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 complications of endoscopic thyroidectomy and conventional thyroidectomy and to analyze causes of them in order to reducing complications of endoscopic thyroidectomy. Methods A total of 1 112 patients with thyroid diseases from September 2008 to March 2017 in the Shanghai Tongren Hospital were collected, then were designed to endoscopic thyroidectomy group and conventional thyroidectomy group. The recurrent laryngeal nerve injury, hypoparathyroidism, postoperative bleeding, tracheoesophageal injury, poor healing of surgical wound, skin ecchymosis and subcutaneous effusion, neck discomfort, and CO2 related complications were observed. Results ① There were 582 cases in the endoscopic thyroidectomy group and 530 cases in the conventional thyroidectomy group, the baselines such as the gender, age, most diameter of tumor, diseases type, operative mode, operative time, and intraoperative bleeding had no significant differences between the endoscopic thyroidectomy group and the conventional thyroidectomy group (P>0.05). ② All the operations were performed successfully, none of patients was converted to the open operation. The rates of the recurrent laryngeal nerve injury, hypoparathyroidism, postoperative bleeding, and tracheoesophageal injury had no significant differences in these two groups (P>0.05). The rates of the poor healing of surgical wound and neck discomfort were significantly lower and the rate of the skin ecchymosis and subcutaneous effusion was significantly higher in the endoscopic thyroidectomy group as compared with the conventional thyroidectomy group (P<0.05). There were 32 cases of CO2 related complications in the endoscopic thyroidectomy group. Conclusion Results of this study show that endoscopic thyroidectomy is safe for thyroid diseases, it’s complications could be reduced by improving operation technique.
ObjectiveTo summarize the latest progress of parathyroid gland identification in thyroid surgery, and to provide some reference for improving the clinical efficacy.MethodThe literatures about the identification of parathyroid gland in thyroid surgery in recent years were collected to make an review.ResultsThere were many methods for identifying parathyroid gland in thyroid surgery, such as naked eye identification method, intraoperative frozen section, intraoperative staining identification method, intraoperative optical identification method, intraoperative parathyroid hormone assay, γ-detector, and histological identification, each method had its own advantages and disadvantages.ConclusionThe identification of parathyroid gland does not only depend on a certain method, but also require surgeons to enhance their ability to distinguish parathyroid gland.
ObjectiveTo explore the safety, effectiveness, and cosmetic advantage of endoscopic thyroidectomy for differentiated thyroid cancer in the cT1N0 stage. MethodsThe clinical data of 148 patients underwent thyroidectomy for the cT1N0 differentiated thyroid cancer in the First Affiliated Hospital of PLA General Hospital and the PLA General Hospital from September 2010 to September 2013 were analyzed retrospectively, including 36 patients by total endoscopic thyroidectomy (TET group), 41 patients by endoscopic-assisted thyroidectomy (EAT group), and 71 patients by open thyroidectomy (OT group). The intraoperative status, early complications, late complications, and cosmetic result were compared among these three groups. ResultsAll the procedures were accomplished successfully.①In the intraoperative status: The operation time of the TET group was significantly longer than that of the EAT group(P < 0.05)or OT group (P < 0.05), drainage on the first day after operation in the TET group was significantly more than that in the EAT(P < 0.05)or OT group (P < 0.05), the intraoperative bleeding of the TET group or EAT group was significantly less than that of the OT group (P < 0.05), there were no statistical significances in the total number of lymph nodes dissection and number of positive lymph nodes among three groups (P > 0.05).②In the early complications: The postoperative pain score of the TET group was significantly lower than that of the EAT group (P < 0.05)or OT group (P < 0.05), there were no statistical significances in the postoperative bleeding, seroma, infection, transient recurrent laryngeal nerve paralysis, or transient hypoparathyroidism among three groups (P > 0.05).③In the late complications: there was no statistical significance in the perpetual recurrent laryngeal nerve paralysis, perpetual hypoparathyroidism, or thyroid cancer relapse among three groups (P > 0.05).④The best cosmetic result was obtained by the patients underwent TET as compared with the patients underwent EAT(P < 0.05)or OT (P < 0.05). ConclusionsEndoscopic procedure has the same effectiveness and safety with open procedure for differentiated thyroid cancer in the cT1N0 stage, but endoscopic procedure has a better cosmetic result than that open procedure. Compared with EAT, TET has more advantages in the cosmetic result.
Objective To explore value of multidisciplinary team (MDT) model in diagnosis and treatment of patients with advanced special thyroid cancer who lost chance of operation. Method Two patients with the advanced special thyroid cancer who lost chance of operation were treated by low dose apatinib (250 mg/d) after the MDT discussion. Results One medullary thyroid cancer patient with the compressing of the trachea for mediastinal metastatic lymphadenopathy and inability to lie down underwent the multiple surgical treatment, the therapeutic effect was poor. Then low dose apatinib (250 mg/d) was performed, the patient could supine, breathe smoothly, and move freely, whose life quality was obviously improved, the mediastinal lymph nodes reduced and no serious drug toxicity occurred on month 1 after the treatment. One undifferentiated thyroid cancer patient with the lung metastasis, hemoptysis, and tumor invasion resulted in the inability to lie down and having difficulty in breathing, these symptoms still existed and more pleural effusion occurred after the resection of the invaded trachea. Then low dose apatinib (250 mg/d) was performed, the patient could supine, the pleural effusion disappeared, the hemoptysis stopped, the breathing was smooth, and could do some minor housework, no drug toxicity occurred on month 1 after the treatment. Conclusion After MDT discussion, low dose apatinib in treatment of advanced special thyroid cancer is reliable and safe and has a good short-term effect, which could be used as a new remedy, but long-term effect should be further researched by increasing case samples and a long-term following-up.
Objective To investigate the efficacy of fine needle aspiration-thyroglobulin (FNA-Tg) with colloidal gold immunochromatographic assay (CGICA) on the assessment of lymph node metastasis during surgery in papillary thyroid carcinoma (PTC) patients. Methods Seventy-eight patients with PTC who underwent surgery in the Department of Thyroid Surgery of West China Hospital of Sichuan University from August to December 2019 were selected as the research objects, 289 neck lymph node specimens cleaned during the operation were prepared into eluent after lymph node FNA within 10 minutes in vitro, and then the FNA-Tg level was detected rapidly and quantitatively by CGICA. The specimen of washout fluid was labeled and sent to the laboratory for FNA-Tg detection by Roche electrochemiluminescence immunoassay. The lymph nodes in the whole group were divided into central region group and lateral cervical region group according to their location. According to the long diameter of lymph nodes, they were divided into <5 mm group, 5–10 mm group and >10 mm group. With postoperative pathological report as the gold standard, the receiver operating characteristic (ROC) curve of the whole group of data subjects was drawn, and the area under curve (AUC) was compared to calculate the best cut-off value of FNA-Tg in diagnosing PTC lymph node metastasis. The sensitivity, specificity, diagnostic accuracy, positive predictive value and negative predictive value of FNA-Tg CGICA method and Roche method in the whole group and different subgroups were compared. The data of 55 lymph nodes detected by FNA-Tg CGICA method and rapid frozen pathology were collected, and the diagnostic efficacy indexes of CGICA method and rapid frozen pathology in the diagnosis of lymph node metastasis were compared. Results The ROC curves AUC of FNA-Tg detected by CGICA method and Roche method was 0.850 and 0.883, respectively, the difference was not statistically significant (Z=1.011, P>0.05). The sensitivity was 77.7% and 79.6% respectively (χ2=0.05, P>0.05), specificity was 84.9% and 93.5% respectively (χ2=7.50, P<0.05). Using McNemar test, there was no significant difference in the diagnostic results between the CGICA method and Roche method of FNA-Tg in the whole group (P>0.05). The diagnostic efficacy of FNA-Tg CGICA method was better in the lateral cervical region group than that in the central region group, and the diagnostic efficacy of the group with the long diameter of lymph nodes >10 mm was better than those of the groups with the long diameter of lymph nodes <5 mm and 5–10 mm. There was no significant difference in diagnostic results between FNA-Tg CGICA method and rapid frozen pathology (P>0.05). Conclusions The FNA-Tg CGICA method has high value in diagnosing PTC cervical lymph node metastasis, and has the characteristics of rapidity and convenience. The diagnostic efficiency is similar to that of Roche method.
ObjectiveTo understand the research status of phosphatidylinositol-3-kinase/protein kinase B (PI3K/AKT) signaling pathway in the thyroid cancer (TC), as well as its role in the occurrence, cell differentiation, invasion, and metastasis of the TC, so as to find potential targets for treatment of TC. MethodThe literature about the research of PI3K/AKT signaling pathway in the TC was searched and summarized. ResultsThe PI3K/AKT signaling pathway was abnormally activated directly or indirectly in the TC, resulting in inhibition of cell apoptosis, malignant proliferation, accelerated cycle progression, invasion, and metastasis, etc., which promoted the occurrence and development of the TC. There were also some tumor suppressor genes, microRNAs, long chain non-coding RNAs, etc., which indirectly inhibited the activation of PI3K/AKT signaling pathway, or directly acted on it inhibiting its activity to inhibit the occurrence and development of the TC. ConclusionsFor the TC, some proteins, genes, microRNAs, and long chain non-coding RNAs directly or indirectly activate the PI3K/AKT signaling pathway through different targets to promote the occurrence and development of TC. At the same time, many targets inhibit the activation of the PI3K/AKT signaling pathway, which inhibits the malignant proliferation, invasion, and metastasis of TC. At present, there have been studies trying to use PI3K/AKT signaling pathway as a breakthrough for the treatment of TC. In-depth exploration of the role of PI3K/AKT signaling pathway in different TC is of great significance to find new targets for the treatment of TC.
Objectives To assess the relationship between subclinical hyperthyroidism and the incidence of coronary heart disease (CHD). Methods PubMed, EMbase, The Cochrane Library, Web of Science, CNKI, VIP, WanFang Data and CBM databases were searched for studies on the relationship between subclinical hyperthyroidism and the incidence of CHD from inception to October 2016. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies. Then, meta-analysis was performed by using RevMan 5.3 and Stata 12.0 software. Results In total, 14 cohort studies were included. The results of meta-analysis showed that subclinical hyperthyroidism was associated with the incidence of coronary heart disease (RR=1.19, 95%CI 1.01 to 1.40, P=0.04) and all-cause mortality (RR=1.36, 95%CI 1.11 to 1.67, P=0.003). Conclusions Subclinical hyperthyroidism is associated with an increased risk of CHD and all-cause mortality. Due to the limitation of quality and quantity of the studies, the above conclusions are required to be verified by large-scale and high quality research.
ObjectiveTo investigate the expressions of Snail and N-cadherin protein in thyroid papillary carcinoma (PTC) tissues and cell lines, and then discuss the clinical value of Snail and N-cadherin expressions. MethodsImmunohis-tochemical SP technique was performed to detect the expressions of Snail and N-cadherin protein in 60 cases of PTC, and the relation between the expression of Snail or N-cadherin and clinicopathologic indicators was analyzed. Western blot was used to investigate the constitutive and inducible expressions of Snail and N-cadherin protein. Results①The positive rates of Snail and N-cadherin protein expressions were 85.0% (51/60) and 78.3% (47/60) respectively in the PTC tissues of 60 patients with PTC, which were significantly higher than those (0, 0, respectively) in the corresponding normal tissues adjacent to the cancer (P < 0.01).②The positive rates of Snail and N-cadherin protein expressions in the PTC with lymph node metastasis were significantly higher than those in the PTC without lymph node metastasis (P < 0.01), which were not related with the gender, age, tumor size of the patients (P > 0.01).③There was a positive correlation between Snail and N-cadherin protein positive expression (rs=0.721, P < 0.001).④The constitutive and inducible expressions of Snail and N-cadherin in the PTC tissues and cell lines further were identified by Western blot. ConclusionsSnail and N-cadherin could constitutively express in PTC, which might play important roles in the development and metastasis of PTC. Snail and N-cadherin might be used as effective indicators.
OBJECTIVE: To review the role of thyroid hormone in the peripheral nerve regeneration. METHODS: The recent literatures of experimental study and clinical application on the role of thyroid hormone in nerve regeneration were reviewed. The researches on expression, isoform and changes of thyroid hormones in rat sciatic nerve in normal or injury were summarized. The effect of thyroid hormone on local rat sciatic nerve was studied, too. RESULTS: Nuclear thyroid hormone receptors expressed in numerous nuclei of sciatic nerve during a limited period of development extending from the third week of embryonic life to the end of the second postnatal week and after injury of adult sciatic nerve. A single and local administration of thyroid hormone at the level of the transected sciatic nerve produced a lasting effect on peripheral nerve regeneration. CONCLUSION: The beneficial effects of thyroid hormones upon injured peripheral nerve may have considerable therapeutic potential.