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Abstract: The patient was found to have a thyroid nodule on physical examination and came to our hospital for further confirmation of the diagnosis, and underwent ultrasound-guided puncture biopsy of the thyroid nodule after standardized examination in an outpatient clinic. The pathological diagnosis confirmed that the nodule was a malignant tumor of the thyroid gland, and a standardized thyroidectomy and lymph node dissection in the central region were performed as soon as possible to prevent the malignant tumor from growing and invading the surrounding vital organs.
Basic information】Female, 49 years old
Disease Type】Papillary carcinoma of the right thyroid
Hospital】The First Hospital of Harbin Medical University
Date of consultation】June 2022
Treatment plan】Surgery (right thyroidectomy with thyroidectomy + lymph node dissection in the right central area) + medication (levothyroxine sodium tablets)
[Treatment Period] 6 days in hospital, 1 month later outpatient review
Effectiveness】The lobe and isthmus of the thyroid gland where the papillary thyroid cancer was located were standardized and completely excised, effectively preventing further growth, invasion of surrounding vital organs, and further metastasis of the tumor.
I. Initial consultation
The patient was found to have a thyroid nodule on physical examination 1 week ago and came to the clinic for a definitive diagnosis and treatment. A peanut-sized mass was palpated on the right side of the patient’s neck. The patient’s ultrasensitive thyrotropin 3.9454uIU/ml, free thyroxine 0.94ng/dl, free triiodothyronine 2.34pg/ml, peroxidase antibody 2.08IU/ml, thyroglobulin antibody 1.23IU/ml. thyroid ultrasonography showed a hypoechoic nodule of about 0.8cm×1.0cm in size in the right upper middle lobe. The outpatient physician performed ultrasound-guided thyroid nodule puncture after full communication with the patient, and the pathological diagnosis was confirmed as papillary thyroid carcinoma. Combined with the patient’s medical history and relevant examinations, the patient was considered to have papillary thyroid carcinoma on the right side.
II. Treatment history
Since the patient had undergone thyroid nodule puncture and the pathological diagnosis confirmed papillary thyroid carcinoma, surgery was considered for her. After the patient was hospitalized and the thyroid CT and necessary preoperative examinations were completed, the patient and her family were fully communicated, and she underwent right thyroidectomy with thyroid isthmus resection and lymph node dissection in the right central region to treat papillary thyroid cancer from the root. Because of the papillary thyroid cancer, the patient needs to take levothyroxine sodium tablets for long-term endocrine therapy after surgery, and needs to follow the doctor’s prescription for review and adjustment of the dosage if necessary.
III. Treatment effect
The patient underwent right thyroidectomy with thyroid isthmus resection and lymph node dissection in the right central region. Since the lobe and isthmus where the papillary carcinoma was located were completely removed, the risk of further tumor growth and invasion of surrounding vital organs was effectively avoided, and further metastasis was prevented. The malignant thyroid tumor was treated fundamentally, and the patient’s quality of life was improved. After the operation, the patient was discharged from the hospital with a length of stay of 6 days, and was asked to come back to the hospital for a review one month before discharge.
IV. Notes
We are glad that the patient’s symptoms have improved after treatment, but the patient still needs to pay attention to some other matters.
1, levothyroxine sodium tablets taking: levothyroxine sodium tablets after taking, pay attention to avoid consuming milk, soy milk and other foods rich in protein that affect the absorption of drugs. Patients also need to follow the doctor’s prescription for review and adjust the dose of medication if necessary to inhibit the recurrence and metastasis of papillary thyroid cancer.
2. Diet: Many patients with papillary thyroid cancer need to have a normal diet after surgery, and there is no need to control the iodine content in the diet. A light diet and moderate amount of water are recommended for a short time after surgery.
3. Incision care: thyroid surgery usually leaves an incision of about 5cm in the neck with absorbable sutures, which usually does not need to be removed after surgery, and avoid water exposure and strenuous activities of the neck for 1 week.
V. Personal insight
For people who have thyroid nodules found in physical examination like this patient, they should be alert to the possibility of malignant thyroid tumor. Papillary thyroid carcinoma is the most common type of thyroid malignancy and the one with the best prognosis. However, when papillary carcinoma continues to grow and increase in size to a certain extent, it will invade surrounding organs (such as trachea, esophagus and laryngeal nerve) and produce corresponding symptoms, so papillary thyroid carcinoma still needs standardized surgery and strict endocrine therapy as soon as possible. Patients also need to undergo regular review in the outpatient clinic to monitor the recurrence and metastasis of papillary thyroid cancer.