(Disclaimer: This article is for scientific use only, and the information in the following content has been processed to protect patient privacy)
Abstract: The patient, a 49-year-old female, was found to have a thyroid nodule on physical examination 1 week ago. After consultation, thyroid puncture was performed under ultrasound guidance, and the pathological diagnosis was confirmed to be hypofractionated thyroid cancer. The patient was recommended to be admitted to hospital for treatment, and the patient agreed. Total thyroidectomy and lymph node dissection in the central region were given, together with radioactive iodine therapy and medication, and the lesion was completely removed. The patient recovered well and the survival time was effectively prolonged.
Basic information】Female, 49 years old
Disease Type】Lowly differentiated thyroid cancer
Hospital】The First Hospital of Harbin Medical University
Date of consultation】November 2021
Treatment plan】Surgical treatment (total thyroidectomy, lymph node dissection in central area) + radioactive iodine treatment + medication (levothyroxine sodium tablets)
Treatment period】6 days of inpatient treatment, 1 month of outpatient follow-up
Treatment effect] The lesion was completely removed, effectively prolonging the patient’s survival time.
I. Initial consultation
The patient was found to have a thyroid nodule on physical examination 1 week ago and came to our hospital for a definite diagnosis. A yolk-sized mass was palpated on the right side of the patient’s neck, with ultrasensitive thyrotropin: 1.0278uIU/ml, free thyroxine: 0.92ng/dl, free triiodothyronine: 2.85pg/ml, peroxidase antibody: 18.69IU/ml, and thyroglobulin antibody: 5.10IU/ml. Ultrasonography of the thyroid gland showed that the size of the right lobe was The boundary is still clear, the outline is not regular, large lobes are visible, the internal echogenicity is not homogeneous, and the strong echogenicity of the dotted piece is visible within it, the elasticity score is 3, TI-RADS classification is 4c, and the rest of the parenchyma is homogeneous. The blood supply to the gland was normal on ultrasound examination. After full communication with the patient, ultrasound-guided thyroid aspiration was performed, and the pathological diagnosis was confirmed as hypofractionated thyroid cancer.
II. Treatment history
Since the patient had already undergone thyroid nodule puncture and the pathological diagnosis was confirmed as hypofractionated thyroid cancer, surgery was considered for her. After the patient was hospitalized, the CT of the thyroid gland was completed, and the specific condition of hypofractionated thyroid cancer was clarified. After thorough communication with the patient and her family, total thyroidectomy and lymph node dissection in the central region were performed. After the operation, the patient was put on an iodine-free diet for 1 month and then treated with radioactive iodine. After radioactive iodine treatment, the patient continued to take levothyroxine sodium tablets for long-term endocrine therapy, and needed to be reviewed and the dosage adjusted if necessary. The patient was discharged after 6 days of inpatient treatment and was instructed to follow up with an outpatient clinic after 1 month.
III. Treatment results
After total thyroidectomy and lymph node dissection in the central region, the complete removal of the lesion relieved the pressure of the tumor on the patient’s airway, effectively prevented the tumor from further invading the surrounding important organs (such as the laryngeal nerve, trachea and esophagus), reduced the chance of adverse events, and effectively prolonged the patient’s survival time. There was still no recurrence or metastasis in the postoperative review within 6 months, and the patient recovered well after surgery without obvious discomfort.
IV. Notes
We are glad that the patient’s surgery was successfully completed, but patients with hypofractionated thyroid cancer need a 1-month iodine-free diet after surgery to prepare for radioiodine therapy. During this period, patients need to consume iodine-free salt stir-fry and eat less or no seaweed and seaweed with high iodine content. However, after radioactive iodine treatment, the patient still needs to have a normal diet without having to control the amount of iodine in the diet. It is recommended to eat lightly and drink moderately for a short period of time after surgery, because the patient needs to be intubated during surgery, and intubation will cause some irritation to the patient’s trachea and throat.
Since the patient is a hypofractionated thyroid cancer, after radioiodine therapy, regular oral levothyroxine sodium tablets are needed for endocrine therapy to inhibit the recurrence and metastasis of hypofractionated thyroid cancer. Hypofractionated thyroid cancer is more malignant than the common papillary thyroid cancer, and the risk of recurrence and metastasis is also higher than that of papillary thyroid cancer. Therefore, patients need to undergo standardized and strict review in outpatient clinics according to medical prescriptions to monitor whether the tumor recurs and metastasizes, and to provide early treatment.
V. Personal insight
When thyroid nodules are found in middle-aged women during physical examination, they should be alerted to the possibility of hypofractionated thyroid cancer. The malignancy of hypofractionated thyroid cancer is between differentiated thyroid cancer and undifferentiated thyroid cancer, once found, patients need to go to regular hospitals for thorough surgery as soon as possible. Surgery is the main treatment for hypofractionated thyroid cancer, which can reduce the chance of tumor recurrence and metastasis and prolong the survival time of patients. Strict postoperative review is needed to monitor the recurrence and metastasis of tumor. In this case, the patient still did not have recurrence and metastasis 6 months after surgery, and the efficacy is good.