Objective To sum up experiences in diagnosis and treatment for Hashimoto′s disease (HD). Methods Clinical records of 78 patients who underwent operations and were diagnosed as Hashimoto′s disease by histologic examination in our hospital from Jan. 1988 to Dec. 1998 were analyzed. Results Seventy females and 8 males, aged 9 to 70 years (average of 41.6 years). HD was coexistent with 10.3% of thyroid gland malignant tumor, 23.1% of adenoma and 30.8% of other thhroid gland diseases. The misdiagnosis rate was 35.9% and missed diagnosis rate was 46.2%. The clinical feature of HD and most common cause of misdiagnosis and missed diagnosis have been discussed. Conclusion It is emphasized that patients with diffuse goiter, palpable nodules, lighty color on scintillation scintigraphy, elevation of antimicosomiaux and antithyroglobuline but no finding on Bus should be highly suspected of having Hashimoto′s disease.
Objective To explore the reoperative techniques of differentiated thyroid carcinoma. Methods Clinical data of 56 patients who treated in The First Affiliated Hospital of General Hospital of PLA and General Hospital of PLA from Feb. 2011 to Feb. 2013 were analyzed retrospectively. Results All performed surgeries were successful. Surgeries took 90-150 minutes with an average of 120 minutes. Bleeding during surgeries was 70-200 mL with an average of 120 mL. Postoperative drainage was 90-210 mL with an average of 100 mL. The pathological diagnosis of the second surgery in 44 cases were as the same as the first， but there were no malignant tumor tissues of dissected glands in 12 cases. All patients had no postoperative bleeding and bucking， but 8 patients experienced hand and foot numbness， and 5 patientsexperienced transient hoarseness. Fifty patients were followed-up for 6-30 months （average 10.8 months） from the reoper-taion and 18-66 months （average 45.2 months） from the first operation， and rate of postoperative followed-up was 89.3%（50/56）. During the followed-up， 1 patient with papillary thyroid carcinoma and 1 patient with follicular thyroid carcinoma died in 44 months and 38 months respectively， 3 patients suffered lymph node metastasis at non-Ⅵ region ofaffected side， no one suffered recurrence. Conclusions For differentiated thyroid carcinoma patients who are undergoingthe second surgery， thorough whole body condition analysis should be performed and appropriate type of surgery should be chosen. By using recurrent laryngeal nerve monitoring， carbon nanoparticles for lymph node clearance， and protecting parathyroid gland to lower the possibility of postoperative complication， to improve survival rate and life quality.
摘要:目的:采用Meta分析的方法评价甲状腺球蛋白在甲状腺良性疾病和甲状腺癌中的临床意义。方法:通过检索MEDLINE、EMBASE、The Cochrane Library, 中国生物医学文献数据库、中国学术期刊全文数据库和其他方式广泛收集文献。根据QUADAS质量评价标准评价纳入文献的质量,用MetaDisc软件对其敏感度、特异度、阳性似然比、阴性似然比等进行合并分析,并进行异质性检验,绘制综合受试者工作特征曲线(summary receiver operator characteristic curve,SROC)。结果:最终纳入5篇文献。合并敏感度0.60,合并特异度0.83,合并比值比2.68, SROC下面积(AUC)=0.645 4。结论:现有研究证实:甲状腺球蛋白在甲状腺癌中的阳性率是甲状腺良性疾病中的2.68倍,有统计学差异,但敏感度不高。尚需更多设计严谨、科学的临床试验进一步证实。Abstract: Objective: To evaluate the quality of the current studies involving the value of serum thyroglobulin in the diagnosis of thyroid benign diseases and thyroid carcinoma. Methods: We comprehensive collected current studies about serum thyroglobulin in thyroid benign diseases and thyroid carcinoma by computer and manual searches. QUADAS items were used for quality assessment in our systematic review. Metadisc software was used to analyze pooled sensitivity, pooled specificity,pooled positive likelihood ratio and pooled negative likelihood ratio,pooled diagnostic test odds ratio and heterogeneity test,and draw summary receiver operator characteristic curve (SROC). Results: Totally 5 studies were included. To identify thyroid benign diseases and thyroid carcinoma, pooled sensitivity was 0.60, pooled specificity was 0.83,pooled odds ratio was 2.68, the area under curve (AUC) was 0.645 4.Conclusion: The results of statistic alanalysis showed that the positive rate of thyroglobulin in thyroid carcinoma is 2.68 times more than in benign thyroid diseases. There was significant difference. But sensitivity was not high and reporting quality of the studies was relatively poor. The conclusion still need more clinical trials to confirm.
ObjectiveTo explore a method for establishing a priority-scoring model for thyroid carcinoma patient admission. MethodsA questionnaire survey was conducted among specialists and outpatients in the thyroid surgery department of the hospital. The weight coefficient of the index factors was calculated to establish the priority-scoring mode by the analytic hierarchy process. The differences in results between specialists and patients were compared. The logical rationality of the model index was tested. ResultsA priority-scoring model for thyroid carcinoma surgery admission was established, including 10 first-level indicators, such as sex, age, cancer type and TNM stage. The weight coefficients of the indicators from high to low were cancer type (0.137), TNM stage (0.134), tumor size (0.127), tumor invasion degree (0.126), tumor invasion site (0.124), relationship between tumor and capsule (0.111), age (0.093), sex (0.061), place of residence (0.05) and medical insurance type (0.035). After the total ratio test, the model CR value was 0.0073, and the model index was highly rational. ConclusionThis study successfully establish a priority-scoring model for thyroid carcinoma surgery admission, which can provide references and a basis for tiered medical services and relevant researches in the future.
ObjectiveTo investigate the structure, ligand, and tissue distribution of galectin-3, the relationship of galectin3 with tumor and the expression of galectin-3 in several thyroid diseases. MethodsRelated articles were reviewed. ResultsGalectin-3 was expressed in normal and tumor cell that regulated cell growth, differentiation, adhesion, apoptosis, and angiogenesis, which participated invasion and metastasis of tumor. ConclusionGalectin-3 may be used to discriminate benign and malignant thyroid tumor.
Objective To investigate influence of iodine-131 (131I) treatment following total thyroidectomy on menstrual rhythm and fertility of childbearing age patients with papillary thyroid carcinoma (PTC). Methods The clinical data of 342 childbearing age patients with PTC treated with total thyroidectomy from January 2007 to December 2016 in the First Affiliated Hospital of Xinjiang Medical University were retrospectively analyzed. The patients were designed to 131I treatment group (126 cases) and non-131I treatment group (216 cases) according to the postoperative treatment. The menstrual rhythm and pregnancy after operation were regularly followed-up on postoperative 1 month. The age, nationality, occupation, menstrual rhythm, and pregnancy were analyzed by two independent samples t or Chi-square or Fisher test. Results ① There were no significant differences in the age, nationality, and occupation between the 131I treatment group and the non-131I treatment group (P>0.05). ② Compared with the non-131I treatment group, the proportions of the irregular menstruation were significantly increased on the 1st month and 3rd month of follow-up (P<0.05) in the131I treatment group, which had no statistically significant differences on the 6th month and 12th month of follow-up in two groups (P>0.05). Further the analysis results of the age stratification showed that had no significant differences at different follow-up time in these two groups (P>0.05). ③ The success rate of pregnancy also had no significant differences in these two groups both in the general and the age stratification analysis results (P>0.05). Conclusions 131I treatment following total thyroidectomy can affect menstrual rhythm of women in childbearing age at the early stage (within 6 months), but there is no abnormal menstruation on 6 months later, which dosen’t effect on pregnancy in women of childbearing age, and it is recommended that pregnancy should be renewed in 1-year after 131I treatment.
Objective To explore the protein expressions of matrix metalloproteinase-9 (MMP-9) and tissue inhibitor of metalloproteinase-1 (TIMP-1)， and to investigate their relationships between their serum concentration before operation and the infiltration and metastasis of thyroid carcinoma. Methods The protein expressions of MMP-9 and TIMP-1 in 32 cases of thyroid carcinomas, 23 cases of adjacent tissues and 30 cases of benign hyperplastic lesions were measured by using immunohistochemistry. The preoperative serum concentrations of MMP-9 and TIMP-1 in 21 cases of thyroid carcinomas and 19 cases of benign hyperplastic lesions were determined by enzyme-linked immunosorbent assay. Results The positive expression rates of MMP-9 and TIMP-1 in tumor tissues were significantly higher （75.0%,56.3%）than those in adjacent tissues and benign hyperplastic lesions （30.4%, 21.7%; 26.7%, 23.3%) P＜0.05. There were correlations between the expressions of MMP-9 and TIMP-1 and the local infiltrative degrees, lymph node metastasis and TNM stage （P＜0.05）. There was a negative correlation between the expression of MMP-9 and the expression of TIMP-1 （r=-0.509， P=0.003）. The concentration of MMP-9 in serum of thyroid carcinoma patients was (122.60±36.20) ng/ml, whereas TIMP-1 was (59.44±38.65) ng/ml, both of which were significantly higher compared to those of benign group (P＜0.05). In addition, there was a positive correlation between the expressions of MMP-9/TIMP-1 in the carcinoma tissues and their concentrations in serum （P＜0.05）.Conclusion To detection the expressions of MMP-9 and TIMP-1 in the lesion and their concentrations in the serum may not only contribute to the differential diagnosis of thyroid tumors, but may also help to predict the prognosis of the carcinoma.
Objective To study the clinical value ofNa＋/I－ symporter (NIS) expression on thyroid carcinoma diagnosis and 131I therapeutic effects prediction. Methods Thirty-one cases of thyroid carcinomas enrolled in this hospital from 1998 to 2006 were included. Using immunohistochemical method, NIS expression location, positive cell staining and expression intensity were observed, which was calculated by immunohistochemical scores (IHS) and NIS expression level was compared between primary and metastatic carcinoma. Results NIS was over-expressed on the basolateral membrane in positive control——Grave disease tissue, and showed no staining in negative control. NIS was expressed in cytoplasm in all 31 primary carcinomas, and IHS was over or equaled to 4 in 80.65% of them. Except for 2 no staining, NIS was expressed in cytoplasm in the rest 28 metastatic carcinomas. NIS expression was related to the pathological type of thyroid carcinoma, the best in PTC, then FTC, and the weakest in fvPTC. NIS expression in metastatic carcinoma was related to that in primary carcinoma.Conclusion NIS is over-expressed in cytoplasm in most thyroid carcinoma, and the iodide uptaking defect is mainly due to its wrong location. It has great potential to be applied in clinic by that it can help with the differential diagnosis of benign and malignant thyroid diseases, especially between FTA and FTC, and that it can help predict the therapeutic effects of 131I therapy following thyroid operation.
ObjectiveTo explore the factors that predict the prognosis of papillary thyroid carcinoma.MethodThe literature searching terms include "prognosis of papillary thyroid carcinoma" "ultrasound of papillary thyroid carcinoma" "papillary thyroid carcinoma and Hashimoto's thyroiditis", and "genes related to papillary thyroid carcinoma". The factors used to predict the prognosis of papillary thyroid carcinoma such as the patient's clinical characteristics, ultrasound characteristics, serological indicators, genes mutations, etc. were reviewed.ResultsUltrasound features such as lesion diameter greater than 1 cm, extra-glandular invasion, and related gene mutations may increase the risk of postoperative recurrence. Patients with Hashimoto's thyroiditis may have better prognosis.ConclusionThere are many factors that can predict the risk of recurrence in patients to a certain extent, but most of them are just in the study, so it is necessary to enact more standardized follow-up management to improve the survival rate.
Objective To summarize the basic principle of electrical impedance spectrum technology and the latest progress in the diagnosis of thyroid carcinoma. Methods By the domestic and overseas literatures review， medical application and diagnostic prospect in thyroid carcinoma of electrical impedance spectrum were summarized. Results Electrical impedance spectrum was a kind of somatic function imaging， whose measurement results was objective， and it could diagnose thyroid carcinoma in early stage effectively. In addition， it could be used as a complementary form of fine needle aspiration biopsy， improving the diagnostic accuracy rate of thyroid carcinoma， thereby reducing the unessential thyroid operations. Conclusion Electrical impedance spectrum technology is a potentially useful imaging modality for diagnosing thyroid carcinoma in early stage， and functions as a auxiliary clinical diagnosis method for fine needle aspiration biopsy.