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.
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 discuss the diagnosis, treatment, and follow-up visit mode of thyroid carcinoma showing thymus-like elements (CASTLE). Mothods For a systematic review of a case with CASTLE, the domestic and overseas literature was searched to analyze final diagnosis, treatment and follow-up visit indexes of that case. Results For CASTLE, the pathology combined with immunohistochemistry was the only method for final diagnosis, the operation was the main treatment, and the ultrasound as well as the computed tomography (CT) could be the follow-up visiting indexes. Conclusion CASTLE is a special kind of thyroid carcinoma, which is different from differentiated thyroid carcinoma in diagnosis, treatment and follow-up visit.
Objective To systematically evaluate the effectiveness and safety of minimally invasive video-assisted thyroidectomy (MIVAT) and conventional open thyroidectomy (COT) in treatment of thyroid carcinoma without lymph node metastasis. Methods Databases including PubMed, EMbase, The Cochrane Library (Issue 3, 2015), WanFang, CBM, VIP and CNKI were searched to collect the randomized controlled trails (RCTs) and non-RCTs about MIVAT and COT in treatment of thyroid carcinoma without lymph node metastasis. The retrieval time was from inception to October 2015. The studies were screened according to the inclusion and exclusion criterias, and the data was extracted and the quality of studies was evaluated by 2 reviewers independently. Then the Meta-analysis was conducted by using RevMan 5.2 software. Results A total of 13 non-RCTs involving 3 083 cases were included. The results of Meta-analysis showed that: compared with COT group, operative time of MIVAT group was longer (MD=31.36, 95% CI: 27.68-35.03, P<0.05), hospital stay (MD=-0.16, 95% CI: -0.28--0.04, P=0.01) and length of scar (MD=-1.51, 95% CI: -1.63--1.39, P<0.05) of MIVAT group were shorter, but there was no significant difference in the incidences of transient hypocalcemia (OR=1.29, 95% CI: 0.93-1.78, P=0.13), transient laryngeal nerve palsy (OR=1.42, 95% CI: 0.93-2.17, P=0.11), hemotoma (OR=1.21, 95% CI: 0.64-2.29, P=0.56), recurrence (OR=0.61, 95% CI: 0.28-1.33, P=0.22), number of retrieved central lymph nodes (MD=-0.10, 95% CI: -0.98-0.78, P=0.82), and the size of tumors (MD=-0.02, 95% CI: -0.06-0.02, P=0.39) between the 2 groups. Conclusion MIVAT is safe and feasible in treatment of thyroid carcinoma without lymph node metastasis when its indications are strictly controlled.
Objective To analyze the clinical relationship between primary hyperthyroidism and thyroid carcinoma, and diagnosis and treatment for the combination of the two. Methods The clinical data of 15 patients with primary hyperthyroidism complicated with thyroid carcinoma from January 1998 to December 2008 were retrospectively analyzed. Results Fifteen cases were smoothly discharged. The morbidity was 2.56% (15/585) of primary hyperthyroidism complicated with thyroid carcinoma. There were no operative complications. Five cases showed thyroid nodules and all cases were performed thyroidectomy. Neither hyperthyroidism nor thyroid carcinoma recurred during 9 months to 10 years (average 5.5 years) follow-up.Conclusions The diagnosis of primary hyperthyroidism complicated with thyroid carcinoma is still difficult to be made preoperatively and chiefly depend on postoperative pathology. Rational surgical treatment can result in good effectiveness and better prognosis.
ObjectiveTo investigate the succession model for hyperthyroidism and thyroid carcinoma secondary to nodular goiter in iodine deficiency area. MethodsA total of 216 specimens of goiter patients from iodine deficiency area were collected in the former 3rd hospital of Norman Bethune Medical College from January 1980 to December 1994. Twentyfour heteroploid samples were selected by the method of Hedley with Flow cytometry (FCM) analysis. Paraffin-embedded tissues from the same position were used to perform immunohistochemical staining for proliferating cell nuclear antigen (PCNA), laminin (LN), factor Ⅷ related antigen (FⅧ-RAg), and p53. The proliferative activity, stroma change, and angiogenesis were observed. ResultsPCNA label index (PCNA-LI) and proliferation index (PI) consistent in 24 heteroploid samples with PCNA staining were significantly higher value. PCNA positive cells were mainly distributed over nonfollicular parenchymatous structures, small follicles, and multilayered structures with large bubbly follicles. Destroyed basement membrane and necrosis were found by LN staining in PCNA positive position with vigorous reproductive capacity. Combining FⅧ-RAg staining with LN staining, interstitial proliferation and angiogenesis were obvious in follicular epithelial cells with vigorous reproductive capacity, providing nutrition and superior environment for them. ConclusionsThe reproduction of thyroid follicular epithelial cells, interstitial proliferation, and angiogenesis are all involved in tuberosis and hyperthyroidism, forming precancerous lesion, which suggest the succession model of goiter in iodine deficiency area.
ObjectiveTo observe changing trend of thyroid hormones levels for postoperative patients with differentiated thyroid carcinoma,and to discuss the best therapeutic timing of thyrotropin (TSH) suppression. MethodsNinety-six patients with differentiated thyroid carcinoma from January 2011 to December 2013 in this hospital were selected.All of these 96 cases were divided into total thyroidectomy group (n=50) and thyroid lobectomy and isthmectomy group (n=46) according to the surgical approach.Serum thyroid hormones levels (T3,FT3,T4,FT4,and TSH) were detected on day 1,2,4,5,7,14 after operation. Results① In the total thyroidectomy group,the levels of T3 and FT3 elevated transiently on day 5,then decreased gradually,and which were lower than the low limit of normal range on day 14.The levels of T4 and FT4 elevated transiently,then reached the peak on day 2,and which started to decrease gradually and reached the low limit of normal range on day 14.The value of serum TSH decreased transiently,which started to increase rapidly on day 2 and surpassed the high limit of normal range on day 4,then continued to rise until on day 14.② In the lobectomy and isthmectomy group,the values of T3 and FT3 decreased gradually,then started to rise on day 5,and which were lower than preoperative values until on day 14.The values of T4 and FT4 elevated transiently and which reached the peak on day 2,and then gradually decreased,which appeared to be lower than preoperative values on day 14.The value of TSH decreased transiently,and which started to rise on day 4,then elevated gradually and exceeded preoperative level on day 7,which reached the high limit of normal range on day 14. ConclusionsThere are dynamic changes of thyroid hormones in postoperative patients with differentiated thyroid carcinoma.It is feasible to determine the best therapeutic timing of TSH suppression according to the levels of postoperative thyroid hormones.The best timing of thyrotropin suppression therapy is that TSH is above the high limit of normal range after operation.
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 value of carbon nanoparticles on surgery for thyroid carcinoma. MethodLiteratures about application of carbon nanoparticles and lymphatic mapping in the thyroid carcinoma were reviewed. ResultsThe carbon nanoparticle was a new lymph tracer with a clear lymphatic mapping and a longer time for dying, which could accurately reflect the status of cervical lymph nodes, trace the sentinel lymph node in the thyroid carcinoma. The parathyroid gland could not be stained black, it was easy to be identified and protected. ConclusionsThe carbon nanoparticle provides an effective help in treatment for thyroid carcinoma. The more extensive and more profound application of lymphatic mapping depends on more clinical study.
ObjectiveTo investigate the expression of tumor suppressor gene Tat interacting protein 30 (TIP30) gene in papillary thyroid carcinoma and it’s clinical significance in treatment of thyroid carcinoma. Methods Thirty cases of pathological specimens wax pieces of papillary thyroid carcinoma from 2003 to 2006 in our hospital were selected, in which there were 7 male, 23 female； and the age was from 15 to 70 years old, average 44.7 years. Six cases were nodular goiter with carcinomatous change in local area (papillary), 2 cases were thyroid capsular invasion. Distant lymph node metastasis and lesions surrounding the thyroid tissue were not confirmed by pathology. Every specimen was divided into tumor tissue and adjacent tissue (1-2 cm far away from tumor and non-cancerous tissue was confirmed by pathology). The expression of TIP30 in specimen was detected by immunohistochemical method with staining index and the average absorbance. ResultsTIP30 was expressed in the cell membrane and cytoplasm, which was showed as brown particles. ①Staining index: TIP30 in adjacent tissues was expressed highly with 21 (70.0%) positive cases (gt;2 points) and 9 (30.0%) negative cases (≤2 points), while its expression in cancer tissues was reduced or missed with 11 (36.7%) positive cases (gt;2 points) and 19 (63.3%) negative cases (≤2 points). There was a statistical difference between them (P＜0.05), and it was not related to age and gender of patients (Pgt;0.05). ②The average absorbance of TIP30 in cancer tissues was significantly lower than that in adjacent tissue (P＜0.05). ConclusionThe expression of TIP30 in papillary thyroid carcinoma is reduced or deleted, which can supply some theory support for its gene therapy.