical superior area in 38.37% of patients, but none was found in subparotid gland ar ea. Conclusions The incision designed by authors is hard to see face to face. It is suitable for the young woman with thyroid cancer. There is almost no lymph nodes metastasis in the subparotid gland area, so it was unnecessary to dissect this area for it could reduce the operation time and extension of neck dissection. Able to protect the nerve function of spinal accessory, great auricular and lesser occipital nerve, so this operation can improve the life quality of patients with thyroid cancer.
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Objective To assess the results of surgical intervention on patients with medullary thyroid carcinoma(MTC), and determine the value of measuring plasma calcitonin concentration postoperatively. Methods The diagnosis and treatment of 14 patients with MTC from January 1992 to December 1998 were analysed retrospectively. Results The diagnosis of MTC in the 14 patients was confirmed by pathology. Of them, 64.3% of patients had lymph node metastases. According to AJCC staging system, 1 patient was in stage Ⅰ, 7 in stage Ⅱ, 5 in stage Ⅲ and 1 in stage Ⅳ. Of nine patients measured plasma calcitoinin after initial operation, 4 had persisted hypercalcitoninemia. In the 4 patients, MTC in residual thyroid and enarged lymph node were comfirmed by B mode ultrasounography. After re operation, the calcitonin level returned to normal in 3 cases, but one remained in higher level. Postoperative follow up ranged from 2 to 8 years, 2 patients died of the disease. Twelve patients still lived, 6 of them survived more than 5 years. Conclusions The clinical stage of MTC at the time of diagnosis is an important prognostic factor. An aggressive surgical approach at the initial operation is essential to achieve a curative effect in patient with MTC. Measuring plasma calcitonin postoperatively helps to detect residuled MTC or recurrent MTC.
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Objective To evaluate the rate of residual tumor after local resection of thyroid carcinoma,and provide theoretical basis to determine the indications for re-operation.Methods The clinical data of 56 patients,who had re-operation in our hospital after local resection of thyroid carcinoma,were summarized.Results As confirmed by pathology,the rate of residual tumor of patients was 42.8% at re-operation.When the tumor was larger than 4 cm,or smaller than 2 cm before the first operation,the residual tumor rate was 80% and 11.1% respectively.The residual tumor rate was 86.3% in patients with tumor invading thyroid capsule,14.7% in patients without capsule invasion,47.6% in patients who had only nodule resection,50% after ipsi-lateral partial lobectomy,and 12.5% after subtotal thyroidectomy.The sensitivity of finding residual tumor by CT and doppler ultrasound examiination before re-operation was 64.0% and 60.0% respectively,and the positive predictive value was 80.0% and 30.0% respectively.Conclusions The rate of residual tumor is high in patients with thyroid cancer operated by local resection.And it′s necessary to re-operation.The condition of tumor before the first operation and CT examination are significant for selection of patients to have re-operation.
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Objective To summary the experience in diagnosis and surgical treatment of differentiated thyroid carcinoma (DTC). Methods The clinical data and follow-up results of 167 cases of DTC were retrospectively analysed. Results (1) The accurate rate of preoperative cytology diagnosis was 76.9%(97/126). (2)121 patients were diagnosed as thyroid carcinoma before or during operation. Histologic examination after primary operation revealed that the carcinoma spread to the isthmus and the opposite lobe in 5 cases. 57 cases were followed up with only 2 cases recurred 2 and 3 years after the operation, and 3 died 6 to 10 months after operation. (3)87.5%(42/48)cases of the reoperation were due to misdiagnosis as benign lesions in primary operation. Histologic examination revealed that residual tumor in the remnant thyroid tissue was found in 45.2%(19/42)cases, and residual tumor in the lymph nodes of the suffered side in 19.0%(8/42)cases. 30 cases were followed up without any recurrence. Conclusions (1) Cytological diagnosis must be paid great attention to preoperatively; (2) Excision of the suffered lobe, isthmus and greater partial of the opposite lobe, along with clearing the enlarged lymphnodes of the isolateral side are generally performed for the DTC; (3) Reoperation due to misdiagnosis as benign lesions in primary operation must remove the remnant tissue of thyroid and the isolateral lymphnodes. The cases should also be followed up even if enough excising is performed in primary operation.
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Objective To investigate the diagnosis, surgical treatment of thyroid cancer and prevention of the surgical complications. Methods Clinical data of 246 cases of thyroid cancer were analysed retrospectively from March 1990 to April 2001. Results 135 and 80 patients were diagnosed before and during operation, and all patients were diagnosed after operation; Reoperation was performed in 57 patients and residual carcinoma tissue was found in 30 patients; 1, 3 and 5 years surviving rate of thyroid cancer after operation were 99.2% , 96.3% and 91.5% respectively; No death occurred in the 246 cases after operation, 4 cases of whom showed temporary vocal cord paralysis and 3 cases showed tic due to hypocalcemia. Conclusions Intraoperative frozen section is helpful for the diagnosis and the choice of operative methods; The extention of thyroidectomy and whether to perform lymph dissection vary with the pathology types and risk factors. Patients should take thyroid tablets all their lives.
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Objective To study the clinical characteristics, surgical treatment and prognosis of thyroid carcinoma in children. Method The clinical data of 25 children with thyroid carcinoma undergoing operative treatment from 1980 to 2001 were analyzed retrospectively. Results 25 children all underwent surgical treatment .Of them,17 were papillary carcinomas,3 papillary carcinomas with follicular elements,3 follicular carcinomas,1 medullary carcinoma and 1 fibrosarcoma. 21 children were followed up periodically from 4 months to 18 years (average time 6years). There were two deaths in the followed-up period,1 died of pulmonary insufficiency in extensive pulmonary and cervical lymph nodes metastases two years after the operation; 1 died of fibrosarcoma recurrence. The other children were all alive in good condition. Conclusions Most of the thyroid carcinoma in children are papillary carcinomas, and the prognosis is usually excellent. Operation is the main therapeutic method. A proper surgical procedure is major approach in treatment. Re-operation is also necessary, and might get a long-term survival even if the patient has recurrent thyroid carcinoma with cervical lymph node metastases.
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Objective To study the diagnosis and treatment of hyperthyroidism companied with thyroid carcinoma . Methods The clinical data of 11 cases of hyperthyroidism with thyroid carcinoma were retrospectively analysed. Results 9 of 11 cases were diagnosed preoperatively,and comfirmed by frozen section intra-operatively and underwent suitable operation. In the other two cases the final diagnosis was made by pathological examination postoperatively, and re-operation was performed on 1 case . All the patients were followed up for 1～16 years and neither hyperthyroidism nor thyroid carcinoma recurred. Conclusion It is difficult to make diagnosis of hyperthyroidism with thyroid carcinoma preoperatively. B mode ultrasonography may find some nodes in enlarged thyroid; but fine needle aspisation biopsg(FNA) has high false negative diagnostic rate. Intra-operative frozen section examination is important in the diagnosis of hyperthyroidism with thyroid carcinoma .
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Objective To study the feasibility and effect of scarless endoscopic thyroidectomy(SET) and minimally invasive video-assisted surgery of the thyroid(MIVA) endoscopic technique. Methods SET: Incisions were made on the anterior part of the breast and mareolata,blunt dissection of the subcataneous planes of the neck and chest were administered .MIVA: Incisions were made 3cm above the thymus notch and the operation was video assisted in the thyroid adenoma extripation and subtotal thyroidectomy. The thyroid nodules were extirpated or subtotal thyroidectomy was performed. Results All 10 cases of the SET and 12 cases of the MIVA were successful performed and without complications. Conclusions For thyroid surgery,SET is a good cosmetic operation,MIVA is a minimal trauma and effective operation.
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Objective To explore the indications and attention points in one-stage thyroidectomy and bilateral neck dissection for thyroid carcinoma.Methods The clinical and pathological data of 68 thyroid carcinoma patients treated with one-stage thyroidectomy and bilateral neck dissection from Jan 1990 to Dec 2005 were reviewed retrospectively.Results There was no operative death in this series.Of the 68 patients,60 had bilateral and 4 had unilateral positive lymph nodes;4 had negative lymph nodes.The metastatic rate of patients who had unilateral thyroid cancer with contralateral cervical enlarged lymph nodes,bilateral thyroid cancer with unilateral cervical lymph nodes and isthmus cancer with lymph nodes was 100%(7/7),90%(9/10) and 66.67%(4/6) respectively.Postoperative complications include 7 cases of facial and flap edema,2 headache,5 postoperative hoarseness,7 temporary hypoparathyroidism,1 permanent hypoparathyroidism,1 left chylus fistula,and 3 unilateral accessory nerve injury.Conclusions The patients with unilateral thyroid cancer and enlarged contralateral neck lymph nodes,with bilateral thyroid cancer and unilateral cervical lymph nodes,and with isthmus cancer and enlarged lymph nodes are high-risk patient of bilateral neck metastasis,and should be treated with one stage thyroidectomy and bilateral cervical lymph node dissection.The procedure is safe,no serious postoperative complications occurred,and the survival rate and life quality can be improved.
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Objective To investigate the diagnosis and treatment of nodular goiter with thyroid carcinoma.Methods The clinical data of forty cases of nodular goiter with thyroid carcinoma admitted to our hospital from January 2005 to December 2007 were retrospectively analyzed.Results Among the 40 cases,only four cases were preoperatively diagnosed as nodular goiter with thyroid carcinoma.All cases received operation and the diagnosis were comfirmed by frozen section examination.Various modes of thyroidectomy were performed according to the pathological results,including four cases had unilateral total thyroidectomy,27 had unilateral total thyroidectomy combined with opposite subtotal thyroidectomy,one case had bilateral subtotal thyroidectomy,and eight cases of bilateral total thyroidectomy.Of all 40 cases,11 cases received unilateral cervical lymph node dissection.There were only three cases occurred convulsion or numbness,and no hoarseness occurred postoperatively.Compared to simple nodular goiter,the incidence of calcification in nodular goiter with thyroid carcinoma was significantly increased(P
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Objective To study the clinical characteristics of thyroid carcinoma in young females,in order to improve the diagnosis and treatment of this disease.Methods The clinical data of 74 consecutive young female patients with thyroid carcinoma treated in our hospital in the recent ten years were analysed.In most of the cases,there was no firm texture or fixation of the thyroid nodules to surrounding structures on physical examination before operation.Ultrasonography was performed in all patients and multiple thyroid nodules were found in 61 cases(82.43%).Thyroid scintiscans were performed in 43 cases,and thyroid nodules were found in 41 cases.The cold,cool and warm nodules were found in 14,18 and 9 cases,respectively,by scintiscans.Fine needle aspiration biopsy(FNAB) was performed in 11 cases,and in 2 cases were negative,1 case showed abnormal cell,3 cases were suspicious of carcinoma,and 5 cases were confirmed papillary carcinoma.Results Papillary carcinoma was found in 70 cases,follicular carcinoma in 3 cases and medullary carcinoma in 1 case by histological examination,and benign disease was also accompanied in most cases.Lymph node metastases was found in 28 cases(37.84%),and the rate of metastases was significantly different than that of older female patients(16.46%) at the same time.There were 2 cases who died 3 years after operation because of metastases.Conclusions The lymph node metastases were prevalent in young female patients with thyroid carcinoma.The texture and mobility of the nodules cannot be used to differentiate benign from malignant nodules.We should carefully analyze every nodule found on ultrasonography.For the solid nodules with diameter larger than 1.0cm,we suggest operation;for the non-solid nodules with diameter larger than 2.0cm,we prefer scintiscans and FNAB for diagnosis.