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Primary hyperthyroidism and thyroid cancer are usually considered as independent diseases,but recent studies suggest that these two diseases may share common pathogenic mechanisms.This article aims to emphasize the standardized diagnosis and treatment of primary hyperthyroidism patients with concomitant thyroid cancer.By comprehensively analyzing related domestic and foreign research,it provides useful reference and guidance for clinicians when dealing with patients with hyperthyroidism and concurrent thyroid cancer,to improve the level of diagnosis and treatment.
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Medullary thyroid carcinoma(MTC) is a rare neuroendocrine neoplasm caused by the malignant hyperplasia of thyroid parafollicular cells, accounting for 4% of all diagnosed thyroid cancer. Patients with MTC have a relatively poor outcome. Distant metastasis, especially in liver, is usually found at the time of diagnosis and the effect of chemotherapy is unsatisfactory in most cases. Due to its highly progressive characteristic and poorer prognosis compared with other subtypes of thyroid cancer, MTC has always been the focus and difficulty of clinical research. In the era of precision therapy, the classification of MTC is more accurate with the application of genetic testing technology and various kinds of individual treatments, such as targeted therapy and peptide receptor radionuclide therapy have been developed. This review will describe the latest development in MTC in the era of precision therapy.
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Objective:To observe the relationship between the occurrence of symptomatic hypocalcemia (SH) and various potential influencing factors in patients after thyroidectomy, stratify according to the scope of thyroidectomy, and explore the predictive value of intact parathyroid hormone (iPTH) for postoperative SH.Methods:Among 3 379 patients with thyroidectomy who admitted into the First Affiliated Hospital of Zhengzhou University from January 2020 to February 2021, 122 patients with SH after thyroidectomy were collected retrospectively and set as SH group. 100 patients of the remaining 3 200 patients who did not suffer from SH in the same year were selected by systematic sampling method and set as control group. Pearson correlation analysis was used to analyze the potential influencing factors such as age, preoperative calcium, postoperative calcium, preoperative iPTH, postoperative iPTH, central lymph node number, blood loss, operation duration, gender, lymph node dissection method, thyroidectomy range, postoperative pathological type and other. Among them, the measurement data of normal distribution were expressed by mean±standard deviation( Mean± SD), t-test was used for the comparison between the two groups, and Chi-square test was used for count data. By drawing the receiver operating characteristic curve (ROC), the iPTH levels in patients with and without SH before/after operation (different surgical methods) were studied, and the diagnostic threshold, sensitivity and specificity of iPTH were predicted. Results:Among 3 379 patients, 122 patients suffered from SH after thyroidectomy, with the incidence rate of 3.6%. There were significant differences in gender (8 males and 114 females in SH group; 27 males and 73 females in control group), whether lateral area dissection was performed (58 cases with dissection and 64 cases without dissection in SH group; 7 cases with dissection and 93 cases without dissection in control group), thyroidectomy range (14 cases with one side and 108 cases with both sides in SH group; 73 cases with one side and 27 cases with both sides in control group), age (40.1 years old vs 43.2 years old), dissection number of central lymph nodes (8.6 vs 4.6), dissection number of cervical lymph nodes (12.3 vs 0.7), blood loss (22.8 mL vs 11.0 mL), operation duration (1.7 h vs 0.8 h), postoperative iPTH (16.4 pg/mL vs 41.9 pg/mL), preoperative iPTH (39.4 pg/mL vs 47.8 pg/mL) in SH group; and postoperative calcium level (1.9 mmol/L vs 2.2 mmol/L). There was significant differences between the two groups ( P<0.05). However, there was no significant differences between them with postoperative pathological type (4 cases with toxic goiter, 3 cases with medullary thyroid carcinoma, 1 case with thyroid follicular carcinoma, 114 cases with papillary thyroid carcinoma in SH group; 1 case with medullary thyroid carcinoma, 1 case of thyroid follicular carcinoma, 98 cases with papillary thyroid carcinoma in control group, P=0.25) and preoperative calcium (2.3 mmol/L vs 2.3 mmol/L, P=0.10). For patients with bilateral thyroidectomy, SH was easy to occur when postoperative iPTH < 20.08 pg/mL, and its sensitivity and specificity were 74.07% and 96.30%; however, for patients with unilateral thyroidectomy, SH was easy to occur when iPTH < 24.00 pg/mL after operation. Conclusions:Gender, age, postoperative calcium, preoperative iPTH, postoperative iPTH, central lymph node number, blood loss, operation duration, lymph node dissection method and thyroidectomy range are important factors affecting the occurrence of SH after thyroidectomy. With the expansion of surgical range, the postoperative iPTH level gradually decreases, which predicts the occurrence of symptomatic hypocalcemia. In order to avoid the occurrence of symptomatic hypocalcemia after operation, it is necessary to supplement calcium in time according to the range of operation and postoperative iPTH level.
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Thyroid carcinoma (TC) is one of the most prevalent endocrine malignancies worldwide. Patients with TC have high overall survival, but TC experienced the largest increase in incidence. Therefore, it is necessary to get further understanding of the mechanism involved in the development and progression of TC. The concept of the competing endogenous RNA (ceRNA) further illuminates the mechanism of tumorigenesis. Current studies indicate that psedugenic RNA, lncRNA, circRNA and mRNA, all of which may take part in the construction of ceRNETs as ceRNAs. These ceRNAs harbour the same miRNA response element (MRE) as mRNAs. Thus, ceRNAs can also competitively inhibit mRNA binding to the miRNAs, which results in affecting mRNA expression to exerts a pro-oncogenic or tumor-suppressive influence in tumor. Recently, a large number of studies have shown that ceRNA molecules play an important role in the malignant behavior of thyroid cancer. Therefore, it is necessary to summarize these studies. The purpose of this paper is to classify these ceRNA molecules in thyroid cancer and to elaborate the functions of these molecules in thyroid cancer.
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The fungal microbiota from self-retained soil and tongue coating of 18 patients with precancerous lesions of upper gastrointestinal (PLUG) were sequenced. The diversity of α, β in and the structure of the microbial community were analyzed, and the association of them was quantified by using the Spearman rank correlation method. The richness index (1.67±2.79) and the diversity index (0.25±0.10) of the fungal microbiota from tongue coating of PLUG patients were significantly lower than those from soil (4.00±4.69; 0.99±0.18) (all P values<0.001). The relative abundance of 11 taxa from tongue coating of these PLUG patients was positively associated with that from soil (all P values<0.05).
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Objective This paper aims to observe and analyze the effect of hepatic arterial chemoemboliza-tion combined with arsenic trioxide injection in the patients with primary liver cancer.Methods This study includ-ed Ninety patients with primary liver cancer who were treated in our hospital from January 2013 to June 2016.The patients were divided into the study group and control group and the two groups were given different treatment proto-cols. The patients in the control group were treated with hepatic arterial chemoembolization and the patients in the study group were treated with arsenic trioxide injection.On the basis of the treatment effect was observed and com-pared. Results There was no significant difference between the two groups in recent curative effect(P > 0.05);the study group had higher one year survival rate than the control group(P<0.05).There was no significant differ-ence between the two groups in adverse reactions(P>0.05);the study group was superior to the control group in terms of improvement of quality of life(P < 0.05). Conclusions Hepatic arterial chemoembolization combined with arsenic trioxide injection can improve one year survival rate of primary liver cancer patients,and provide good long-term survival rate without obvious adverse reactions,and improve quality of life of patients.