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Objective To evaluate the feasibility and effects of endoscopic thyroidectomy(ETE) for papillary thyroid carcinoma(PTC).Methods A total of 137 patients with PTC were enrolled from January 2013 to January 2016.The patients were divided into two groups depended on different surgical approaches.The patients'' characteristics,such as age,gender,pain,intraoperative blood loss,hospitalization,central lymph node metastasis etc were retrospectively analyzed in the two groups.Results In the study,78 patients performed ETE,and 58 performed COT.There was one case converted to open surgery from ETE due to intraoperative bleeding.The clinicopathological characteristics and operative complications between the two groups had no significant differences,such as gender,time of drainage,postoperative hospitalized days,positive lymph node metastasis,injury of recurrent laryngeal nerve,permanent injury of parathyroid glands.The age of patients was younger in ETE(t=-4.299,P=0.000).The drainage content(t=9.539,P=0.000),intraoperative blood loss(t=2.862,P=0.005) and subcutaneous ecchymosis (χ2=13.482,P=0.000) were found more in the ETE.ETE required a longer operative time(t=8.162,P=0.000).However,ETE provided better cosmetic outcomes than COT [(9.4±0.5)points vs.(5.4±1.0)points,t=30.142,P=0.000].No clinical recurrence and metastasis occurred for at least one-year follow-up.Conclusion With excellent cosmetic results,ETE is a feasible and safe operation for patients with PTC without metastasis to lateral cervical lymph nodes.
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Recent studies have revealed that obease increases the risk of differentated thyroid carcino-ma (DTC);iodine increases the risk of papillary thyroid carcinoma wheras decreases the risk of follicular thy-roid carcinoma;vitamin D decreases the risk of DTC,but there are not enough evidences to prove that vitamin A,C and E can decrease the risk of DTC;alcohol may decrease the risk of DTC,but the mechanism is still un-known;xenobiotics increases the risk of DTC.It is essential for DTC prevention to clarify the protection and risk factors.
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Objective To investigate the feasibility and efficacy of untransection of anterior cervical muscles assisted by ultrasonic scalpel in the treatment of benign thyroid neoplasma. Methods A total of 108 cases with benign thyroid tu-mor were randomly divided into treating group and control group. 62 cases in treating group were treated with the un-transection of anterior cervical muscles assisted by ultrasonic scalpel, while 46 cases in control group were treated with tradition thyroidectomy. The preoperative, intraoperative and postoperative indicators of the two groups were analyzed. Results The average length of incision, operating time, blood loss, postoperative drainage volume, pain scores, scar scores and hospital time of treating group had significantly differences compared with control group (P<0.05). However, no significant difference was found in operative injuries and complications between the treating group and the control group (P>0.05). Conclusion Ultrasonic scalpel-assisted thyroidectomy is a safe and effective procedure for benign thy-roid diseases, with little trauma, less blood loss, and excellent cosmetic benefits. It is worthy of popularization and ap-plication, especially in the basic level hospital.
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Objective To study the effects of quantitative 24-hour urinary protein on the thyroid hormone levels in patients with severe preeclamp-sia,and clarify the impact of severe urinary protein on hypothyroid in severe preeclampsia patients. Methods A total of 166 patients with severe pre-eclampsia were recruited for the study and divided into mild proteinuria group(2.0-4.9 g/d),midrange group(5-10 g/d)and severe group(>10 g/d)according to the quantitative 24-hour urinary protein. 268 healthy female individuals with normal blood pressure and uric routine in the same stage of pregnancy and of the same age were selected into control group. Serum thyrotropin(TSH),free triiodothyronine(FT3)and free thyroxine (FT4)levels were determined by solid-phase chemiluminescent enzyme immunoassay method(CMIA). The thyroid peroxidase antibody(TPOAb) and thyroglobulin antibody(TGAb)concentration were detected by electrochemiluminescent assay(ECLIA). Results TSH levels were signifi-cantly higher in patients comparing to the control group(P0.05). The incidence of subclinical hypothyroidism and clinical hypothyroidism in severe group was significantly higher than that in mild group and in control group(OR=2.5,P<0.05 and OR=9.0,P<0.05;OR=8.0,P<0.01 and OR=43.4,P<0.01). Conclusion Our re-sults indicated that 24-hour urine protein in severe preeclampsia patients has extensive effects on thyroid hormones levels. With the increasing of quantitative 24-hour urinary protein,the level of TSH increased and the FT4 decreased. Thyroid autoantibody positiveness has extensive effects on 24- hour urine protein. Incidence of hypothyroid increased with the increase of quantitative 24-hour urinary protein. 24-hour urinary protein quantitative was a risk factor for hypothyroidism in severe preeclampsia patients. More attention should be paid to the monitoring of 24-hour urinary protein in se-vere preeclampsia patients.
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We report a case of an eight year old female child with a midline neck mass for seven years. Since its early presentation, this midline mass has recently increased in size. A presumptive diagnosis of thyroglossal duct cyst was made clinically & planned for surgery. Preoperative evaluation revealed hypothyroidism, hence she was referred to us for the management of the same prior to excision. On further evaluation 99 Tc-thyroid scan showed that this midline mass was in fact the only functioning thyroid tissue & ultrasonography revealed no thyroid tissue in usual location, therefore no surgery was performed. This case demonstrates the essential role of a thyroid scan and ultrasonography in the preoperative evaluation of a midline neck mass.
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One hundred children aged 8-10 years and 100 adults aged 18-45 from their families in three townships Baoshan,Mingcheng,and Yantongshan of Panshi city,Jilin province were selected in April 2009. In addition,50 pregnant or lactating women,and their 50 infants aged 0-2 years were selected.The median level of iodine in salt at household was 30.2 mg/kg and that of drinking water was 2.8 μg/L.The median levels of urine iodine in school age chidren ( 196.5 μg/L),during pregnancy( 198.5 μag/L),lactation( 224.9 μg/L),and in infants (209.0 μg/L) all were optimal according to World Health Organization criteria.Only the median urine iodine in adults ( 269.0 μg/L) was more than adequate.The prevalence of goiter evaluated by B-ultrasound was 1.8％ in 8-10year-old children.The incidences of various thyroid dysfunctions were low in these residents,such as subclinical hyperthyroidism ( 2.1％ ),subclinical hypothyroidism ( 1.5％ ),and hyperthyroidism ( 1.2％ ). Subclinical hypothyroidism occurred mostly in adults (2.7％),pregnant women ( 1.7％ ),and lactating women ( 1.8％ ) ; and subclinical hyperthyroidism occurred mostly in 8-10 years old school chidren (4.5％) and lactating women (3.6％).These results show that the current iodized salt content has no harmful effect on thyroid function of rural residents in Jilin province.
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The levels of macrophage migration inhibitory factor (MIF) in peripheral blood mononuclear cell (PBMC) and serum in patients with Hashimoto's thyroiditis (HT) were detected by real-time PCR and ELISA,respectively.The results revealed that the expression of MIF mRNA in PBMC ( Z =-4.276,P＜0.01 ) and protein level in serum ( Z=-5.358,P＜0.01 ) were increased in HT patients,and positively correlated with thyroid specific autoantibodies and TSH levels.
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Objective To observe the effects of iodine excess on thyroid morphology,the expression of thyroid peroxidase and sodium iodide symporter mRNA and to explore their mechanisms.Methods One-month SD rats were divided into three groups:control iodine(CI),high iodine Ⅰ(HI Ⅰ)and high iodineⅡ(HI Ⅱ)and were fed with water containing iodine in different concentrations by adding K103(5,5000,10 000μg/L)respectively.Rats were sacrificed after being fed for six months.The morphology of thyroid was investigated under light microscopy and electron microscopy,the serum thyroid hormones and ratio of TPO/β-actin and NIS/β-actin were measured by radio-immunoassay and RT-PCR method.Results The major changes were increased follicles with colloid accumulation in HI groups.The levels of serum thyroid hormones TT3 and TT4 were decreased gradually from CI[(75.68±13.99,1.45±0.49)nmol/L]to HI Ⅰ[(73.82±16.48,1.34±0.31)nmol/L]and HIⅡ groups[(70.65±11.43,1.15±0.39)nmol/L],but there were no significant differences among three groups(F=O.371,l.163,P＞0.05).The TPO and NIS mRNA expressions in HI Ⅰ(1.28±0.10,0.56±O.17)and HI Ⅱ(1.14±0.04,0.39±0.06)were significantly lower(F=30.863,62.62.675,P＜O.05)than those of control group(1.39±0.08,0.71±0.13).Conclusions Chronic iodine excess leads to definite histological changes in rat thyroid,and inhibits the expressions of TPO and NIS mRNA as well as thyroid hormone synthesis,which in turn acts as a protective mechanism against iodine excess.
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Objective To evaluate the reliability and sensitivity of detection of thyroid carcinoma lymph node micrometastasis with MUC1.Methods In 488 cases of thyroid disease,1% methylene blue 1.0-2.0mL was injected into the thyroid nodule or surrounding thyroid tissue 24hours before operation.The dye-stained lymph nodes were detected at operation and RT-PCR method was used to determine MCUI in the clinically blue-stained lymph nodes.Results The detection rate of the blue-stained lymph nodes in thyroid carcinoma was 93%,and in benign lesions was 0%.In the research group,80 cases were found to have blue-stained lymph nodes,the detection rate was 95% and was higher than the pathologr diagnostic rate which was 86%(P
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Objective To study the choice of initial operative approach for thyroid nodule and the necessity of reoperation after local excision of differentiated thyroid cancer.Methods Clinical data of 138 patients with differentiated thyroid cancer after local tumor excision had reoperation at our hospital during a period of four year were retrospectively reviewed.All the reoperations were bilateral thyroidectomy and cervical lymph node excision.Results There were 76.8% patients with residual cancer in thyroid and cervical lymph node.There were 23 patients(16.7%) with recurrent laryngeal nerve injury that included 22 cases with unilateral and 1 case with bilateral injury after the initial operation,and 19 of the 23 patients with recurrent laryngeal nerve injury recovered after nerve repair.After thyroid reoperation,3 cases(2.2%) had recurrent laryngeal nerve injury,2 cases(1.4%) had partial parathyroid gland injury,2 cases(1.4%) had superior laryngeal nerve injury,but there were no cases of esophageal injury or postoperative bleeding.Conclusions The incidence of residual cancer is high after local excision for differentiated thyroid cancer,therefore,reoperation with bilateral thyroidectomy and cervical lymph node excision is necessary.
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Hypothyroidism may be accompanied by different rheumatic syndromes such as neuropathy. Arthropathy and myopathy. Sebere myopathy with high elevations of creatine kinase (CK) is rarely seen in hypothyroidism. Authors experinced a case of myopathy with hypothyroidism. Similar to rheumatoid arthritis or polymyositis like syndrome. We have treated with thyroid hormone replacement (Levothyroxine sedium 100ug/day) for 10 months. The initial serology resulted in : free T4 0.51ng/dl, TSH 110ulU/ml, LDH 465 units, and CK 4385 units. After tratment, we gained free T4 1.60ng/dl, TSH 0.14uIU/ml, LDH 110 units, and CK 80 utits and musculoskeletal symptoms are much improved We reprort this patient with a review of literatures.
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Humanos , Artrite Reumatoide , Creatina Quinase , Hipotireoidismo , Doenças Musculares , Polimiosite , Glândula TireoideRESUMO
Objective To summarize the methods and outcome of surgical treatment of thyriod carcinoma(TC).Methods The clinical data of 126 cases of TC admitted between 1990 to 2005 to our 2 hospitals was analyzed.Results Among the 126 cases,there were papillary carcinoma in 94 cases(74.5%),follicular carcinoma in 20 cases(15.9%),medullary carcinoma in 5 cases(4%),anaplastic carcinoma in 4 cases(3.2%),lymphoma in 2 cases(1.6%) and squamous cell carcinoma was in 1 case(0.8%).Thyroid microcarcinoma(TMC) was found in 56 of 126 cases and all of them were papillary carcinoma.(Seventy)-eight cases were followed up for more than 5 years after operation and 36 cases for 3 to 5 years,and all have good quality of life.All of the 4 cases with anaplastic carcinoma died in 3 to 6 months.Two cases with medullary carcinoma and 1 case with squamous cell carcinoma died from pulmonary metastases 1 year after operation.Conclusions For differentiated TC,surgical treatment is the ideal treatment.However,for(anaplastic) TC,operation is not to be recommended,the choice of treatment is radiotherapy.
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Objective To investigate the calcification of thyroid nodule detected on ultrasound and the relation with benign and malignant disease.Methods Data of 107 cases of malignant and 703 cases of benign(thyroid) nodules examined by high-resolution colored ultrasonography preoperatively and pathological diagnosis by paraffin embedded slides postoperatively were collected from our hospital over a period of 3 years.The(percentages) of calcification and fine stippled psammomatous(FSP) calcification in benign and malignant(nodular) disease,in different sexes and different age groups were retrospectively reviewed.Results The(incidences) of calcification and FSP calcification were significantly higher in malignant group(63.55%,(29.02%),respectively) than in benign group(P0.05).Calcification rate showed no(significant) difference between different age groups(0.05);however,there was a significant difference of the FSP calcification rate between different age groups(P