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Tian Wen
(Chief physician)
General Surgery Department of Beijing 301 Hospital
Thyroid tumor is a common tumor in head and neck, which is more common in women.The symptoms are anterior and median cervical mass. With swallowing activity, some patients have hoarseness andDysphagiaDifficulty in breathing.There are many kinds of thyroid tumors, both benign and malignant. Generally speaking, a single tumor is more likely to be malignant if it grows faster, while a thyroid tumor with a younger age is more likely to be malignant.Because of the obvious symptoms, patients can generally see a doctor in time.
The thyroid gland is located under the thyroid cartilage in the neck of the human body, and on both sides of the trachea. It is shaped like a butterfly, like a shield, so it is called the thyroid gland.The thyroid gland is divided into left and right lobes and isthmus.The left and right lobes are located in the lower part of the larynx and the two sides of the upper part of the organ.The upper end starts from the midpoint of the thyroid cartilage and ends at the lower end to the 6th tracheal cartilage ring, sometimes reaching the suprasternal fossa or posterior sternum.
physiology
Thyroid gland has the function of synthesizing, storing and secreting thyroxine, and its structural unit is follicles.Thyroid hormone is an organic bound iodine containing iodothyrosine, including tetraiodothyrosine (T4) and triiodothyrosine (T3). After synthesis, it combines with thyroglobulin and stores in thyroid follicles.The thyroxine released into the blood is bound to serum protein, 90% of which is T4 and 10% is T3.The main functions of thyroxine are: to accelerate the efficiency of the whole body cells to use oxygen, accelerate the decomposition of protein, carbohydrate and fat, comprehensively increase the metabolism of the human body, and increase heat productionPromote the growth and development of human body, mainly affecting the brain and long bones after birth.
Benign thyroid tumor
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Benign thyroid tumor is very common, in the neck mass, thyroidadenomaAbout 50%.Generally, there is no obvious symptom. When the tumor is large, it will cause difficulty in breathing due to compression of the trachea, esophagus and nervesDysphagia, hoarseness and other symptoms, when the tumor combined with bleeding and rapidly increased, it will produce local pain.Because benign thyroid tumors may become malignant, some of them are benign, but they are "hot nodules" (i.e., highly functional), so they need active treatment.
thyroid adenoma(thyroid adenoma, TA) is the most common benign thyroid tumor, and its pathology is follicular typeadenoma(follicular thyroid adenoma, FTA) and nipple typeadenoma(salary tyre adenoma, PTA), the former is the most common, accounting for aboutthyroid adenoma70%~80%, the latter is relatively rare and should be differentiated from papillary carcinoma.adenomaThere is often a complete capsule around.The reason is unknown, which may be related to gender, genetic factors, radiation (mainly external radiation) and long-term over stimulation of TSH.thyroid adenomaIt is mostly seen in women under 40 years old.The onset of the disease is concealed, and the chief complaint is the neck mass. Most patients are asymptomatic. Those who suddenly increase (bleed) in the course of the disease are often accompanied by local pain.On physical examination, it was found that most of the nodules in the anterior cervical region were single, round or oval, often confined to one gland, with medium texture, smooth surface, no tenderness, and moved up and down with swallowing.If accompanied by cystic change or bleeding, the nodules are mostly "hard" due to high tension, and may have tenderness.Color Doppler Flow Imaging (CDFI) shows that the boundary of the mass is clear, the blood supply is not rich, and there may be cystic changes.thyroid adenomaCausinghyperthyroidism(The incidence rate is about 20%) and malignant change (the incidence rate is about 10%), in principle, early resection should be performed.Generally, subtotal thyroidectomy (includingadenomaInside);If the adenoma is small, simple adenoma resection is feasible, but wedge resection should be performed, that is, a small amount of normal thyroid tissue should be wrapped around the adenoma.The resected specimen must be immediately examined by frozen section to determine whether there is canceration.
Nodular goiter (NG) may be caused by iodine deficiency in diet or enzyme deficiency in thyroid hormone synthesis. The disease history is usually long, and it often grows up unconsciously, but is occasionally found during physical examination.Most were multinodular, and a few were single nodules.Most nodules are gelatinous, and some of them form cysts due to hemorrhage and necrosis;There may be more fibrosis or calcification, or even ossification, in some areas of the chronically ill.Thyroid hemorrhage often has a history of sudden pain, and there are cystic masses in the gland;If there are colloidal nodules, the texture is hard;Those with calcification or ossification are hard.Generally, it can be treated conservatively, but the large nodule will cause compression symptoms (dyspneaDysphagiaOr hoarse voice), malignant tendency or mergerhyperthyroidismSurgery should be performed when symptoms occur.
Thyroglossal duct cystThyroglossal duct is a congenital malformation related to thyroid development.In the embryonic stage, the thyroid gland is formed at the lower end of the thyroglossal tube, which extends from the bottom of the mouth to the neck.The thyroglossal duct is usuallyfetusAbout 6 weeks, it locks itself. If the thyroid lingual tube does not degenerate completely, it can form a congenital cyst. After infection and collapse, it becomes a thyroid lingual tube fistula.This disease is more common in children under 15 years old, twice as many men as women.It showed that there was a round mass with a diameter of 1~2cm in the middle line of the anterior cervical region and under the hyoid bone.The state is clear, the surface is smooth, and has a sexy bladder, and can move up and down with swallowing or stretching or contracting the tongue.The treatment should be surgical resection. A segment of hyoid bone should be removed to completely remove the cyst wall or sinus, and be separated upward to the base of the tongue to avoid recurrence.
Also known as De QuervainthyroiditisOr giant cellthyroiditis。The size of the nodule depends on the extent of the lesion, and the texture is often hard.Frequently secondary toupper respiratory tract infectionHe has a typical medical history, including acute onset, fever, sore throat, significant thyroid pain and tenderness, and pain often affects the affected ear, temporal and occipital regions.There is often an increase in body temperature and ESR.In acute phase, 131I uptake rate of thyroid decreases, mostly presenting as "cold nodules", but serum T3 and T4 increase, and basal metabolic rate slightly increases, which is helpful for diagnosis.The mild cases can be treated with aspirin and other non steroidal anti-inflammatory drugs, and the severe cases are often treated with prednisone and dry thyroid preparations.
Thyroid malignant tumor
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Thyroid malignant tumorThe most commonThyroid carcinoma(Thyroid carcinoma), very few may be malignantlymphomaAnd metastatic tumor,Thyroid carcinomaIt accounts for 1% of malignant tumors in the whole body.Except for medullary carcinoma, most of themThyroid carcinomaIt originates from follicular epithelial cells.Thyroid carcinomaThe incidence of HIV/AIDS is related to region, race and gender.AmericanThyroid carcinomaThe incidence rate is relatively high. According to statistics, the annual incidence of thyroid cancer in the United States increased from 3.6 per 100000 to 8.7 per 100000, about 2.4 times (P<0.001), and this trend is still growing year by year.The incidence of thyroid cancer in China is low. According to statistics, about 0.8-0.9/100000 men and 2.0-2.2/100000 women have thyroid cancer.
Pathogenesis
Thyroid malignant tumorIts pathogenesis is still unclear, but its related factors include many aspects, mainly including the following categories:
1. Oncogenes and growth factors: Recent studies have shown that the occurrence of many animal and human tumors is related to the overexpression, mutation or deletion of proto oncogene sequences.
2. Ionizing radiation: It has been found that external radiation of head and neck is an important carcinogen of thyroid.
3. Genetic factors: partialMedullary carcinoma of thyroidIt is an autosomal dominant genetic disease;In some patients with thyroid cancer, family history can often be inquired
4. Iodine deficiency: As early as the beginning of the 20th century, it has been proposed that iodine deficiency can cause thyroid tumors
5. Estrogen: Recent studies suggest that estrogen can affect thyroid growth mainly by promoting pituitary to release TSH, because when the level of estrogen in plasma increases, the level of TSH also increases.It is not clear whether estrogen acts directly on thyroid.
Thyroid carcinoma
Pathological classification
1. Papillary carcinoma accounts for about 70% of the total thyroid cancer in adults, while thyroid cancer in children is often papillary carcinoma.Papillary carcinoma is commonly seen in young and middle-aged women, with the majority of women aged 21-40 years.This type has good differentiation, slow growth and low malignancy.The disease has a tendency of multicentric occurrence, and cervical lymph node metastasis may occur earlier. It is necessary to strive for early detection and active treatment, and the prognosis is relatively good.
2. Follicular carcinoma accounts for about 15%, mostly seen in women around 50 years old.This type develops rapidly, is moderately malignant, and tends to invade blood vessels.Cervical lymph node metastasis only accounts for 10%, so the prognosis is inferior to that of papillary carcinoma.
3. Undifferentiated carcinoma (anaplastic thyroid carcinoma) accounts for about 5% - 10%, mostly seen in the elderly, develops rapidly and is highly malignant, and about 50% of them have cervical lymph node metastasis, or invade the recurrent laryngeal nerve, trachea or esophagus, and often metastasize to distant areas through blood transportation.The prognosis is very poor. The average survival time is 3-6 months, and the one-year survival rate is only 5% - 10%.
4. Medullary thyroid carcinoma is rare.It occurs in parafollicular cells (C cells) and secretes calcitonin.The cells are arranged in the form of nests or bundles, without papilla or follicular structure, and there is amyloid deposition in the interstitium, which is undifferentiated, but its biological characteristics are different from undifferentiated cancer,.The degree of malignancy is moderate, with cervical lymph node metastasis and blood circulation metastasis.
In conclusion, different types of thyroid cancer have different biological characteristics, clinical manifestations, diagnosis, treatment and prognosis.
clinical manifestation
Papillary carcinoma and follicular carcinoma usually have no obvious symptoms at the initial stage. The former can sometimes seek medical treatment due to enlargement of cervical lymph nodes.With the progress of the disease, the mass gradually increases and becomes hard, and its mobility decreases when swallowing.Undifferentiated cancer develops rapidly and invades surrounding tissues.Hoarseness, dyspneaDysphagia。The compression of the cervical sympathetic ganglia can lead to Horner syndrome.When the superficial branch of the cervical plexus is invaded, the patient may have pain in the ear, pillow, shoulder, etc.There may be cervical lymph node metastasis and distant organ metastasis (lung, bone, central nervous system, etc.).
In addition to cervical mass, medullary carcinoma can produce 5-hydroxytryptamine and calcitonindiarrhea, palpitations, flushed face, and low blood calcium.For those with family history, attention should be paid to the possibility of multiple endocrine neoplasia syndrome type II (MEN-II).
Diagnostic differentiation
Supplementary Examination
1. Thyroid function test: mainly the determination of thyroid stimulating hormone (TSH).High functional hot nodules with decreased TSH are less malignant, sohyperthyroidismTreatment is more important.TSH normal or elevatedThyroid nodule, as well as cold or warm nodules under TSH reduction, they should be further evaluated (such as puncture biopsy).
2. Nuclide scanning: the isotope scanning test (ECT) of radioactive iodine or technetium is to judge whetherThyroid noduleThe size of the function is an important means.The American Thyroid Society pointed out: "The results of ECT examination include high functional (higher than the uptake rate of surrounding normal thyroid tissue), isofunctional or warm nodules (the same as the uptake rate of surrounding tissue) or nonfunctional nodules (lower than the uptake rate of surrounding thyroid tissue). The malignant transformation rate of high functional nodules is very low, if the patient has obvious or subclinicalhyperthyroidism, the nodules need to be evaluated.If the serum TSH level is high, the nodule should be evaluated even if it is only at the highest limit of the reference value, because the malignant rate of the nodule is high ".However, ECT is often unable to show nodules or small cancers smaller than 1cm, so it is not suitable to use ECT for such nodules.
3. B-ultrasonic examination: ultrasound is a discoveryThyroid noduleIt is an important means to preliminarily judge the benign and malignant status of FNA, which is the standard to judge the possibility of FNA implementation, and also the inspection means with the highest benefit ratio.The European and American guidelines all mention the indications of suspicious malignant transformation under ultrasound, including: hypoechoic nodules, microcalcifications, rich blood flow signals, unclear boundaries, nodules with height greater than width, solid nodules, and absence of halos.Some people in China have analyzed and evaluated the nodule in terms of its shape, boundary, aspect ratio, peripheral acoustic halo, internal echo, calcification, and cervical lymph nodes. After comparing the pathological results after surgery, statistics of the nodule shape, calcification, and internal echo were obtainedThyroid noduleIt is more relevant in the differentiation of benign and malignant tumors, and this feature can be emphatically observed (only for papillary carcinoma).
4. Needle aspiration cytology: needle aspiration biopsy includes fine needle aspiration biopsy and thick needle aspiration biopsy. The former is cytology, and the latter is histology.For suspicious malignant change found by B-ultrasoundThyroid nodule, this method can be used for clear diagnosis.At present, fine needle biopsy is generally used. During the operation, the patient lies on his back and assumes an overextended position of the neck.It is better to use localanaesthesia。The importance of multi-directional puncture should be emphasized. At least 6 times should be punctured to ensure sufficient specimens are obtained.When puncturing, fix the nodule with the middle finger of the index finger of the left hand, hold the needle cylinder with the right hand, draw back the needle plug to generate negative pressure, and slowly pull out the needle for 2mm outward, and then puncture again. After repeated several times, stop the suction, remove the negative pressure, pull out the needle, detach the needle cylinder, inhale several milliliters of air into the needle cylinder, connect the needle, and discharge the specimen in the needle onto the glass slide,It is required to have 1-2 drops of orange liquid with cell debris inside.Then smear inspection.
differential diagnosis
Thyroid nodules are the obvious manifestations of thyroid cancerNodular goiterIt is of great significance to distinguish between benign and malignant nodules.Common diseases causing thyroid nodules are as follows:
1、Simple goiter: To causeNodular goiterThe most common cause of the disease.The medical history is usually long and often grows up unconsciously, but it is found accidentally during physical examination.Nodules are developed from glands in the process of hyperplasia and compensation, and most of them areNodular goiterA few are single nodules.Most nodules are gelatinous, and some of them form cysts due to hemorrhage and necrosis;There may be more fibrosis, calcification or even ossification in some areas of the chronically ill.Due to the different pathological properties of nodules, their size, hardness and appearance are different.Thyroid hemorrhage often has a history of sudden swelling and pain, and there are cyst like masses in the gland;If there are colloidal nodules, the texture is hard;Those with calcification and ossification are hard.
2、thyroiditis: SubacutethyroiditisThe size of the nodule depends on the extent of the lesion, and the texture is often hard.Have a typical medical history, including acute onset, fever, sore throat, and significant thyroid pain and tenderness.In the acute phase, the thyroid uptake rate decreased, the imaging mostly showed "cold nodules", and the serum T3 and T4 increased, showing a "separation" phenomenon, which is helpful for diagnosisChronic lymphocytic thyroiditis: Symmetric diffuse goiter without nodules;Sometimes due to asymmetric swelling and lobulation on the surface, it can be shaped like a nodule, as hard as rubber, without tenderness.The onset of this disease is slow, showing a chronic development process, but it can occur at the same time with thyroid cancer, which is difficult to differentiate clinically, and should be noted.The titers of anti thyroglobulin antibody and anti thyroid peroxidase antibody are often increased.ƒ Invasive fibrous thyroiditis: the nodules are hard and fixed with adjacent tissues outside the gland.The cavalry develops slowly, and may have local dull pain and tenderness, accompanied by obvious compression symptoms. Its clinical manifestations are similar to thyroid cancer, but the local lymph nodes are not large, and the I uptake rate is normal or low.
3. Thyroid adenoma: caused by thyroid adenoma or multiple colloidal nodules.One or more can coexist with or appear alone with goiter.The adenoma is generally round or oval, and its texture is mostly harder than the surrounding thyroid tissue, without tenderness.It is shown on the scan that the function of photographing I is normal, increased or decreased;Thyroid imaging was divided into "warm nodules", "hot nodules" and "cold nodules".The thyroid uptake rate may be normal or high.The tumor develops slowly, and most of them are asymptomatic clinically, but some patients have hyperfunction symptoms.
4. Thyroid cyst: the cyst contains blood or clear liquid, has a clear boundary with the surrounding thyroid tissue, and can be quite hard. B-ultrasound is often helpful for diagnosis. In clinical practice, except for goiter and nodules, most of the cysts have no functional changes.[1]Disease treatment
Surgical treatment is the basic treatment for all types of thyroid cancer except undifferentiated cancer, and it is assisted by iodine-131, thyroid hormone and external irradiation.
1、Surgical treatment: surgical treatment of thyroid cancer includes the operation of the thyroid itself, and neck lymph node dissection.At present, the scope of thyroidectomy is still different, and there is no evidence for the results of prospective randomized controlled trials.However, complete resection of tumor is very important, and meta-analysis data suggest that complete resection of tumor is an independent prognostic factor.Therefore, even if it is differentiated thyroid cancer, it is inappropriate to resect it smaller than the glandular lobe.The smallest scope is the resection of the glandular lobe and isthmus.Maximum to total thyroidectomy.The trend of thyroidectomy is more extensive.There is evidence that the recurrence rate after subtotal thyroidectomy or total thyroidectomy is low.The 30 year recurrence rate of patients in the low-risk group after lobectomy was 14%, while that of patients in the total resection group was 4%. Generally, there was no much debate about the scope of the first operation for patients in the high-risk group. It was reported that the local recurrence rate of patients in the TNM III stage after lobectomy was 26%, and the local recurrence rate after total resection was 10%. There was no difference between total thyroidectomy and near total thyroidectomy.The advantage of a wide range of operations is to reduce the local recurrence rate, while the main disadvantage is the increase of short-term or long-term complications after the operation, while lobectomy rarely leads to recurrent laryngeal nerve injury, and almost no severe hypoparathyroidism occurs.
Recently, many scholars believe that age is an important factor to divide low-risk and high-risk groups, and choose treatment principles according to low-risk and high-risk groups.The patients in the low-risk group were treated with lobectomy and isthmus resection. If there was no tumor at the cutting edge, the treatment could be achieved.It is appropriate to take subtotal or subtotal resection of the affected lobe or contralateral lobe for high-risk patients.The surgery can also be designed according to the clinical characteristics of the tumor: lobectomy+isthmus resection is applicable to low-risk patients with tumor diameter less than 1cm and clearly limited to one lobe of thyroidTotal thyroidectomy on the affected side+isthmus resection+subtotal thyroidectomy on the opposite side, suitable for patients with tumor diameter greater than 1cm, more extensive unilateral papillary carcinoma with lymph node metastasis;Total thyroidectomy is applicable to highly invasive papillary and follicular carcinoma with obvious multifocal, bilateral lymph node enlargement, tumor invasion of surrounding neck tissue or distant metastasis.In cases under 15 years old or over 45 years old, the lymph node metastasis rate is high, up to 90%. For this group of cases, total thyroidectomy should be considered.
The scope of neck lymph node dissection is also controversial. It is still inconclusive to routinely perform neck lymph node dissection in the central area or modified lymph node dissection, or only remove the palpable swollen lymph nodes.Meta analysis data suggest that only two factors can help predict whether cervical lymph node metastasis occurs, namely, tumor lack of capsule and tumor invasion around the thyroid gland.The rate of cervical lymph node metastasis was 38% in patients without both factors, and 87% in patients with both factors.
Although the surgical effect of cervical lymph node dissection is certain, the quality of life of patients may be affected, so the decision of preventive cervical lymph node dissection is very cautious at present.Especially for patients in the low-risk group, if the swollen lymph nodes are not touched during the operation, neck lymph node dissection may not be performed.If enlarged lymph nodes are found, rapid pathological examination should be performed after resection. If lymph node metastasis is confirmed, neck lymph node dissection in the central area or modified neck lymph node dissection can be performed.The former refers to the removal of lymph nodes in the common carotid artery, around the thyroid, between the tracheoesophageal sulcus and the upper mediastinum;The latter refers to the neck lymph node dissection with preservation of sternocleidomastoid muscle, internal jugular vein and accessory nerve.Since the recurrent laryngeal nerve and parathyroid gland are easily damaged by lymph node dissection in the central area during the second operation, it is suggested that the central area should also be cleared if no swollen lymph nodes are found during the first operation.For patients in high-risk group who can see cervical lymph node metastasis, tumor invasion outside the capsule, and those over 60 years old, improved neck lymph node dissection should be performed;If the disease stage is late and the cervical lymph nodes are extensively involved, traditional lymph node dissection should be performed.2、Endocrine therapy: After subtotal or total thyroidectomy for thyroid cancer, patients should take thyroxine tablets for life to preventHypothyroidismAnd TSH suppression.Both papillary carcinoma and follicular carcinoma have TSH receptors, through which TSH can affect the growth of thyroid carcinoma.The dose of thyroxine tablets should be adjusted according to the TSH level, but there is still insufficient effective data to support the precise range of TSH inhibition.Generally speaking, TSH should be maintained below 0.1mU/L for patients with residual cancer or recurrence risk factors;However, TSH of disease-free patients with low risk of recurrence should be maintained near the lower limit of normal (slightly higher or lower than the lower limit of normal);For those with positive laboratory test but no organic substanceSTDTSH should be maintained at 0.1-0.5mU/L in low-risk group patients with thyroid globulin positive and imaging negative changes;TSH may be maintained within the normal reference value for patients who have survived without disease for a long time.Levothyroxine sodium tablet (Youjiale) can be used, 75ug-150ug per day, and blood T4 and TSH are measured regularly, and the dosage is adjusted according to the results.
3、Radionuclide therapy (131 iodine therapy): For papillary carcinoma and follicular carcinoma, postoperative iodine therapy is suitable for patients over 45 years old, multiple cancer foci, local invasive tumors and those with distant metastasis.It is mainly to destroy the residual thyroid tissue after thyroidectomy, which is conducive to reducing recurrence and mortality in high-risk cases.The purpose of iodine therapy is: ① to destroy the hidden microcarcinoma in the residual thyroidIt is easy to use nuclide to detect recurrent or metastatic lesions; ③During the follow-up, the value of adenoglobulin as a tumor marker was increased.
4、External radiation therapy (EBRT): mainly used for other thyroid cancer except papillary cancer.[2-3]
Disease prognosis
In malignant tumors, the prognosis of thyroid cancer is generally good. Many thyroid cancers have metastasized, but patients can still survive for more than 10 years.There are many factors related to prognosis, such as age, sex, pathological type, range of lesions, metastasis and surgical method, among which pathological type is the most important.95% of well differentiated thyroid cancer patients can survive for a long time, especially papillary cancer with good biological characteristics and the best prognosis. Recessive papillary cancer has a better prognosis, but a few can also become undifferentiated cancer with extremely high malignancy;The prognosis of undifferentiated cancer is the worst, and patients often die within half a year.The larger the tumor volume, the more chances of invasion, and the worse the prognosis.According to relevant statistical data, whether there is lymph node metastasis or not does not affect the survival rate of patients. Uncontrolled primary tumor or local recurrence can lead to increased mortality. The extent of direct tumor spread or invasion is more important than lymph node metastasis.
Diet attention
Patients with thyroid cancer can basically eat and work normally after operation, properly control iodine rich food, avoid excessive fatigue, and avoid smoking and alcohol.Attention should be paid to thyroid examination, including imaging and thyroid function examination. If any abnormality is found, it is necessary to see a doctor in time.
lymphoma
Primary thyroidlymphomaIs rareThyroid malignant tumor, accounting for 1%~2% of thyroid cancer, male: female 1:3.Most of them are based on Hashimoto's thyroiditis, and most of them are non Hodgkin'slymphoma。yeslymphomaThe only female tumor in China.It is mostly seen in middle-aged and elderly women, mainly neck tumors. The tumor increases at an inconsistent speed. Those with faster speed are similar to undifferentiated thyroid cancer in clinical symptoms, and may be accompanied byDysphagia, such as compression of the trachea and even dyspnea, occasionally involving the recurrent laryngeal nerve, causing hoarseness and local pain;Some grow slowly, andNodular goiterIt is not easy to distinguish from Hashimoto's disease.The qualitative diagnosis of this disease mainly depends on fine needle aspiration cytology and surgical biopsy, which is easy to be confused with undifferentiated cancer mainly consisting of small cells.The treatment of primary thyroid lymphoma has developed from single operation to comprehensive treatment such as surgery, radiotherapy and chemotherapy.
Metastatic tumor
Thyroid metastases are rare. According to autopsy data, 4%~24% of the thyroid gland of patients who died of disseminated cancer were affected.The origin of thyroid metastasis is no more than three aspects: direct diffusion of adjacent structures (such as throat, esophagus, etc.), lymph node metastasis (common mainlymammary cancer）Blood transfer（mammary cancer、lung cancer、renal cell carcinomaSkin melanoma, fibersarcoma, liver and biliary canceroophoromaEtc.).The diagnosis mainly depends on the clinical manifestations and histological means, and the treatment measures are mainly the treatment of the primary disease.
Expert opinion
thyroid disease In particular, thyroid cancer is on the rise, which requires great attention.Thyroid surgery is prone to surgical complications such as hoarseness and low calcium. The scope of surgery should be judged according to the patient's condition and medical technical conditions. It should comply with the principle of tumor resection. At the same time, it should try to preserve nerve functions and improve the quality of life of patients.Improving surgical skills and strengthening comprehensive treatment are the direction of efforts to improve the efficacy.For those with scar constitution and special cosmetic requirements, endoscopic thyroid surgery without scar on the neck is also feasible.
