Clinical analysis of differentiated thyroid carcinoma in children and adolescent: 75 cases / 中华内分泌外科杂志

Objective To investigate the clinical characters and treatment strategies of differentiated thyroid carcinoma in children and adolescent.Methods The clinical data of 75 cases of thyroid carcinoma in children and adolescents(≤ 18 years old)from Jan.2004 to Mar.2017 in the First Hospital of China Medical University were retrospectively analyzed.Clinical pathology characters and prognosis between patients ＜13 years old (group A) and those ≥ 13 years old (group B) were compared.Results There were 74 cases with papillary carcinoma and 1 with follicular carcinoma.The rate of lateral neck lymph node metastasis(100％ vs 54.5％,x2=6.818,P=0.025) and bilateral location (55.6％ vs 18.2％,x2=6.311,P=0.037) in group A were higher than in group B.There were no significant differences in central lymph nodes metastasis (88.9％ vs 69.7％,x2=1.758,P=0.420),gender composition ratio (22.2％ vs 31.8％,x2=0.343,P=0.841),extra-thyroid extension (33.3％ vs 18.2％,x2=1.136,P=0.534),distant metastasis(11.1％ vs 1.5％,x2=2.810,P=0.566) and recurrent disease(25％ vs 7.8％,x2=1.141,P=0.183) between the two groups.Conclusions Papillary carcinoma is the most common pathology type in children and adolescent thyroid carcinoma.Patients＜13 years old are more likely to present lateral neck lymph node metastasis and bilateral location.

Analysis of the imageology characters of predominantly cystic thyroid carcinoma / 中华内分泌外科杂志

Objective To explore the ultrasonographic and CT imaging features of predominantly cystic thyroid carcinoma (PCTC).Methods The retrospective analysis was performed on 30 cases of thyroid carcinoma with predominantly cystic composition confirmed by pathololy in the General Surgery Department of the First Affiliated Hospital of China Medical University from Jan.2011 to Dec.2016.The distribution of their solid portion's ultrasound characters including the eccentric configuration,irregular margin and increased vascularity were observed in all PCTCs.The CT images of 9 cases were analyzed,and the distribution of their solid portion's CT characters including irregular margin,uneven enhancement and papillary structure were observed in 9 PCTCs.Results In the ultrasound images of 30 PCTCs' whole shapes,26 cases (86.7％) showed oval and 24 cases (80.0％) showed smooth margin.26 cases (86.7％) showed eccentric configuration,20 cases (66.7％) showed rich blood flow and 19 cases (63.3％) showed irregular margin in the solid portion's ultrasound image.Only 7 cases(23.3％) showed microcalcification.Every ultrasound image of 30 PCTCs showed at least one or more of the three ultrasound characters,including eccentric configuration,irregular margin and increased vascularity.In the solid portion of 9 PCTCs,7 cases (77.8％) showed irregular margin,6 cases (66.7％) showed uneven enhancement and 6 cases(66.7％) showed papillary structure in the CT image,and every one of them showed at least one or more of the above 3 CT characters.Conclusion When the solid portion of predominantly cystic thyroid nodule appears to have some suspicious malignant characters in the image of ultrasound or CT,we should be vigilant that the nodule may be malignant.

Current situation and thoughts on radiofrequency ablation in the treatment of thyroid cancers / 中华外科杂志

Radiofrequency ablation (RFA) was originally used primarily for the treatment of regional metastatic lymph nodes from recurrent thyroid cancers in the field of thyroid surgery. In recent years it is gradually used to treat a part of benign thyroid nodules. However, the domestic issues resulting from indiscriminately enlarged RFA indication and lack of standardization of therapy become more and more prominent, including initial treatment of operable thyroid cancers by RFA, which is against by the current consensus about RFA for patients with thyroid nodules and management guidelines for patients with thyroid cancers. Therefore, RFA should be avoided for initial treatment of operable thyroid cancers before the introduction of guidelines based on evidence-based medicine.

Clinical analysis of the changing trend of serum thyrotropin in patients after hemithyroidectomy / 中华内分泌代谢杂志

Objective To evaluate the changing trend of serum thyrotropin (TSH) levels for hemithyroidectomy patients,and to discuss the necessity and strategy of TSH suppression for low-risk differentiated thyroid carcinoma(DTC). Methods One hundred and twenty-seven patients with benign thyroid nodules undergoing hemithyroidectomy between January 2013 and June 2014 were retrospectively studied. Serum thyroid hormones levels FT3,FT4,TSH,thyroid peroxidase antibody(TPOAb),and thyroglobulin antibody(TGAb)were detected at 1 month after surgery for all patients and at 3 month for 54 patients. Results (1)Mean TSH level at 1 month after surgery was significantly higher than preoperative TSH level(2.45 mIU/L vs 2.20 mIU/L,n=127,P<0.01). The mean TSH level at 3 month after operation was significantly higher than preoperative ones(2.46 mIU/L vs 2.35 mIU/L,n=54, P<0.05). (2)TSH<2. 0 mIU/L was found in 52 patients(40. 9%) and TSH>4. 94 mIU/L in 18 patients (14.17%) at 1 month after operation. TSH<2.0 mIU/L was found in 28 patients(51.85%)and TSH>4.94 mIU/L in 8 patients(14.81%) at 3 month after operation. (3)A preoperative TSH≥2.0 mIU/L and the coexistence of Hashimoto's thyroiditis were found to be independent risk factors for the TSH levels higher than 2.0 mIU/L. Among the patients with TSH≥2. 0 mIU/L at 1 month, 13 exhibited spontaneous recovery at 3 month, coexistence of Hashimoto's thyroiditis was related to this phenomenon. Among the patients with TSH<2.0 mIU/L at 1 month,TSH levels were elevated over 2. 0 mIU/L in 7 patients by 3 month comparing to that by 1 month. Coexistence of Hashimoto's thyroiditis was independent risk factor for the TSH elevation. Conclusion TSH suppression may still be performed to patients with low risk DTC after operation especially to whom the preoperative TSH≥2.0 mIU/L and the coexistence of Hashimoto's thyroiditis. Suppression therapy should be carefully considered with close follow-up.

The characteristics and risk factors of central lymph node metastasis in cN0 PTC coexisting with HT / 中华内分泌外科杂志

Objective To investigate the characteristics and risk factors of central lymph node metastasis in clinically node negative (cN0) papillary thyroid carcinoma (PTC) (T1 or T2 stage) coexisting with Hashimoto' s thyroiditis (HT).Methods A total of 398 patients undergoing thyroidectomy with central lymph node dissection were enrolled in the study.Patients were divided into the trial group (PTC with HT)and the control group (PTC without HT).The difference of the clinicopathological characteristics between the 2 groups and risk factors for central lymph node metastasis were analyzed.Results Among the total 398 patients,98 (24.6％)had coexistent HT.Central lymph node metastasis rate was similar in the 2 groups (40.8％ vs 41.3％).The number of dissected central lymph nodes was significantly more in the trial group than in the control group (4.9 vs 2.9,P＜0.01) while the number of metastatic lymph nodes had no statistical significance between the 2 groups (1.0 vs 1.0).Univariate analysis showed that tumor size＞1 cm was significantly associated with central lymph node metastasis in the trial group (P＜0.01).Male,＜45 years,tumor size＞1 cm,and tumor located in the middle/lower third of lobe were all significantly associated with central lymph node metastasis in the control group (P＜0.01).Multivariate analysis showed that tumor size＞1 cm was independent predictor for central lymph node metastasis in the trial group,while female,＜45 years,tumor size＞1 cm,and tumor located in the middle/lower third of lobe were all independent predictors for central lymph node metastasis in the control group.Conclusions The number of central lymph nodes was larger in cN0 PTC coexisting with HT patients than that in PTC patients,but there was no statistical difference in the number of metastatic lymph nodes between cN0 PTC with and without HT.Central lymph node dissection is recommended when tumor size 1 cm in cN0 PTC coexisting with HT patients.

Significance of Medical Imaging for Primary Thyroid Malignant Lymphoma Diagnosis / 中国医科大学学报

Objective To evaluate the diagnostic value of medical imaging for primary thyroid malignant lymphomathe(PTML). Methods The medical imaging of 45 PTML cases admitted between January 2000 and December 2014 in the First Hospital of China Medical University were ana?lyzed retrospectively. Results In ultrasound imaging,PTML exhibits a hypoechoic mass and enhancement of posterior echoes,the uninvolved thy?roid tissues also exhibit low echoes but they have clear boundaries with extremely low echo areas of PTML.CT imaging of PTML often shows homoge?neous enlargement of the lobes of the thyroid gland and isthmus with densities lower than the adjacent muscles. In contrast?enhanced CT images,le?sions are moderately enhanced,but they are obviously enhanced in the edge or internal area and the degree of enhancement remains lower than that of the adjacent muscle. Calcification is uncommon. A lesion withcold nodulecan be observed in ECT imaging. Conclusion The characteristic im?aging findings are helpful for preoperative diagnosis of PTML.

Diagnostic value of ultrasound-detected calcification in thyroid nodules

<p><b>INTRODUCTION</b>This study analyses the diagnostic value of ultrasonography (US) detection for calcification in thyroid nodules.</p><p><b>MATERIALS AND METHODS</b>We analysed the preoperative US findings and clinical characteristics of 577 malignant and 3434 benign thyroid patients who underwent surgery in our hospital.</p><p><b>RESULTS</b>The malignant rate in patients with microcalcification hyperechoic and tiny calcification foci ≤2 mm in diameter was significantly higher than the non-calcification and other calcification group (P <0.001). The malignant rate in single calcifi cation nodule was signifi cantly higher than that in multiple nodule group (P <0.01). Most of the patients (37/39) with lymph node calcification were malignant. The malignant rate of calcification and microcalcification was significantly higher in patients <45 years old than in older patients (P <0.05).</p><p><b>CONCLUSION</b>Compared with other calcifications, microcalcification should be a better predictor of thyroid carcinoma. Malignancy should be highly suspected in patients with single calcification nodule, especially with lymph node calcification. Patients younger than 45 years of age with calcification or microcalcification have a greater risk for thyroid carcinoma.</p>

Value of ultrasound detection of calcification in the diagnosis of thyroid carcinoma / 中华普通外科杂志

ObjectiveTo investigate the clinical value of sonographic detection for calcification in diagnosis of thyroid carcinoma.MethodsClinical data of 3924 thyroid disease patients examined by ultrasonography and pathology at First Hospital of China Medical University were retrospectively reviewed to investigate the relationship between calcification, microcalcification, macrocalcification and peripheral calcification with thyroid carcinoma,the relationship between solitary nodule with calcification and multiple nodules with calcification with thyroid carcinoma and the relationship between calcification with thyroid carcinoma in different age groups. ResultsThe incidences of calcification,microcalcification in malignant and benign thyroid patients were 32.05％,6.50％ and 80.07％,51.53％,the incidences of calcification and microcalcification were significantly higher in malignant group than in benign group (P ＜ 0.01 ).The incidence of carcinoma in solitary nodules with calcification was 53.33％ while it was 22.2％ in multiple nodule group,the incidence of carcinoma in solitary nodules with calcification was significantly higher than that in multiple nodules (P ＜ 0.01 ).The incidence of carcinoma in solitary nodules with microcalcification was 74.1％ while in multiple nodule group it was 47.9％,the incidence of carcinoma in solitary nodules with microcalcification was significantly higher than that in multiple nodules ( P ＜ 0.01 ).The incidence of carcinoma younger than 70 years of age with caicification in different age groups was significantly different (P ＜ 0.05).In 40 and younger age group,the incidence of carcinoma with microcaicification was higher than that in over 44 years group (P ＜ 0.01 ).ConclusionsCalcification or microcalcification is considered to be a risk factor of thyroid carcinoma.Solitary nodules with calcification or microcalcification found in younger patients were more likely to coexist with thyroid carcinoma.