”Director Fan, my sister has had thyroid cancer, she had an operation last year, should I do any more tests? “Professor Fan, I found a ‘thyroid nodule’ in my physical examination. Should I have an operation sooner?” This is the site of the free consultation lecture at the Citizens’ Health Center on the 15th floor of the Sixth People’s Hospital of Shanghai Jiao Tong University, where Prof. Fan Youben, who has just finished teaching about the prevention and treatment of thyroid diseases, was surrounded by people who came to listen to the lecture. He looked at the lab reports brought by the public, carefully examined the patients’ necks, and patiently explained one question after another. …… Nowadays, in the “Shanghai Sixth Hospital Thyroid Paradise WeChat Group” established in February 2015, the team of experts led by Prof. Fan Youben can answer all kinds of questions without any time limit. “The group has 62 friends. Dr. Fan’s team: “Is it best to be isolated from my family for a while after Iodine 131 treatment? I need to apply for leave from my office, so I need to arrange it in advance, thank you!” Prof. Fan @”Junyuan”: The hospitalization is isolated for almost a week, and the dose is very small after discharge, so it does not affect much without isolation.” WeChat named “ball mom” “@fandirector: this is my friend to do the puncture report, help to see, whether to operate ah?” Now, the “Difficult Thyroid and Parathyroid Integration Clinic”, which was first established in July 2015, brings together experts from four departments: thyroid surgery, endocrinology and metabolism, nuclear medicine and ultrasound medicine, and treats patients together every Thursday morning at the hospital’s specialist clinic on the 10th floor. The ultrasound examination of special needs specialists can be done on the same day, and the report can be obtained on the same day, providing one-stop “seamless” all-round service, which greatly facilitates patients’ consultation and improves the efficiency and effect of consultation. For example, there are several treatments for moderately enlarged hyperthyroidism, and patients are often at a loss as to whether to take endocrine medication (Sage), direct isotope I131 treatment, or surgery, each with its own advantages and disadvantages. Another example is that after thyroid cancer surgery, suspicious recurrence of lymph node metastasis is found outside the hospital, does it exist? It can be reviewed by accurate expert ultrasound on the same day, whether to use isotope therapy, or enhanced endocrine therapy, or the need for another surgical excision and clearance. This can be discussed in a face-to-face consultation for a quick, reliable, convenient and accurate choice. In recent years, the incidence and detection rate of thyroid disease has been increasing year by year with the change of environment and the improvement of health level and awareness, and the popularity of physical examination, especially high-resolution ultrasonography. People are often not aware of thyroid disease, some people think that nodules are not painful and insignificant, while others are like an enemy and want to get rid of them as soon as possible. So, let’s get to know this “butterfly”! Many doctors like to refer to the thyroid gland as a “butterfly” because it is located in the neck below the thyroid cartilage, the shape of the thyroid gland on both sides of the trachea is like a butterfly with open wings. The thyroid gland is divided into two lobes, often connected by a thin isthmus in the middle. The thyroid gland is like the “engine” of our body and is an important organ for the regulation of the metabolism of the whole body. Its main function is to synthesize and secrete thyroxine, which is transported to all tissues of the body with the blood, stimulating and participating in the metabolic activities of the body, maintaining the body temperature and ensuring the normal survival of the brain, heart, muscles and organs. It is said that the thyroid gland affects every part of the body. The parathyroid glands are closely attached to the back of the left and right lobes of the thyroid gland in the neck and are the size of a soybean. There are usually four pairs, usually upper and lower. Hyperparathyroidism occurs when the parathyroid glands themselves become diseased, such as adenomas, hyperplasia or adenocarcinoma, causing an overproduction of parathyroid hormone (PTH). The beautiful “butterfly” can sometimes cause problems, such as inflammation, especially chronic inflammation, which can cause discomfort, panic attacks and weakness, and can be easily confused with symptoms of the flu. For example, if the butterfly is not moving, the patient has hypothyroidism. On May 29, 2012, the first survey report on thyroid diseases in Shanghai, in which endocrinologists from 20 hospitals (14 tertiary and 6 secondary) and more than 5,000 patients with thyroid diseases participated, showed that the top three diseases among all thyroid diseases were hyperthyroidism, thyroid nodules and hypothyroidism. The survey also found that there is a gender bias in thyroid disease patients, with women accounting for about 80%, three times higher than men, while the survey results also showed that the malignancy rate of thyroid nodules is higher in young people, twice as high as in older people! According to Professor Fan, there are various pathological changes that cause thyroid nodules, such as goiter, hyperthyroidism, thyroid adenoma, thyroiditis, differentiated thyroid cancer (papillary carcinoma, follicular carcinoma), medullary carcinoma and undifferentiated thyroid cancer. However, malignant tumors can also invade surrounding organs such as trachea, esophagus, nerves, and even metastasize to lung and bone. Therefore, it is important to correctly identify the benignity and malignancy of thyroid nodules for each patient. If a thyroid nodule is hard to palpate, if the surface is not smooth and if it is less mobile, malignancy should be suspected. If enlarged, hard lymph nodes in the neck are also palpated, the patient should be on high alert. If ultrasound reveals a nodule with microcalcifications, local hypoechogenicity, unclear borders, and abundant blood flow in the nodule, the nodule is likely to be malignant. Fine needle aspiration cytology can also play a very important role in determining the benignity and malignancy of the thyroid gland. Director Fan said that if a thyroid nodule is malignant, early surgery is generally recommended. Depending on the size, location and nature of the tumor, and whether there are lymph nodes, lung or bone metastases to choose the appropriate surgical method. However, even if the nodule is thyroid cancer, there is no need to be nervous because most thyroid cancers are differentiated type and their 10-year survival rate can reach 90%. Patients with benign nodules should not be nervous, as small benign nodules can be followed up carefully with ultrasound of the thyroid and lymph nodes in the neck once every six months. Only when the benign nodules are larger, such as 3-125 px or more, with symptoms of pressure, or significantly affect the appearance, should surgery be considered. Minimally invasive thyroid surgery with small incisions in the neck, single-port lumpectomy or transoral surgery without scars in the neck is currently carried out on a scale of general surgery at Shanghai Sixth Hospital to cure the disease while significantly reducing the disfigurement of the patient’s neck. It is reported that the Sixth People’s Hospital of Shanghai Jiaotong University and Jiaotong University Thyroid Disease Clinic has completed thousands of fully lumpectomy and lumpectomy-assisted thyroid and parathyroid surgeries with very satisfactory efficacy and cosmetic appearance, which is at the forefront in China. It is the first in the world to perform single-port or trans-chin thyroid endoscopic surgery on the thoracic breast, and often carries out scarless thyroid cancer surgery on the thoracic breast route in the neck. In recent years, the Department of General Surgery has achieved greater development in the field of difficult and critical thyroid and parathyroid diagnosis and treatment by establishing multidisciplinary collaboration with the Department of Ultrasound Medicine, Department of Radiology, Department of Nuclear Medicine, Department of Orthopedics, Osteoporosis Specialists, Department of Thoracic Surgery, Department of Plastic Surgery, Department of Five Organs, Department of Urology, Department of Renal Rheumatology, etc., and has achieved good results. The “fish and bear’s paw” can also be both minimally invasive surgery to round the beautiful dream In the surgical ward three bed 45 Shan Shan’s bedside table above, put Shan Shan beautiful model and family photos, the original Shan Shan graduate, not only to stay in Shanghai a large company work, but also sometimes part-time modeling. Xiaoqi’s face was full of happiness when she talked about her parents, and she couldn’t tell that she had undergone “total lumpectomy of the left thyroid gland”, she said that the operation was very successful, and now there is no discomfort and no trace of the operation on her neck. We support her to undergo this minimally invasive surgery, after all, she is still young and unmarried, the disease should be treated, beauty is also needed.” Shan Shan, a 26-year-old unmarried senior white-collar worker, was found to have an enlarged thyroid gland during her annual health checkup last year, and two months ago she had an ultrasound examination and found that the nodule was already 4 cm in size. After careful examination, Professor Fan Youben recommended surgery. However, Shan had serious concerns about the scar on her neck after surgery. According to Prof. Fan, after thyroid surgery, scars of 6-250px in size often remain, which not only affect the aesthetics, but also cause local swelling and numbness and pulling discomfort. Thanks to advances in medical technology, it is possible to perform surgery through smaller incisions. Through an incision the size of a locking eye, the surgeon can insert a tiny light source, a camera and surgical instruments, and guide the operation of surgical instruments to perform minimally invasive surgery through images transmitted to a monitor. The hospital’s Department of Surgery currently performs lumpectomy to treat thyroid masses with less trauma, faster recovery, and relatively cosmetic results. Shan was hospitalized and underwent “total lumpectomy of the left thyroid gland” after completing the routine preoperative examinations. The on-the-spot frozen pathology indicated a left adenoma. The surgery went well. Shan had a strange sensation in her chest on the first day after surgery, but she was discharged the next day with no discomfort, and her biggest concern about the beauty of her neck was eliminated. According to Prof. Fan, lumpectomy can also be performed for some low-risk thyroid cancer patients with simultaneous lymph node dissection to achieve ideal surgical results. A 13-year-old girl, Xiaoyu, who lives in rural Xiapu County, Fujian Province, was raised by her aunt and uncle because her parents are both disabled. Following the fracture of Xiaoyu’s right hand the year before last, her left wrist was fractured again last year, and after surgery, both wrists became deformed and healed. The local doctor thought Xiaoyu was suffering from “malnutrition and calcium deficiency”, and then she was referred by a neighbor to Shanghai Sixth Hospital for treatment by Professor Zhang Zhenlin, who diagnosed her with “hyperparathyroidism and right parathyroid adenoma”. After consultation with Professor Fan Youben of the Department of General Surgery, she was immediately admitted to the ward, and then Professor Fan performed “lumpectomy-assisted right parathyroid adenoma resection” on Xiaoyu. One month later, Xiaoyu came to the Sixth Hospital for a follow-up visit and her walking was already normal. According to Prof. Fan, although the parathyroid glands and the thyroid gland are only one word apart, they are two completely different endocrine organs in the neck, and their biological roles are very different. The parathyroid glands are located on the dorsal side of the thyroid gland and there are generally four of them, each of which is normally only 5mm*3mm*1mm in size and not easily distinguishable. Their physiological function is to secrete PTH, which is involved in maintaining the balance of calcium and phosphorus metabolism and bone metabolism in the body. Its main “target” organs are bone and kidney, which can promote bone calcium into the blood, promote the kidney’s reabsorption of calcium and excretion of phosphorus to increase blood calcium concentration and reduce blood phosphorus concentration. Under normal conditions, the blood calcium concentration can also feedback regulate PTH to balance the blood calcium concentration. Xiaoyu’s blood calcium was as high as 3.25, which was significantly higher than the normal value of 2.10-2.55, and her parathyroid hormone (PTH) was as high as 2842 ng/I, which was significantly higher than the normal value of 15-65 ng/I. The abnormal calcium and phosphorus metabolism caused by excessive secretion of PTH by the parathyroid glands resulted in hypercalcemia, which mainly manifested as osteoporosis or pain, bone brown tumor, and easy fracture. , easy fracture, or with kidney stones, Xiaoyu has already had two fractures. Professor Fan emphasized that parathyroid disease is easy to misdiagnose or miss, but people can get timely diagnosis and treatment by understanding the typical features of the disease mentioned above. Early hyperparathyroidism can also manifest as easy fatigue, fatigue, personality changes, mental and memory loss as well as irritability, allergies, insomnia and emotional instability, as well as loss of appetite, nausea, vomiting and chronic constipation. If the above non-specific symptoms as well as elevated blood calcium are found, they should be alerted. In recent years, the general surgery thyroid (parathyroid) gland specialty group of the hospital has established multidisciplinary collaboration with orthopedics, osteoporosis specialty, endocrinology and metabolism, urology, renal rheumatology, laboratory, nuclear medicine, ultrasound medicine and radiology, and has made great development in the field of parathyroid diagnosis and treatment, and has completed more than 300 cases of lumpectomy-assisted or open small-incision, single-port parathyroid surgery on the chest and breast, with good efficacy and cosmetic appearance. It is in the forefront in China. At the same time, we have performed surgery for renal dialysis patients to resolve their secondary hyperparathyroidism. When in doubt, he never gives up and studies carefully for his patients. 49-year-old Mr. Zhang had suffered from hepatitis A, hepatitis E and hepatitis B since 1984 and paid extra attention to his health after he was cured of the three liver diseases. During his physical examination last year, he was found to have an increased CEA (carcinoembryonic antigen) and suspected that it was caused by a bad liver and gastrointestinal tract. During the follow-up period of one and a half years, he insisted on having 3 abdominal CT exams, 5 colonoscopies and 5 gastroscopies, but no abnormalities were found. Mr. Zhang thought that he had hyperthyroidism when he was young, so he tried to go to the endocrinology department of the Sixth Hospital and found a small mass in his neck on ultrasound examination. Prof. Fan found that Mr. Zhang did have a painless mass of 10×15 mm palpable in the left neck. Since elevated CEA is mainly associated with gastrointestinal tumors, especially intestinal cancer, it is generally not associated with thyroid nodules. However, after further examination, calcitonin was found to be mildly elevated at the same time. Ultrasound and CT examination of the neck revealed a 10×12 mm solid occupancy of the left thyroid gland, and ECT (single photon emission computed tomography) showed a cool nodule on the left side of the thyroid gland, so Professor Fan highly suspected that Mr. Zhang had medullary thyroid cancer. On admission, Prof. Fan performed “total bilateral thyroidectomy under general anesthesia + lymph node dissection of the left central region”. Intraoperative frozen and pathological examination confirmed that Mr. Zhang had medullary thyroid carcinoma (8×9×8mm) on the left side, and no lymph node metastasis was found. Mr. Zhang recovered well after surgery, and his calcitonin test was normal immediately after surgery, and his CEA test gradually decreased to normal.