目的 探讨利用特殊手术器械和相应的手术操作技巧对提高甲状腺外科手术的安全性及质量的作用。方法 借助MPBS系列器械和超声刀的推剥、分离、切割、止血等技术完成甲状腺手术。结果 完成甲状腺部分切除、次全切除或侧叶切除术共468例，手术时间（40±20）min，术中出血量（30±25）ml，住院时间（4±1）d；切口细小，瘢痕平整；术后出现短暂声嘶3例，饮水呛咳2例，局部皮下积液2例。随诊1～3年，平均1.8年，3例复发，1例甲状腺功能低下。无甲状旁腺功能低下和永久性神经损伤病例。结论 利用MPBS器材和超声刀技术在甲状腺疾病外科治疗中的应用安全可靠，具有手术安全、简捷、出血少、时间短、切口小、副损伤少、恢复快的临床效果，值得进一步推广和探讨。
ObjectiveTo explore the diagnostic value of sonography in thyroid imaging reporting and data system (TI-RADS) for thyroid nodules. MethodsA total of 292 patients (423 nodules) underwent thyroid examination with high frequency ultrasound. The results were retrospectively compared with histopathological diagnosis and TI-RADS lexicon. ResultsThe category 1-5 of 423 thyroid nodules were evaluated by using TI-RADS, and it’s frequency of being malignancy rate was 0(0/129), 6.3%(11/176), 33.3%(10/30), 86.8%(46/53), and 100% (35/35), respectively. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value for benign thyroid nodule of ultrasound in TI-RADS was 96.3%（309/321）, 83.3%（85/102）, 93.1%（394/423）, 94.8%（309/326）, and 87.6%（85/97）, respectively. Positive likelihood ratio, negative likelihood ratio, and Youden’ index was 5.77, 0.04, and 79.6%, respectively. The benign and malignancy nodule of TI-RADS category were statistically difference in shape, margin, echogenicity, echotexture, composition, and calcification inside the nodule (Plt;0.001). ConclusionsTI-RADS lexicon has an important guiding value for clinical diagnosis and treatment in ultrasound examination of thyroid nodule.
ObjectiveTo investigate the diagnosis, treatment, classification, and epidemiology of thyroid tuberculosis. MethodsA retrospective study of 5 cases of thyroid tuberculosis and a review of the literatures were analyzed, which related to the clinical characteristics, the gist of the diagnosis and treatment, the causes of misdiagnosis and the methods of operation. ResultsAll of the cases were misdiagnosed before operation. Two cases were diagnosed by the frozen sections during the operations and three cases were diagnosed by postoperative pathology. Subtotal resection or lobectomy and local excision (3 cases) were performed respectively. Debidement and anti-tuberculosis medicine were given locally in 2 unresectable cases. All patients underwent standard chemotherapy for 6－8 months after operations and recovered finally. Four cases were caseous necrosis, 1 case was hyperplasia, all of which were chronic infections thyroid tuberculosis, and no acute thyroid tuberculosis be found. No recurrence was found in the 2－15 years of follow-up. ConclusionsUsually, it is difficult to establish a definite preoperative diagnosis for thyroid tuberculosis. Treatment, such as resection, debridement with local medication or systemic chemotherapy, shall be taken individually according to pathology types, focal features, and comorbidities. For hyperplasia cases, surgical resection shall be the best choice, while, for caseous necrosis cases, sometime difficult to remove, debridement with local medication may be suitable.
Objective To summarize the advanced researchs of autoimmune thyroid disease(ATD) complicated with differentiated thyroid cancer (DTC). Methods The related literatures about concurrent ATD and DTC were consulted and reviewed. Results Hashimoto diseas (HD) complicated with DTC at home and abroad were reported more and more, whether merging with HD or other ATD disease could affect the prognosis of papillary thyroid cancer (PTC) was a controversial topic. HD and DTC (mainly PTC) had some same epidemiological and molecular features. Conclusion Better understanding of clinical pathology and characteristic of DTC concurrent with ATD can provide some new insights to immunotherapy for DTC.
Objective To explore the change of constitution in thyroid diseases of West China Hospital between 2000 and 2012， in order to provide clinical evidence. Methods Clinical data， including gender， age， and pathological diagnosis of patients with thyroid disease who underwent primary thyroid surgery in our hospital from 2000 to 2012 were collected retrospectively and analyzed statistically. Results A total of 9 642 patients were enrolled， including 1 893 male patients and 7 749 female patients. The ratio of male to female patients was 1 to 4.09. In male patients， the proportion of thyroid carcinoma were significantly higher than those of female group （P=0.02）；in male patients younger than 45 group， the proportion of thyroid carcinoma were significantly higher than those of female group （P＜0.01）. There was no statistical difference on the proportion between male and female patients older than 45 group （P=0.90）. Proportion of thyroid carcinoma， especially proportion of papillary thyroid carcinoma （PTC） increased in general. Proportion of Hashimoto thyroiditis （HT） increased in general too. HT with thyroid carcinoma accounted for an increasing proportion of all patients with HT. Proportion of nodular goiter （NG） increased at first and then declined. Proportion of thyroid adenoma （TA） decreased on the whole. Conclusions Proportion of thyroid carcinoma， especially proportion of PTC increase in recent years on the whole in patients underwent surgery. All these changes need to be given sufficient attention.
Objective To compare the economic effectiveness of universal screening, high-risk population screening, and no screening strategies for thyroid disease prevention and control among pregnant women in China through cost-effectiveness analysis, providing evidence-based support for optimizing health policy decisions on prenatal thyroid disease screening. Methods Based on the characteristics of thyroid disorders during pregnancy, a combined decision tree and Markov model was developed to conduct a lifetime cost-effectiveness analysis across three strategies: no screening, high-risk population screening, and universal screening. Sensitivity analyses were performed on key parameters. Results Base-case analysis demonstrated that universal screening was the most cost-effective strategy when the World Health Organization (WHO)-recommended payment threshold of 1×gross domestic product (GDP) per capita was used, with an incremental cost-effectiveness ratio (ICER) of 20636.18 yuan per quality-adjusted life year (QALY) compared to no screening, followed by high-risk population screening (ICER=21071.71 yuan/QALY). The results of the sensitivity analysis showed a strong stability of the model. Conclusions Of the 3 screening programs for thyroid disease in pregnancy, universal screening is the most cost-effective when the WHO-recommended payment threshold of 1×GDP per capita is used.
ObjectiveTo summarize and analyze the possible association between thyroid diseases and alopecia areata. MethodThe literatures on the relationship between thyroid disease and alopecia areata in recent years were searched and reviewed. ResultsAmong individuals with alopecia areata, the risk of thyroid disease was heightened. They were more susceptible to autoimmune thyroid conditions, often accompanied by thyroid function abnormalities. Moreover, alopecia areata patients face an increased risk of thyroid cancer. However, in patients with thyroid disease, the change of the incidence of alopecia areata was not completely clear. The risk of alopecia areata was increased in patients with autoimmune thyroid disease, and abnormal thyroid function may be one of the potential reasons for the persistence of alopecia areata. ConclusionsAutoimmune thyroid disease and alopecia areata may have a common disease basis. Patients with alopecia areata are at greater risk of autoimmune thyroid disease and thyroid dysfunction. The increased risk of alopecia areata in patients with autoimmune thyroid disease may be related to abnormal thyroid function.
Objective To investigate the clinical significance of the three iodide transporters in thyroid diseases. Methods Literatures about the Na+/I- symporter (NIS), pendrin and human apical iodide transporter (hAIT) in recent years were reviewed and their expressions in different thyroid diseases were also analyzed. Results NIS proteins express at the basolateral membrane of thyrocytes in normal thyroid tissue, while pendrin and hAIT proteins are limited to the apical membrane of thyrocytes lining in the follicular lumen. In the tissues of thyroid carcinomas, it was found that the NIS proteins expressed in the cytoplasm and their expressions decreased; The mutation of NIS gene may be one of the main causes of congenital hypothyroidism. The expression of prendrin protein may be related to the function of follicles: its expression level increased significantly both in Graves diseases and toxic adenomas, but significantly decreased in differentiated thyroid carcinoma. However, the correlation between the decrease and the degrees of differentiation of carcinoma cell line are still disputable. The expression of hAIT protein does not significantly altered in hyperfunctioning tissues. It only slightly decreased occasionally in hypofunctioning adenomas, but it decreased significantly in thyroid carcinomas. Conclusion The abnormal expressions of the three iodide transporters may be related closely with the type of thyroid diseases. However, their pathogenic mechanisms and the causes of their abnormal expression are still unknown, which need to be studied further.
目的 探讨超声刀在开放性小切口甲状腺手术中的应用效果。方法 总结我科于2004年4月至2007年12月期间对89例甲状腺良性疾病患者开展的开放性小切口(3～4 cm)甲状腺切除术，手术中采用超声刀代替传统的结扎和缝扎方法对甲状腺血管和腺体进行处理。结果 手术平均时间70(40～135) min，术中平均出血量15(5～20) ml，术后24 h平均切口引流量25(10～50) ml。无出血、神经、甲状旁腺损伤及其他并发症。切口Ⅰ类/甲级愈合，术后平均住院时间5(3～6) d。结论 超声刀应用于开放性小切口甲状腺切除，可以方便手术操作，提高手术效率，止血效果可靠，有特有的实用价值。