The Diagnosis And Surgical Treatment Of 210 Differential Thyroid Carcinoma Cases

Purpose: To investigate the diagnosis, surgical management and prevention of post-operation complications for patients with differentiated thyroid carcinoma.Methods: A retrospective study with the clinical information of 210 patients with differentiated thyroid carcinoma who received surgeries that were conducted at Xiangya First Hospital from January 2006 to August 2008.Results: The sample of this study consists 210 differentiated thyroid carcinoma surgical cases, of which 148 patients had only one surgery and the rest 62 ones received re-operation. For the 148 cases, 65 patients had solitary thyroid nodule and rest 83 cases involved multiple nolules. Calcified were detected in 87 cases, in which 47 cases were coarse calcification while other 40 cases were micro-calcification. In 182 cases of thyroidectomy, pathological examinations were not performed before the operation. However, frozen section for thyroid was performed during these operations, and only 3 patients (1.6%) were misdiagnosed. In 11 (15.3%) out of the 73 initial thyroidectomy where sarcoidosis are found on both sides of the thyroid, cancer tissues are developed in the smaller sarcoidosis. There are 37 (17.6%) post-operation complications. Nine patients (4.3%) developed hoarseness, of which 2 cases are permanent hoarseness and they are found on un-explored recurrent laryngeal nerves. Fifteen (7.1%) patients got numbness on hands and feet, or muscle convulsion, all of them were temporary. There was no statistical difference between < 1 month group and 1～2month group in the incidence of complications.Conclusions: For patients with thyroid multiple nodules, especially those who have calcified nodules, operations should be performed. Intraoperative frozen section should be performed in all thyroidectomy for rapid diagnosis and surgical decision-making. In thyroid surgeries where multiple nodules are found, all nodules must be closely examined to avoid misdiagnosis. Surgeons must well understand and strictly perform detailed surgical procedures in thyroidectomy of both sides of the thyroid. Recurrent laryngeal nerves must be exposed throughout the operation to avoid the damages on the nerve.