A Results of Surgical Treatment of Patients with Thyroid Nodules by Difference of First Visiting Department

ABSTRACT

PURPOSE: Although thyroid diseases have a high prevalence, controversy over their diagnosis and treatment continues owing to the difficulties in the differentiation between malignant and benign states in the thyroid nodule and in the decision of medical treatment, surgical intervention, and surgical method and extent. METHODS: We researched the clinical features, prevalence of malignant thyroid cancer and difference of prognosis between two groups of patients group 1 was treated primarily with TSH suppression management or observation and then surgery, while group 2 underwent immediate surgery. In addition, we studied the proper management and diagnostic method for patients with thyroid nodule. RESULTS: The research comparison between group 1 (301 cases) and group 2 (920 cases) produced the following results. There was a relatively high prevalence of malignancy in group 1 managed improper TSH suppression as compared with group 2, postoperatively (38.9 18.7%). AMES classification showed a high ratio of the high risk group in group 1 (papillary cancer, 47.6 28.4%; follicular cancer, 41.7 18.4%) and a prolonged treatment period in group 1 (64.6 20.8 days). In addition, group 1 required a more aggressive operation method (bilateral thyroidectomy, 49.2 37.2%). CONCLUSION: These data confirm that the accurate and early diagnosis of patients with thyroid nodule is essential to decide the management method and the patient prognosis, and emphasize the importance of the decision for proper treatment course. We therefore concluded that to decide the management course for patients with thyroid nodule, the selection of high risk group patients through routine examination and fine needle aspiration is very important. Furthermore, for patients with a very hard nodule, consideration should be given to enlarged nodule, past history of irradiation, status of attachment on the local tissue, and cervical lymph node enlargement. Finally, after the selection of the patient group, proper surgical management should be considered primarily.