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.
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.
Positron emission tomography (PET) is a highly sensitive and low invasive technology for cancer biological imaging. Integrated PET/computed tomography (PET/CT) cameras combine functional and anatomical information in a synergistic manner that improves diagnostic interpretation. The role of 18F FDG PET/CT in differentiated thyroid cancer (DTC) is well established, particularly in patients presenting with elevated thyroglobulin (Tg) levels and negative radioactive iodine scan. This review presents the evidence supporting the use of 18F FDG PET/CT throughout the diagnosis and management of thyroid cancer, and provides suggestions for its clinical uses.
ObjectiveTo analyze the influencing factors of fear of cancer recurrence (FCR) and its correlation with social support and quality of life in patients with differentiated thyroid cancer (DTC) at 5 years after surgery. MethodsA total of 116 patients with DTC from West China Hospital, Sichuan University at 5 years after surgery were selected as the research objects. The patients were investigated using the Fear of Progression Questionnaire-Short Form (FoP-Q-SF), Social Support Rating Scale (SSRS) and the European Organization for Reasearch and Treatment of Cancer Quality of Life Questionnare-Core 30 (EORTC QLQ-C30, hereinafter referred to as QLQ-C30). The χ2 test or Fisher exact probability method were used for univariate analysis, and multivariate logistic regression analysis was used for influencing factor analysis. The diagnostic value of variables with significant influence on FCR in multivariate logistic regression was further studied by receiver operating characteristic (ROC) curve, and Pearson correlation analysis was finally adopted to analyze the relationship between FCR and social support and quality of life in patients with DTC at 5 years after operation. ResultsThe questionnaire survey showed that the FoP-Q-SF score of 116 patients with DTC at 5 years after surgery was (35.92±2.52) scores, of which 75 patients had FoP-Q-SF score ≥34 scores, 41 patients had FoP-Q-SF score <34 scores, and the FCR rate was 64.66% (75/116). Multivariate logistic regression showed that gender, family annual income, SSRS score and total QLQ-C30 score were the main factors of FCR in patients with DTC at 5 years after surgery (P<0.05). Further ROC curve diagnosis showed that the accuracy rate of diagnosis of FCR with SSRS score ≤47.5 scores was 70.70%, the total score of QLQ-C30 ≤617.225 scores was 69.02%. The accuracy rate of diagnosis of FCR was 66.03% when the annual income of family was less than 150 000 yuan. The accuracy of women’s diagnosis of FCR was 62.28%. Pearson correlation analysis showed that FoP-Q-SF score was negatively correlated with SSRS score and total score of QLQ-C30 in DTC patients at 5 years after operation (r=–0.629 6, P=0.000 1; r=–0.568 5, P=0.000 1). ConclusionsThe proportion of patients who have FCR at 5 years after DTC operation is high, and gender, family annual income, SSRS score and total score of QLQ-C30 are the influencing factors. Therefore, we can develop targeted management strategies to reduce patients’ FCR and improve their quality of life.
Galectin-3 and human bone marrow endothelial cell marker (HBME-1), which play an important role in tumor growth and metastasis, are good markers for thyroid cancer. The diagnosis specificity and accuracy for thyroid cancers have been increased with the application of 18F-fluordeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT). The value of Galectin-3, HBME-1 expression and 18F-FDG imaging in differentiated thyroid carcinoma is reviewed in the present paper.
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 analyze clinical features of reoperation patients with differentiated thyroid cancer, and to explore reason, surgical pattern and therapeutic effectiveness of reoperation. Method The clinical data of 80 patients with differentiated thyroid cancer underwent reoperation from January 2012 to June 2016 in Peking Union Medical College Hospital were analyzed retrospectively. Results ① Eighty (5.37%) patients with differentiated thyroid cancer underwent reoperation were identified from a total of 1 491 patients with thyroid cancer in our treatment team. Twenty-seven cases were males, 53 cases were females. The male to female ratio was 1∶1.96. The age was (44±13) years with a range from 14 to 66 years. The median time between reoperation and the first operation was 16.8 months with a range from 8 days to 17 years. ② Thirteen cases underwent reoperation because of uncertain frozen sections, and the reoperation style was residual lobectomy and selective lymph node dissection. Sixty-seven cases underwent reoperation because of local recurrence or metastasis, 15 of them accepted residual lobectomy and selective lymph node dissection while the other 52 accepted selective lymph node dissection. ③ The rate of residual in thyroid cancer confirmed by postoperative pathology was 18.8% (15/80). The rate of cervical lymph node metastasis was 63.8% (51/80). The temporary laryngeal recurrent nerve injury occured in 6 cases, the temporary hypocalcemia occured in 9 cases, and the lymphorrhagia occured in 2 cases. ④ The hospitalization time was (6.50±0.97) d with a range from 3 to10 d, the time of drainage tube remove was (2.41 ±0.95) d with a range from 2 to 7 d. Seventy-three cases were followed up from 3 to 58 months with (32±18) months, 4 of them underwent operation once again because of local recurrence, no distant metastasis or death happened. ⑤ The proportion of male patients in reoperation patients was significantly higher than that of the first operation patients (P<0.05). The proportion of patients aged <45 years, the average hospitalization time, the average time of drainage tube remove, and the postoperative complications rate had no significant differences between the patients with the first operation and the patients with reoperation (P>0.05). Conclusions For reoperation patients, proportion of male patients is higher. Reoperation is proper treatment for patients with residual lobe or local recurrence or metastasis for differentiated thyroid cancer. Serious complications could be avoided by suitable surgical pattern and careful dissection during operation. Residual lobectomy and selective lymph node dissection are suggested for reoperation.
ObjectiveTo analyze the current research status of radioactive iodine (RAI) therapy for differentiated thyroid cancer (DTC) in the past 10 years so as to understand the research hotspots and future development in this field through a bibliometric visualization analysis. MethodsThe literature relevant DTC RAI therapy published from 2014 to 2023 was screened using the Web of Science database. The publication time, country, institution, author, keywords, and other content of literature were analyzed, and the multidimensional scientific research network was constructed, and the visualization analysis was performed using RStudio and Flourish software. ResultsA total of 2 018 studies related to DTC RAI therapy were screened out from the publications from 2014 to 2023, with a fluctuating trend of increasing publication numbers. The publication numbers in China ranked first (422 articles), followed by the United States (374 articles) and Italy (182 articles). In terms of international cooperation, the United States ranked first with the most leading collaborations (289 times), and the top 3 countries in terms of cooperation with the United States were Italy (33 times), China (21 times), and France (21 times). China ranked fifth in leading cooperation, relatively less (52 times), with the main collaborators being Japan (7 times), South Korea (6 times), and Australia (5 times). Half of the top 6 institutions in terms of publication numbers were from the United States, with the top 3 being Unicancer from France (135 articles), Memorial Sloan Kettering Cancer Center from the United States (134 articles), and the UT MD Anderson Cancer Center from the United States (89 articles). Beijing Union Medical College Hospital and Shanghai Jiao Tong University ranked 19th and 23rd, respectively, with article counts of 46 and 44 articles. Tuttle RM, an author from the United States, ranked first in both publication numbers and contribution, with a total of 48 articles published from 2014 to 2023. There were two authors, Lin YS and Tan J, from China who had made it into the top 10 in terms of publication numbers, with 32 and 25 publications, respectively. The trend topics showed the evolution of hot topics, covering from the relation between urinary iodine and DTC, lymph node metastasis, to innovative research and prognosis assessment, as well as in-depth exploration of new therapies for iodine-refractory DTC. The co-occurrence and clustering of keywords included 4 aspects, namely, the standardized management of DTC, related contents during the peri-treatment period, papillary thyroid carcinoma, and the exploration of targeted therapy for iodine-refractory DTC. ConclusionsIn recent years, the research focus in the field of DTC RAI therapy has shifted from technical applications to management concepts, which has also promoted the improvement of treatment modes and made patients’ treatment plans increasingly personalized and precise. Future research will focus on precision medicine, individualized treatment, the combination of targeted therapy and immunotherapy, resistance mechanisms to treatment, and long-term management after treatment, aiming to improve patients’ treatment outcomes and quality of life and achieve a revolutionary breakthrough in treatment.
The 2025 American Thyroid Association Guidelines for the Management of Differentiated Thyroid Cancer in Adults, supported centrally by evidence-based medical evidence, has introduced systematic updates to the diagnostic pathways, treatment regimens, and follow-up strategies for thyroid cancer. Its content not only covers multidisciplinary fields such as internal medicine, surgery, radiology, and pathology, but also fully incorporates perspectives from patient populations—further enhancing the alignment of the guidelines with clinical practice and achieving comprehensive coverage of the whole-course management for differentiated thyroid cancer. In the field of surgical management, the guidelines focus primarily on four core areas: the scientific definition of thyroid resection scope, the rational planning of lymph node dissection scope, the precise protection of the recurrent laryngeal nerve, and the whole-course preservation of parathyroid function. For these key aspects, the guideline has put forward specific and guiding recommendations based on rigorous evidence-based medical evidence and multidisciplinary team consensus. This article integrates the expert interpretation findings from the 2024 American Thyroid Association annual meeting, providing a prospective organization and summary of the key clinical practice points and basis for updates in its surgical management chapter.
ObjectiveTo investigate the effects of thyroid globulin antibody (TgAb) and thyroid peroxidase antibody (TPOAb) statuses on central lymph node (CLN) metastasis in patients with differentiated thyroid cancer (DTC).MethodsA retrospective analysis was performed on 526 patients with DTC confirmed by pathology from nine participating institutions, who underwent the bilateral thyroidectomy plus bilateral CLN dissection. The clinicopathologic characteristics of different TGAb and TPOAb statuses of patients with DTC were compared, and whether the TGAb and TPOAb statuses were the independent risk factors of CLN metastasis in DTC patients or not was analyzed.ResultsAll of 526 patients with DTC were included in this study, 152 were males and 374 were females. The age was (44±11) years old. There were 63 cases of TgAb＋TPOAb＋, 60 cases of TgAb＋TPOAb－, 30 cases of TgAb－TPOAb＋, and 373 cases of TgAb－TPOAb－. It was found that there was a significant difference in the gender among the four different antibody statuses of patients, that was, women with abnormal antibodies were more common (P<0.001), not found that there were related to the tumor size, blood vessel invasion, nerve invasion, CLN metastasis, tumor multifocality, and bilateral tumor or not (P>0.050). In this study, there were 389 cases of CLN with metastasis and 137 cases of CLN without metastasis. The results of multivariate analysis found that the age and gender of the patients were the independent risk factors (P<0.001), but didn’t find the TgAb and TPOAb Statuses and other factors were related to the CLN metastasis (P>0.050).ConclusionsStatuses of TGAb and TPOAb aren’t obviously associated with CLN metastasis in patients with DTC, which is inconsistent with other studies. It needs to be further researched after expanding existing sample size and determining new predictive factors.