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The occurrence and progression of thyroid cancer are related to a series of molecular changes and the activation of signaling pathways, which is the basis of targeted therapy. For inoperable locally advanced, metastatic and refractory thyroid cancer, especially anaplastic thyroid cancer, the efficacy of targeted therapies, particularly tyrosine kinase inhibitors (TKIs) , has been demonstrated in clinical trials. TKIs can relieve clinical symptoms, improve patients’quality of life, prolong the progress free survival, and even create opportunities for radical operation or reoperation. This article reviews and summarizes the key molecular events in tumorigenesis and progression of thyroid cancer, and analyzes the results of clinical studies on the efficacy and safety of different TKIs in refractory advanced thyroid cancer, in order to provide reference and assistance for individualized targeted therapy of patients.
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One of the major risks of total thyroidectomy, especially with central cervical lymph node dissection, is unintentional resection and devascularization of the parathyroid gland (PG) , which leads to temporary or permanent hypoparathyroidism (hypoPT) and causes hypocalcemia. Nowadays postoperative hypoPT is one of the most troubling complications for both surgeons and patients all around the world. In addition, primary or renal hypoPT requires the removal of pathological PG (s) . However, rapid identification of PGs, particularly ectopic or excess PG, could be sometimes difficult. Currently, the identification and protection of PGs mainly depend on the experience of surgeons and auxiliary methods such as fast frozen pathology, the negative imaging through nano-carbon, or PTH test strip, still have some limitations. As initial researches show, near-infrared autofluorescence imaging and optical coherence tomography can accurately perform the real-time identification of PGs; indocyanine green fluorescence or laser speckle contrast imaging can help to judge the activity of PGs intraoperatively. The basic principle, clinical application and prospect of these optical techniques in thyroid and parathyroid surgery will be reviewed in our article.
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Hypercalcemic crisis (HC) is a rare but critical electrolyte disorder, which may result in death if rapid correct management is not given due to the injury of the neurologic, cardiovascular and renal systems. Severe primary hyperthyroidism (PHPT) is listed as the most common cause of hypercalcemic crisis. Prompt surgical removal of the parathyroid glands is the most effective cure for HC. Nevertheless, hypercalcemic crisis after a successful parathyroidectomy is infrequent. Now, we report a case admitted to the Department of General Surgery of the Shanghai Jiao Tong University Affiliated Sixth People’s Hospital about a successful therapy of hypercalcemic crisis postparathyroidectomy in Sep. 2019, aiming to remind clinicians of the individualized program of calcium supplement after surgery of hyperparathyroidism and emphasize the value of renal dialysis in HC.
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Objective:To analyze the relationship between surgical resection range and prognosis of medullary thyroid carcinoma.Methods:Clinical data of 39 patients with medullary thyroid carcinoma treated in Shanghai Sixth People′s Hospital from Jan 2017 to Mar 2020 were retrospectively analyzed.Results:There were 13 males and 26 females, age ranging from 26 to 72 years old. Preoperative calcitonin levels increased from 21.5 to 20 000 ng/L. Tumor stage: stage Ⅰ was 35.9%, stage Ⅱ 23.1%, stage Ⅲ 25.6%, stage Ⅳ 15.4%. The proportion of lymph node metastasis in central region was 53.8% (21/39). The proportion of lateral cervical lymph node metastasis was 43.6% (17/39), which was statistically related with the preoperative calcitonin level ≥200 ng/L. The median follow-up was 10 months, and the biochemical and anatomical cure rates were 66.7% and 33.3% respectively. Transient recurrent laryngeal nerve palsy, temporary and permanent hypothyroidism were 2.6%, 23% and 2.6%, respectively. There was no postoperative hemorrhage, infection, lymphatic leak or death.Conclusions:Bilateral total thyroidectomy, and at least ispilateral central lymph node dissection were advocated for patients with MTC. When preoperative calcitonin level ≥200 ng/L, lateral cervical lymph node dissection is advised.
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Objective To discuss the feasibility of totally transoral video-assisted thyroidectomy (TO-VAT).Methods Data of 30 hyperthyroidism patients treated with TOVAT from Jan.2014 to Dec.2016 were retrospectively analyzed.Index such as operative time,intraoperative blood loss,hospital stay,complication were recorded.Results No neck scar was found,and patients were satisfied with the cosmetic effects.The average surgical time was (97.3±13.4) min,blood loss 24.0(12.3～28.3)ml,hospital stay (2.0±0.5)d,cosmetic score 8.2± 0.3.No hoarse voice,drinking cough,bleeding,convulsion,or parathyroid injury happened.Two patients had swelling in the anterior cervicaarea,2 patients showed lower jaw numbness and 1 patient showed temporary hypoparathyroidism.During the follow up of 1 to 35 months,all were subjected to symptomatic management and recovered.Conclusion TOVAT is a safe and effective technique with the advantages of minor iniury,quicker recovery,fewer complications and good cosmetic effect.
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The aim of this study was to investigate the correlation between elastography and histologic characteristics including fibrosis and calcification. We also wanted to investigate whether other clinicopathologic indexes influence the strain ratio (SR) of papillary thyroid carcinomas (PTCs). We retrospectively reviewed 126 papillary thyroid carcinomas (PTCs) from 103 patients who underwent ultrasonography and elastography before surgery. The histologic characteristics and clinicopathologic indexes were compared with the SR of ultrasound elastography (UE). The results showed that there was a significantly positive correlation between fibrosis degree and SR measurements (r = 0.754, p = 0.000); the SR was significantly different between the groups with and without calcification (11.34 ± 10.08 vs. 6.81 ± 7.33, p = 0.000). The standard coefficients of collagen and stromal calcification were 0.684 and 0.194, respectively. There was no significant correlation between SR and indices such as size, position, co-existence with Hashimoto's thyroiditis (HT), multifocality or cervical lymph node (CLN) metastasis. In conclusion, we found that the SR of UE is positively correlated with the fibrosis of PTC. Stromal calcification will elevate the SR dramatically, but psammoma bodies will not when they exist in the absence of stromal calcification.
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Carcinoma, Papillary/diagnostic imaging , Carcinoma, Papillary/pathology , Elasticity Imaging Techniques , Thyroid Neoplasms/diagnostic imaging , Thyroid Neoplasms/pathology , Ultrasonography , Adult , Aged , Calcinosis , Elasticity Imaging Techniques/methods , Female , Fibrosis , Humans , Male , Middle Aged , Thyroid Cancer, Papillary , Tumor Burden , Ultrasonography/methods , Young AdultABSTRACT
Objective To analyze whether preoperative serum thyroglobulin (Tg) can be the indicator for predicting malignancy in follicular thyroid tumors (FTC).Methods A retrospective analysis was done for 125 patients with FTC who had been diagnosed by pathology in our hospital.The patients were grouped into benign group and malignant group.Sex,age,tumor size and preoperative serum Tg concentration were analyzed.Results There were 62 patients in benign group (23 male and 39 female).The mean age was 49 years old,ranging from 19 to 78 years,and the mean diameter of tumors was (3.4±1.374) cm,ranging from 0.1 to 5.5 cm.There were 63 patients in malignant group (13 male and 50 female).The mean age was 46 years old,ranging from 15 to 79 years,and the mean diameter of tumors was (3.14±1.143) cm,ranging from 0.3 to 7 cm.The mean preoperative serum Tg concentration was (299.73± 495.02) ng/ml in malignant group and(48.20 ±43.68)ng/ml in the benign group.Through comparing the two groups,we found age and tumors diameter had no statistical difference between the two groups (P＞0.05),while sex and Tg had statistical difference (P＜0.05).When the cutoff of Tg was 100 ng/ml,the sensitivity and specificity for the diagnosis of malignancy was 48.7％ and 90％ respectively.Conclusions Tg can be used as auxiliary diagnosis index of thyroid FTC.High preoperative Tg levels should be highly suspected the possibility of FTC.
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Thyroid cancer is one of the most common malignant tumors.Advanced thyroid cancer usually invades encroachs nerves,blood vessels,trachea,esophagus,and other organs,and needs muhidisciplinary team for better effect.The disease center of diagnosis and treatment provides a good platform for multidisciplinary treatment of advanced thyroid cancer.
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Objective To investigate the application of carotid artery resection and reconstruction in surgical management of thyroid carcinoma with carotid artery involvement.Methods We conducted a retrospective cohort study involving 10 patients whose common carotid arteries were invaded by thyroid carcinoma.All patients underwent tumor en bloc resection and carotid arteries reconstruction.Patients were evaluated by muhidisciplinary team and surgeries were cooperated by general surgeons,orthopedists and vascular surgeons.The perioperative complications and surgical outcomes were also recorded and analyzed.Results No patient had complications of central nervous system.One patient suffered Horner syndrome and one presented hoarseness postoperative.Two patients had wound infection,two patients presented carcinoma recurrence and two patients presented distant metastasis during the follow-up.Conclusion En bloc resection of tumor and carotid artery reconstruction is a feasible modality in treatment of thyroid carcinoma with carotid artery invasion.
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Thyroid cancer is the most frequent endocrine cancer and its incidence is progressively growing.Bone metastasis is are not uncommon in clinic.The efficacy is limited for patients with single treatment.However,multi-disciplinary combination therapy,combined with thyroid surgery,bone tumor surgery,nuclear medicine could get better outcomes and improve the life quality of the patients.
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Recurrent laryngeal nerve injury is one of the serious complications after thyroidectomy.Unilateral injury causes hoarseness,while bilateral injury causes difficulty in breathing or even life-threatening glottis obstruction.Analyzing the root cause of the thyroid injury,firstly it is the anatomical factors of recurrent laryngeal nerve,namely the close and complex relationship between the recurrent laryngeal nerve and the inferior thyroid artery,the existence of branches of recurrent laryngeal nerve and its variation,and the presence of non recurrent laryngeal nerve and Zuckerkandl nodules.Those are all made the recurrent laryngeal nerve easy to be damaged.Secondly it is because of the vulnerability of the recurrent laryngeal nerve itself.Last improper using of energy operation instrument will cause heat injury on nerves.Below counter measures can be implemented to prevent recurrent laryngeal nerve injury.Dissect to show recurrent laryngeal nerve or make it ‘ visualization’ during thyroidectomy.Elaborately anatomize recurrent laryngeal nerve to appropriate degree.Be familiar with the property of energy operation instrument and thus safely use them to reduce the heat injury of recurrent laryngeal nerve.Reasonably use the intraoperative nerve monitoring in the surgery,which assist to reduce the risk of injury of recurrent laryngeal nerve.
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Objective To investigate the heat effects of the high-frequency electric knife on the recurrent laryngeal nerve ( RLN) in pigs and the safety margin in which electric knife can be used .Methods Totally 12 pigs for experiment were randomly divided into 3 groups by the distance between the head of the electric knife and the nerve(2 mm, 1 mm, 0 mm).The application time of the electric knife touching RLN was set to be 3 s and the application energy of the electric knife was 90 W.The data of electromyogram were measured by means of nerve detector before and after operation .Statistical analysis was made based on those data .The nerve tissues were taken to make paraffin sections so that the histological change can be observed and compared before and after damage.Results The data from electromyogram by nerve detector indicated that the difference of the amplitude of group 2(1 mm)and group 3(0 mm)had statistical significance(P<0.05)within group.There were significant difference of the amplitude between the 3 groups.Histological study showed that the tissues of group 3(0 mm)had obvious injury .Conclusions In thyroid surgery , the safety range of high frequency electrical knife used around RLN is:the distance from electrical knife head to nerve should be no less than 2 mm.
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Objective To investigate the effects of targeted forkhead box E1( FOXE1) gene on epitheli-al-mesenchymal transition(EMT) of papillary thyroid cancer (PTC) cell line TPC-1, and to study its role in in-vasion and migration of TPC-1 cells.Methods The lentiviral expression vector for RNA interference of FOXE 1 gene was constructed to silence the expression of FOXE 1.Real-time polymerase chain reaction ( RT-PCR) and Western blot were used to detect the expression of such EMT markers as E-cadherin , N-cadherin and Vimentin . Transwell assay and Scratch assay were used to analyze TPC-1 cells migration and invasion .Results After RNA interference of FOXE1, the morphology of TPC-1 cells indicated a transformation of EMT .The expression of epi-thelial phenotype marker E-cadherin decreased remarkably while mesenchymal marker Vimentin was significantly up-regulated(P<0.01).Compared with the control group , the expression of Vimentin mRNA in the experimen-tal group was 2.24 times higher .The migration and invasion ability of TPC-1 cells increased significantly , and the number of cells in transwell was 2.11 times of the control's.Conclusion The silence of FOXE1 gene probably increases the invasion potential of human PTC cells through EMT .
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Objective To explore the clinical significance of intraoperative neuromonitoring (IONM)of recurrent laryngeal nerve (RLN) during thyroid cancer surgery.Methods 200 patients undergoing thyroid cancer surgery from Oct.2011 to May 2012 were retrospectively reviewed.The 200 patients were divided into 2 groups:100 patients in group A with IONM and 100 patients in group B without IONM.Results Group A had less RLN exposure time than group B(10.5 vs 15.3 mins,P ＜0.01).Group A had shorter operation time than group B (78.5 vs 82.3 mins).The difference had no statistical significance (P ＞ 0.05).Transient RLN palsy occurred to 5 cases in group A and 11 cases in group B(P＜0.05).Permanent RLN palsy occurred to 1 case in group A.No one in groupB had permanent RLN palsy (P ＞ 0.05).Conclusions IONM can reduce the incidence of transient RLN palsy compared with visualization alone.It is an effective procedure for identifying and protecting RLN in thyroid cancer surgery.
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Fox family transcription factors have crucial biology functions,including the regulation of proliferation,differentiation and tumorigenesis.Deregulation of Fox proteins expression may act as both oncogenes and tumor suppressors,the relevant researches have been paid more and more attentions.Here,this review focuses on the roles of Fox family genes in oncogenesis from the articles published recently.
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BACKGROUND: Endoscopic thyroidectomy via thoracic/breast approach is an acceptable and successful technique in Asia. This technique has the advantage of better cosmesis compared with open or even video-assisted thyroidectomy. Unfortunately, because of the need for three separate ports, conventional endoscopic thyroidectomy usually involves significantly more tissue dissection, and thus more injury to patients, limiting the popularity of this technique. We herein present 35 cases of trans-areola single-site endoscopic thyroidectomy (TASSET), which was first performed in 2009. METHODS: Thirty-five patients who underwent TASSET for thyroid nodules from September 2009 to March 2011 were evaluated. The surgical outcomes of the surgery were retrospectively analyzed, including conversion, operative time, estimated blood loss, complications, length of stay, and patient satisfaction. RESULTS: Thirty-one of the 35 patients (88.5%) underwent successful TASSET, with subtotal lobectomy being the most common procedure. Median operative time for the surgery was 153.65 min (range 100-190 min). Estimated blood loss ranged from 20 to 40 mL. Length of postoperative stay ranged from 2 to 4 days (average 2.5 days). Visual analog scale scores were 0 to 4 without administration of analgesics. The complication rate was low (8.6%) and included one case of transient recurrent laryngeal nerve (RLN) palsy, one case of subcutaneous seroma, and one case of tracheal injury. All patients were satisfied with the cosmetic outcome after mean follow-up of 8 months. CONCLUSIONS: TASSET is feasible and safe, with great cosmetic benefits and less injury than other procedures. It may become an alternative procedure for treatment of patients with benign thyroid tumors, especially those with strong desire for cervical cosmesis.
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Endoscopy/methods , Thyroid Nodule/surgery , Thyroidectomy/methods , Adolescent , Adult , Blood Loss, Surgical , Breast/surgery , Feasibility Studies , Female , Humans , Length of Stay , Middle Aged , Pain, Postoperative/etiology , Patient Satisfaction , Pilot Projects , Retrospective Studies , Young AdultABSTRACT
Objective To explore the clinical effects of Kugel surgical treatment for inguinal hernia.Methods Operative time,chornic pain,complications and charges of 355 patients with inguinal hernias were analyzed retrospectively.Results Recurrences occurred in 1 patient,during a mean followl-up of 36 months (range:7-85).The average operation time was 35.4 min (range:20-130),average surgical charges were 6 253 yuan.Postoperaive chronic pain appeared in 6 patients.There are 3 cases of sermoa,1 case of haematoma and 2 case of wound infection.Conclusion The Kugel inguinal hernia repair is safe and effective,with the advantage of mild pain and prompt recovery after operation,and a low risk of complications and recurrence.
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Objective To study the expression of β-catenin and cyclin-D1 in sporadic parathyroid adenomas and the clinical significance.Methods Immunohistochemistry and RT-PCR were used to examine the expression of β-catenin and cyclin-Dl in 20 cases of sporadic parathyroid adenomas,10 cases of parathyroid hyperplasia tissues and 8 cases of normal parathyroid tissues respectively.Results The results of immunohistochemistry showed that the expression of β-catenin was decreased on cell membrane of normal parathyroid tissues,parathyroid hyperplasia tissues and sporadic parathyroid adenomas,and was increased in the cytoplasm and the nucleus.The expression of cyclin-Dl was significantly higher in the adenoma group and hyperplasia group than in the normal group( P ＜ 0.05 ).The difference had no statistical significance in terms of cyclin-Dl expression between the adenoma group and the hyperplasia group( P ＞0.05 ).The abnormal expression of β-catenin was significantly correlated with the overexpression of cyclin-D1 in sporadic parathyroid adenomas( P ＜ 0.05 ).RT-PCR analysis showed that the expression of cyclin-D1 mRNA was 2.36 ± 1.12 vs 1.50 ± 1.03 ( P ＜ 0.05 ),and the expression of β-catenin mRNA was 1.02 ± 0.45 vs 0.88 ± 0.56( P ＞ 0.05 ) in adenomas and normal parathyroid tissues respectively.Conclusion The abnormal expression of β-catenin activates cyclin-Dl and thus leads to the uncontrolled cell proliferation and differentiation,which may be one of the mechanisms of the occurrence of sporadic parathyroid tumors.
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AIM: Single-incision laparoscopic surgery has been successfully applied to abdominal general and bariatric procedures with advantages of less morbidity over conventional laparoendoscopic surgery. Minimally invasive and laparoendoscopic procedures have also recently been expanded for thyroid surgery. We report the first case of trans-areola single-incision endoscopic thyroidectomy (TASIET) in the world. CASE: A 20-year-old female patient presented with a solitary left thyroid nodule. Single-incision endoscopic thyroidectomy was successfully performed by an incision bordering the left breast areola. Two adjacent 10 mm and 5 mm trocars were used for the placement of a 10 mm videoscope (30 degrees) and ultrasonic shears, respectively. A single narrow tunnel was first created from the areola to the neck, and the oval space between platysma and strap muscles in the anterior neck was dissected. Left lobectomy was accomplished after the strap muscles and thyroid were suspended with transcutaneous sutures. The specimen was removed in a self-made plastic bag through the 10 mm incision. RESULTS: Anatomical delineation of the left recurrent laryngeal nerve and parathyroid glands were satisfactory. Blood loss was less than 20 mL. The total operative time was 156 minutes. The patient required no administration of analgesics and was discharged postoperatively without complications. After 3 months follow-up, cosmetic outcome was excellent with a small periareaolar incision and no cervical scar. Pathology revealed a benign follicular adenoma. CONCLUSION: Our first TASIET is feasible with excellent cosmesis and advantages of minimally access surgery. Ongoing studies with TASIET are in progress to define the optimal indications and patient selection criteria for this new thyroidectomy technique.
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Endoscopy/methods , Neck/surgery , Thyroid Nodule/surgery , Thyroidectomy/methods , Biopsy, Fine-Needle , Female , Follow-Up Studies , Humans , Thyroid Nodule/diagnosis , Tomography, X-Ray Computed , Video Recording , Young AdultABSTRACT
Surgery is an important way to treat patients with primary hyperparathyroidism.Recently,conventional bilateral neck exploration is substituted with minimal invasive surgeries gradually due to the development of the technology of pre/intro-operative localization.Video-assisted surgery is one of the minimal invasive surgeries.It includes video-assisted parathyroidectomy and total endoscopic parathyroidectomy.This article summarize the literatures of treatment of primary hyperpatathyroidism with video-assisted surgery in this article.