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.
Objective To compare differences of characteristics of ultrasonic elasticity imaging for benign and malignant small thyroid nodules with or without Hashimoto thyroiditis (HT). Methods The thyroid nodules with ≤1 cm size and the category 4A, 4B, 4C, and 5 of Thyroid Imaging Reporting and Data System (TI-RADS) were included into this study, and a further examination of real-time elastography was performed. The final diagnosis was relied on the pathological diagnosis. The elasticity score and strain ratio (SR) were recorded and compared between these two groups, respectively. Results Of the 424 nodules, 103 nodules were accompanied with HT (thyroid nodule with HT group), 321 nodules were not accompanied with HT (thyroid nodule without HT group). In the thyroid nodule with HT group, the area under the receiver operator characteristic (ROC) curve (AUCs) of the elasticity score and the SR was 0.685 and 0.676, respectively; the optimal cut offs of the elasticity score and the SR was 3 points and 2.45 respectively, their corresponding sensitivity, specificity, and accuracy was 75.7%, 57.6%, 68.0% and 75.7%, 60.6%, 67.6%, respectively. In the thyroid nodule without HT group, the AUCs of the elasticity score and the SR was 0.692 and 0.692, respectively; the optimal cut offs of the elasticity score and the SR was 4 points and 2.84, respectively; their corresponding sensitivity, specificity, and accuracy was 57.5%, 74.2%, 69.2% and 76.1%, 59.7%, 67.7%, respectively. Conclusions Elastography is helpful in differential diagnosis of benign and malignant small thyroid nodules. While, standards of elasticity score and SR value in differential diagnosis are different between benign and malignant small thyroid nodules with HT and without HT, elasticity score and SR ratio decrease in benign and malignant small thyroid nodules with HT.
【Abstract】ObjectiveTo investigate the effect of xenotransplantation of microencapsulated rabbit parathyroid tissue in different sites in rats for the treatment of hypoparathyroidism. MethodsThe parathyroid glands from Wistar rats were removed to make them aparathyroid. Ultimately, sixteen rats were included because their serum calcium values were continuously below 1.6 mmol/L. We also encapsulated the cultured rabbit parathyroid tissue with alginateBaCl2 microcapsule. According to the transplantation sites, rats were randomly divided into two groups: renal adipose microcapsule group and peritoneal microcapsule group, eight in each group. Encapsulated rabbit parathyroid tissues were then transplanted accordingly to different microcapsule groups. The calcium serum contents were examined on 5，15，25，35，45，55 and 65 d respectively after transplantation and the grafts were observed through electron microscope on the 65 d in particular. ResultsThe calcium contents after transplantation in renal adipose microcapsule group restored to normal and the observation outcomes of grafts showed that they survived well. The calcium contents of posttransplantation in peritoneal group also restored to normal with an exception that it dropped to a level lower than 1.6 mmol/L on the 65 d. Electron microscope also showed that there were necrotic tissues in the center and only a few cells survived on the edge of the grafts. Within peritoneal microcapsule group, the values were significantly lower than others taken at different phases. ConclusionMicroencapsulated rabbit parathyroid tissue that was xenotransplanted into rats can survive and function without administration of immunodepressant. There are significant differences of calcium contents at varying phases between two transplantation sites, which demonstrate that renal adipose may be an optimal site for microcapsule xenotransplantation.
ObjectiveTo detect expressions of transient receptor potential channel C5 (TRPC5) and microRNA-320a (miR-320a) in thyroid cancer and explore clinical significances of them in thyroid cancer.MethodsThe expressions of TRPC5 and miR-320a mRNA in the thyroid cancer were investigated by searching the Ualcan database. While the expressions of TRPC5 and miR-320a mRNA in 80 cases of thyroid cancer, 35 cases of thyroid adenoma and 32 cases of normal thyroid tissues adjacent to thyroid adenoma tissues in the Zhengzhou Seventh People’s Hospital from March 2014 to March 2015 were tested. Real time PCR was used to detect the expressions of TRPC5 mRNA and miR-320a mRNA in the various tissues and Western blot was used to detect the TRPC5 protein in the thyroid cancer tissues. Therelationships between the expressions of TRPC5 and miR-320a mRNAs and clinicopathologic features of thyroid cancer were analyzed. The correlation between expressions of TRPC5 and miR-320a mRNA was analyzed by Pearson method. The risk factors influencing the prognosis were analyzed by univariate and multivariate Cox proportional hazards regression model.ResultsThe results of Ualcan database showed that the expression level of TRPC5 mRNA in the thyroid cancer was higher than that in the normal thyroid tissue (P<0.001), while the expression level of miR-320a mRNA was lower than that in the normal thyroid tissue (P<0.001). The results of clinical cases showed that the expression level of TRPC5 mRNA was significantly higher, while the expression of miR-320a mRNA was significantly lower in the thyroid cancer tissues as compared with the normal thyroid tissues (P<0.05). There was a negative correlation between the expression level of TRPC5 and miR-320a mRNA in the thyroid cancer (r=−0.653, P<0.001). The expressions of TRPC5 and miR-320a mRNA were correlated with the degree of differentiation, lymph node metastasis, and TNM stage (P<0.05). Kaplan-Meier survival curve analysis found that the patients with higher expression level of TRPC5 and lower expression level of miR-320a showed the poor prognosis, and multivariate analysis found that the lower tumor differentiation, later TNM stage, with lymph node metastasis, higher expression level of TRPC5 mRNA, and lower expression level of miR-320a mRNA were the risk factors affecting prognostic survival (P<0.05).ConclusionsFrom the database and clinical case data, it is concluded that TRPC5 mRNA is highly expressed, while miR-320a mRNA is lowly expressed in thyroid cancer tissues, and expressions of TRPC5 and miR-320a mRNA are related to degree of tumor differentiation, lymph node metastasis, TNM staging, and prognosis in patients with thyroid cancer. TRPC5 and miR-320a mRNA might be used as potential indicators for clinical and prognostic monitoring.
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.
【Abstract】ObjectiveTo investigate the technique of establishing a model of aparathyroid rat which could be used in the study of parathyroid cells transplantation. Methods Parathyroid glands were surgically excised and identified pathologyically. Serum calcium and parathyroid hormone in rats before operation and on day 2，5，10，15 and 30 after operation were measured. Results Parathyroid glands were resected successfully in 8 rats, and the resection rate was 80% (8/10). No obvious changes of serum calcium and parathyroid hormone levels were found before and after operatiion in sham parathyroid gland excision group (Pgt;0.05). However, statistically significant changes of those data were found perioperatively in parathyroid gland excision group (P＜0.01). Conclusion The model of aparathyroid rat can be established successfully after parathyroid glands in rats are excised exactly. Parathyroid allotransplantation could be performed ten days after parathyriodectomy.
ObjectiveTo systematically evaluate the reliability and stability of transoral endoscopic thyroidectomy vestibular approach (TOETVA) and conventional open thyroidectomy (COT) in the treatment of differentiated thyroid cancer.MethodsThe clinical studies of TOETVA and COT in the treatment of differentiated thyroid cancer were retrieved from major databases including PubMed, Embase, Cochrane Library, Wanfang, and CNKI by computer. The search date ended on March 1, 2020. Two investigators screened the literatures strictly and extracted the data following the pre-defined inclusion and exclusion criteria, and then used RevMan 5.3 software for meta-analysis.ResultsA total of 7 studies including 1 465 patients were included in this meta-analysis. The results showed: compared with the COT group, the operation time of the TOETVA group was longer [WMD=35.18, P=0.000 1], and the number of lymph node dissections in the central area was larger [WMD=1.42, P=0.000 5]. But the intraoperative blood loss [WMD=–5.32, P=0.39], the length of hospital stay after operation [WMD=0.05, P=0.94], the incidences of transient recurrent laryngeal nerve palsy [OR=0.81, P=0.43], transient hypocalcemia [OR=0.55, P=0.35], permanent hypocalcemia [OR=0.39, P=0.22], permanent recurrent laryngeal nerve palsy [OR=1.34, P=0.73], and hematoma [OR=1.29, P=0.69] were not statistically significant between the two groups.ConclusionsTOETVA has a higher stability. Although the COT has a shorter operation time, the former has a higher central lymph node dissection rate, and there is no scar on the neck after surgery and no significant difference in the incidence of postoperative complications.
ObjectiveTo evaluate the safety and efficacy of lenvatinib as targeted therapy for locally advanced thyroid cancer. MethodsThe data of 17 patients with locally advanced thyroid cancer who received targeted therapy in the Department of Head and Neck Surgery, Clinical Oncology School of Fujian Cancer Hospital from September 2021 to June 2023 were prospectively collected and analyzed. ResultsSeventeen patients received lenvatinib for a median of 8 weeks (4–32 weeks), 5 patients achieved partial response, 11 patients achieved stable disease, and 1 patient experienced progressive disease. The objective response and disease control rates were 29.4% (5/17) and 94.1% (16/17) respectively, the median tumor diameter of the target lesion decreased from 43 mm before treatment to 12 mm after treatment. Five patients did not undergo surgery because of tumor progression and their refusal; R0/1 resection was achieved in 11 of the 12 remaining patients (91.7%). All patients suffered from drug-related adverse events, and the commonest drug-related adverse events were hypertension (7/17, 41.2%), diarrhea (6/17, 35.3%), and proteinuria (5/17, 29.4%). There were no major drug-related adverse events. ConclusionPreliminary analysis indicates that lenvatinib is effective and safe for targeted therapy of locally advanced thyroid cancer, with a relatively high rate of R0/1 resection.
Objective To investigate the relationship between thyroid peroxidase antibody (TPOAb) and thyroglobulin antibody (TgAb) and clinicopathological features of breast cancer. Methods Thyroid function data, general clinical data and data reflecting pathological characteristics of breast cancer of 136 breast cancer patients admitted to the Department of Breast and Thyroid Surgery, People’s Hospital of Wuhan University from December 2019 to April 2022 were collected. According to the TPOAb and TGAb antibody levels of patients, 136 breast cancer patients were divided into positive group (antibody level ≥60 U/mL) and negative group (antibody level < 60 U/mL). The general clinical data, thyroid function, breast cancer markers, tumor size, pathological classification, clinical TNM stage, lymph node metastasis and immunohistochemical index expression characteristics of the two groups were analyzed. Results There was no statistically significant difference between the TPOAb positive group and the TPOAb negative group, as well as between the TgAb positive group and the TgAb negative group in terms of age, previous chronic medical history, surgical medical history and menstrual status of breast cancer patients (P>0.05), and there was no significant difference in the results of preoperative ultrasound and molybdenum target examination (P>0.05).Compared with the TPOAb negative group, the level of triiodothyronine (T3) in the TPOAb positive group was lower (P=0.020), and the level of thyroidstimulating hormone (TSH) was higher (P=0.001). TSH level in the TgAb positive group was higher than that in the TgAb negative group (P=0.036). There was no significant difference in tumor markers (carcinoembryonic antigen, carbohydrate antigen 125 and 153) and the number of lymph nodes cleared during operation between the positive and negative groups of TPOAb and TgAb (P>0.05). Compared with the respective negative groups, there was no significant difference tumor size, pathological classification, clinical TNM stage, lymph node metastasis, pathological molecular classification, and the expression of ER, PR and Ki-67 in the TPOAb positive group and the TgAb positive group (P>0.05). The positive rate of HER-2 expression in the TPOAb positive group was higher than that in the TPOAb negative group (P=0.033). There was no significant difference in HER-2 expression between the TgAb positive group and the TgAb negative group (P>0.05). There was no significant difference between the TPOAb positive group and the TPOAb negative group, as well as the TgAb positive group and the TgAb negative group in terms of chemotherapy, invasive carcinoma with carcinoma in situ, with benign lesions and nerve invasion (P>0.05). There was no significant difference between TPOAb positive group and negative group in vascular tumor thrombus rate and single cancer focus rate (P>0.05). Compared with the TgAb negative group, the TgAb positive group had a lower vascular tumor thrombus rate (P=0.034) and a higher single cancer focus rate (P=0.045). Conclusions Thyroid autoantibodies positive breast cancer patients have lower T3 level and higher TSH level, and the positive expression of thyroid autoantibodies is related to HER-2 expression, vascular tumor thrombus and the number of tumor foci in breast cancer. It suggests that thyroid autoantibodies TPOAb and TgAb may have an impact on the prognosis of breast cancer.
Objective To investigate the histological origin, diagnosis, differential diagnosis and treatment of thyroid carcinoma showing thymus-like differentiation (CASTLE). Methods Five patients with thyroid CASTLE were adopted by surgical resection and postoperative radiotherapy, and the CD5, CD117, CK5/6, P63, thyroid transcription factor-1 (TTF-1), carcino-embryonic antigen (CEA), calcitonin (CT), Ki-67, chromogranin A (CgA), thyrobolulin (Tg), peroxisome proliferator activated receptorγ (PPAR-γ), sodium iodide symporter (NIS), and thyroid stimulating hormone receptor (TSHR) were detected in tumor tissues by immunohistochemistry S-P method and v-raf murine sarcoma viral oncogene homolog B1 (BRAF)V600E gene and telomerase reverse transcriptase (TERT) promoter mutations were detected by DNA sequencing. Eight cases of poorly differentiated thyroid carcinoma and 6 cases of anaplastic thyroid carcinoma were adopted by comprehensive comparative analysis. Results Thyroid CASTLE tumor cells showed the positive expression of CD5, CD117, CK5/6 and P63, and the negative expression of TTF-1, CT, CgA, Tg, PPAR-γ, NIS and TSHR. There were partly positive expression for CK5/6, P63, TTF-1, CgA, Tg, NIS and TSHR, and negative expression for CD5 and CD117 in the poorly differentiated thyroid carcinoma and anaplastic thyroid carcinoma. The BRAFV600E gene and TERT promoter mutations were not detected in thyroid CASTLE, and the BRAFV600E gene mutations were also not detected in the poorly differentiated thyroid carcinoma and anaplastic thyroid carcinoma. Four cases of poorly differentiated thyroid carcinoma showed the TERT promoter mutations (4/8) included 3 cases with C228T and 1 case with C250T. Two cases of anaplastic thyroid carcinoma showed the TERT promoter mutations (2/6) included 1 case with C228T and 1 case with C250T. There was no recurrence and metastasis after 3–47 months (an average of 25.6 months) of followed-up in thyroid CASTLE patients. Conclusions The histological origin of thyroid CASTLE may be not related to the thyroid. There is important clinical value to combined detection of CD5, CD117, P63, TTF-1, Tg, NIS, and TSHR for the diagnosis and differential diagnosis of thyroid CASTLE. The further study still need for the diagnosis and differential diagnosis of thyroid CASTLE according to the detection of BRAFV600E and TERT promoter mutations.