Objective To investigate the role of preoperative serum thyroid stimulating hormone (TSH) in evaluating differentiated thyroid cancer (DTC). Methods A total of 551 patients with thyroid nodules met the study criteria, who got treatment in the First Affiliated Hospital of Jiamusi University between Aug. 2017 and Dec. 2017. And the patients were divided into DTC group (n=110) and benign group (n=441) according to the postoperative pathological results. The difference of serum TSH level between the 2 groups was compared and then explored the diagnostic significance of serum TSH level, thyroid imaging report and data system (TI-RADS), and serum TSH combined withTI-RADS. Results The serum TSH level was higher in the DTC group than that of the benign group (Z=5.198, P<0.05). The sensitivity of preoperative serum TSH level in the diagnosis of DTC was 80.9% (89/110), the specificity was 74.4% (328/441), and the area under receiver operating characteristic (ROC) curve was 0.660 ［95%CI was (0.602, 0.719), P<0.05］. The sensitivity of TI-RADS in the diagnosis of DTC was 82.7% (91/110), the specificity was 73.5% (324/441), and the area under the ROC curve was 0.772 ［95%CI was (0.711, 0.823), P<0.05］. The sensitivity of preoperative serum TSH combined with TI-RADS in the diagnosis of DTC was 91.8% (101/110), the specificity was 87.5% (386/441), and the area under the ROC curve was 0.831 ［95%CI was (0.786, 0.876), P<0.05］. Conclusions Preoperative serum TSH level may be a potential risk factor for the occurrence of DTC. Preoperative serum TSH level combined with TI-RADS classification can improve the accuracy of preoperative diagnosis of DTC, not only to reduce the misdiagnosis of thyroid cancer, but also can avoid excessive treatment.
Objective To summarize the advance in targeted therapy for radioactive iodine-refractory differentiated thyroid cancer (RAIR-DTC). Method The literatures relevant to the targeted therapy for RAIR-DTC were reviewed and summarized. Results Targeted therapy for RAIR-DTC mainly included multi-kinase inhibitors suppressing angiogenesis and mutation-specific kinase inhibitors targeting specific mutations. Representative multi-kinase inhibitors such as sorafenib and lenvatinib, which significantly prolonged progression-free survival, had been approved to put into clinical use, though there were shortcomings such as adverse effects and resistance. Mutation-specific kinase inhibitors acted on targets such as RET, mitogen-activated protein kinase pathway, phosphoinositide 3-kinase pathway respectively, with relatively small side effects, most of which had only been applied in clinical trials up to now. Conclusions Targeted therapy for RAIR-DTC has made rapid progress in recent years, filling the gap in treatment for RAIR-DTC. Further explorations and investigations are needed to establish a more effect and safer treatment mode.
ObjectiveTo explore the application value of carbon nanoparticles during radical operation of differentiated thyroid cancer (DTC).MethodsThe DTC patients underwent total thyroidectomy plus neck lymph node (area Ⅳ) dissection from September 2017 to September 2019 in this hospital were retrospectively collected, who were divided into observation group and control group according to using carbon nanoparticles or not during the operation. The operation related informations [operation time, intraoperative blood loss, total drainage volume on day 3 after operation, postoperative hospitalization time, number of lymph nodes dissection (area Ⅳ), lymph node metastasis rate, and rate of parathyroid glands resected by mistake during operation] and blood calcium (Ca2+) level and parathyroid hormone (PTH) level before and after (24 h and 1 month) operation were compared between the two groups.ResultsA total of 134 patients with DTC were collected, including 76 patients in the observation group and 58 patients in the control group. There were no significant differences in baseline data such as gender, age, etc. between the two groups (P>0.05). Although there were no significant differences in terms of operation time, intraoperative blood loss, total drainage volume on day 3 after operation, postoperative hospitalization time, lymph node metastasis rate between the two groups (P>0.05), the numbers of lymph node dissection and metastasis (area Ⅳ) were more and rate of parathyroid glands resected by mistake during operation was lower in the observation group as compared with the control group (P<0.05). On hour 24 after operation, the levels of Ca2+ and PTH in the observation group were higher than those in the control group (P<0.05). On month 1 after operation, the PTH level in the observation group was still higher than that in the control group (P<0.05), but there was no significant difference in Ca2+ level between the two groups (P>0.05). ConclusionCarbon nanoparticles can better protect the function of parathyroid gland during radical operation of DTC and clean neck lymph nodes more thoroughly.
ObjectiveTo investigate the adequate surgical procedures for well-differentiated thyroid cancer (WDTC) located in the isthmus.MethodsNineteen patients with WDTC located in the isthmus were identified with WDTC and managed by surgery in Department of General Surgery in Xuanwu Hospital of Capital University from Jun. 2013 to May. 2018.ResultsAmong the nineteen cases, fifteen patients had a solitary malignant nodule confined to the isthmus, four patients had malignant nodules located separately in the isthmus and unilateral lobe. One patient received extended isthmusectomy as well as relaryngeal and pretracheal lymphectomy; six patients received isthmusectomy with unilateral lobectomy and central compartment lymph node dissection of unilateral lobe; four patients received isthmusectomy with unilateral lobectomy and subtotal thyroidectomy on the other lobe as well as central compartment lymph node dissection of unilateral lobe; seven patients received total thyroidectomy or isthmusectomy with unilateral lobectomy and nearly total thyroidectomy on the other lobe, as well as central compartment lymph node dissection of both sides; one patient received total thyroidectomy and central compartment lymph node dissection of both sides, as well as lateral thyroid lymph node dissection of both sides. The median operative time was 126 minutes (67–313 minutes), the median intraoperative blood loss was 30 mL (10–85 mL), and the median hospital stay was 6 days (4–11 days). Hypocalcemia occurred in 12 patients. There were no complications of recurrent laryngeal nerve palsy or laryngeal nerve palsy occurred. All the nineteen patients were well followed. During the follow up period (14–69 months with median of 26 months), there were no complications of permanent hypoparathyroidism occurred, as well as the 5-year disease-specific survival rate and survival rate were both 100%.ConclusionsFor patients with well-differentiated thyroid cancer located in the isthmus with different diameters and sentinel node status, individualized surgical procedures should be adopted.
ObjectiveTo evaluate the diagnostic efficacy of thyroglobulin in fine-needle aspirate fluid (FNA-Tg) for detecting cervical lateral lymph node metastases (LLNM) in differentiated thyroid cancer (DTC). MethodsThe clinical data of DTC patients who underwent (selective) cervical lateral lymph node dissection at the 900th Hospital of the Joint Logistics Support Force from February 1, 2021 to November 30, 2023 were retrospectively analyzed. The significance level (α) was set as 0.05. ResultsAccording to the inclusion and exclusion criteria, a total of 155 patients with 179 lymph nodes were included, among which 49 lymph nodes were not metastatic and 130 were metastatic. The results of the integral patients showed that the area under the receiver operating characteristic curve (AUC) of FNA-Tg for distinguishing cervical LLNM in the patients with DTC was superior to that of fine-needle aspiration cytology (FNAC). The AUCs (95% confidence intervals) were 0.973 (0.950, 0.995) and 0.778 (0.708, 0.849) respectively, P<0.05, and the AUC (95% confidence interval) of the combination of the two was higher [0.978 (0.959, 0.997)]. The optimal diagnostic threshold of FNA-Tg was determined to be 16.45 μg/L or FNA-Tg/serum thyroglobulin (sTg) was 1.02. After stratification based on the size of the lymph nodes, a paired analysis of the two methods (FNA-Tg and FNAC) showed that the diagnostic efficiency of FNA-Tg was significantly higher than that of FNAC only when the short diameter of the lymph node was ≤0.8 cm [0.955 (0.919, 0.992) vs. 0.718 (0.630, 0.806), P<0.001], and there was no additional benefit from the combination of the two [0.950 (0.912, 0.989)]. ConclusionsThe results of this study suggest that FNA-Tg shows a good diagnostic efficacy for cervical LLNM in patients with DTC, especially has an obvious advantage for small lymph nodes with a short-axis diameter of lymph node ≤0.8 cm. Its optimal diagnostic threshold is 16.45 μg/L or FNA-Tg/sTG is 1.02.
Lung metastases are more common in metastatic disease in differentiated thyroid carcinoma (DTC). Because of its insidious onset and slow development, clinical diagnosis is relatively difficult. Some possible diagnostic methods for detecting the lung metastasis of DTC including serological examination, radionuclide imaging and other medical imaging patterns are discussed in this paper. The progress and the current situation about investigation of those modalities which are in the early diagnosis, recurrent and clinical evaluation for the lung metastasis of DTC are briefly reviewed. Therefore, it is expected to promote DTC with lung metastasis to a higher diagnostic level.
ObjectiveIn order to improve the levels of clinical diagnosis and treatment of differentiated thyroid cancer, the research status and progress of blood markers of differentiated thyroid cancer in recent years were reviewed.MethodThe literatures about blood markers and liquid biopsy of differentiated thyroid cancer at home and abroad in recent years were searched and summarized.ResultsThyroglobulin and thyroglobulin antibody were the most commonly used for markers of differentiated thyroid cancer. The application value of blood markers such as microRNA and long non-coding RNA in the diagnosis, treatment and follow-up of differentiated thyroid cancer had also been found.ConclusionBecause of the advantages of high specificity, high sensitivity, and no-invasion, blood markers are useful indicators to help improve the diagnosis of thyroid cancer patients and monitor the disease progression and recurrence in the future.
Thyroglobulin (Tg) and radioiodine whole body scan (WBS) have been commonly used in follow-up of patients with differentiated thyroid carcinoma (DTC). Tg is associated with radioiodine uptake in local or distant metastases. In minority of patients, the follow-up scan shows no functioning thyroid tissue, but the serum thyroglobulin is still elevated. Therefore, we review recent developments of diagnosis and treatment of those patients with differentiated thyroid cancer and with thyroglobulin elevation but negative iodine scintigraphy.
Initial surgical treatment plays an important role in the treatment of differentiated thyroid cancer, and standardized surgical treatment can help to reduce underdiagnosis and overtreatment. Accurate preoperative diagnosis is the premise of standardized surgical treatment, which helps to reduce the overtreatment of thyroid nodules. Preoperative clinical TN staging assessment for differentiated thyroid cancer should be highly valued, the extent of thyroidectomy should be individualized, and the cervical lymph nodes should be performed in a standardized manner. In addition, the indications for endoscopic thyroid surgery should be strictly selected to maximize the benefit of the patient.
Objective To summarize the value of serum thyroglobulin (Tg) in diagnosis before surgery and monitoring after surgery for differentiated thyroid cancer (DTC). Methods By using the method of literature review, the literatures related to the diagnosis and monitoring value of serum Tg for DTC were studied. Results ① Serum thyroglobulin had a certain value in diagnosis of thyroid nodules, especially in follicular cancer or Hürthle cancer whose diagnosis undetermined by fine-needle aspiration biopsy (FNAB), and it was closely linked with the tumor’s size and distant metastasis of the DTC. ② Raise of serum Tg postoperatively was important for judging the recurrence and metastasis of DTC. However, how to establish an appropriate threshold of serum Tg, identify the differences of results for different measurement methods, make the accurate judgment for false positive and false negative, and combine with other imaging methods appropriately, needed our attention. Conclusion Serum Tg plays a very important role in diagnosis before surgery and monitoring after surgery of DTC, clinical doctors need pay high attention on it.