Disease Overview
thyroidcarcinomais发lifeinthyroidFollicularupper皮orParafollicularcellsofmalignant tumor，isendocrinesystemthe most commonmalignant tumor。in recent yearsincidence呈fast速upper升trend，femalesincidenceapproximatelyasmalesof3times，peak age of onset30-50years old。thyroidcarcinomamajorityrelatively low degree of malignancy，favorable prognosis，5yearsurvival ratecan达90%-95%，butcertain亚type(such asundifferentiated carcinoma、medullary carcinoma)relatively poor prognosis。thyroidcarcinomaofprimarytreatmentmodalityissurgery，postoperativelycancanrequiringradioactive iodine therapyandthyroid hormone suppression therapy。
Major Causes
radiation exposure：childrenstageaccepted头cervicalradiationtreatmentor核radiationExposureisbright确ofrisk factor。
Genetic factors：approximately5%-10%thyroidcarcinomahavefamilial genetic predisposition，includingfamilial non-medullary thyroid carcinoma(FNMTC)、multiple endocrine neoplasia(MEN2type)、Cowden syndromeetc.。
Abnormal iodine intake: Iodine-deficient areasthyroidcarcinomaincidencerelativelyhigh，especiallyfollicular carcinoma;碘amountalsocancanincreasingrisk。
Hormonal factors: Estrogenelementcancanpromotethyroidcarcinoma发life，femalesincidencehighinmales。
Thyroid diseases：Hashimoto's thyroiditis、thyroidnoduleetc.benign lesionscancanincreasingmalignant transformation risk。
Obesity：BMIelevatedandthyroidcarcinomaincidence riskrelated。
Environmental factors：long-termExposure tocertain(such asmoreChlorinated biphenyls,haveOrganochlorine pesticidesdrug)。
Other factors：Smoking、Alcohol consumptionandthyroidcarcinomaofclose系stillnotbrightConfirmed.
Common Symptoms
cervicalmass：the most commonsymptoms，normalasno意infoundofthyroidnodule，relativelyhard，surfacenotSmooth, mobilemovedegreePoor.
hoarseness：Tumor invadeslarynx返nerve，causinghoarsenessorVoice pitchchange。
dysphagia：tumorincreaselargecompressionfoodDuct,causing吞pharynxdiscomfortor困difficult。
dyspnea：advanced-stagetumorcompressiongasDuct,causingrespiratorynotSmooth.
pain：minoritypatientscanappearingcervicalpainorearposteriorradiationPain.
颈lymph nodesenlargement：approximately20%-50%patientsat presentation已havecervicallymph nodesmetastasis。
thyroidfunctiondifferentnormal：majoritypatientsthyroidfunctionnormal，medullary carcinomacansecretiondecrease钙elementcausingdiarrhea。
advanced-stagesymptoms：distantmetastasis(pulmonary、bone)causingofCorrespondingsymptoms，such ascough、bone pain。
Pathological Classification
papillary carcinoma(80%-85%)：mostcommon，well-differentiated，degree of malignancylow，prognosismostFavorable,normalhavelocallymph nodesmetastasisbut血proceedmetastasisrare。
follicular carcinoma(10%-15%)：degree of malignancyinetc.，easy发life血proceedmetastasis(pulmonary、bone)，relatively少lymph nodesmetastasis。
medullary carcinoma(5%-10%)：to源inthyroidParafollicularcells(Ccells)，secretiondecrease钙element，degree of malignancyinetc.，canhavefamilial hereditary。
undifferentiated carcinoma(<5%)：extremely high degree of malignancy，growthrapidly，prognosisExtremely poor,majoritypatientssurvivalstageonly3-6month。
othertype：Hürthlecellscarcinoma, Islandconditioncarcinoma、squamous cell carcinomaetc.。
TNM Staging(AJCC8th edition，<55years old)
Primary Tumor (T)
T1：tumor≤4cm
T1a：tumor≤1cm
T1b：tumor>1cmbut≤4cm
T2：tumor>4cmbut≤7cm
T3：tumor>7cm，oranysizeTumor invades胸bone甲condition肌
T4：Tumor invadeslarynx、gasDuct,foodDuct,larynx返nerveetc.Adjacentstructure
Regional Lymph Nodes (N)
N0：No regional lymph node metastasis
N1：Regional lymph node metastasis present
N1a：Ⅵgroup(inCentral region)lymph nodesmetastasis
N1b：unilateralorbilateralcervical(Ⅰ-Ⅴgroup)、pharynxposteriororuppermediastinallymph nodesmetastasis
Distant Metastasis (M)
M0：No distant metastasis
M1：Distant metastasis present
Clinical Staging(<55years old)
Ⅰstage：anyTanyN M0
Ⅱstage：anyTanyN M1
Clinical Staging(≥55years old)
Ⅰstage：T1-2 N0 M0
Ⅱstage：T1-3 N1 M0，T4 N0 M0
Ⅲstage：T4 N1 M0
Ⅳstage：anyTanyN M1
Diagnosis
Laboratory tests：
thyroidfunction：TSH、FT3、FT4、Tg(thyroid球protein)、TgAb
medullary carcinoma特different：decrease钙element、carcinoma胚antigen(CEA)
Imaging studies：
thyroid ultrasound：preferredexamination，assessmentnodulesize、formstate, Borders, blood flowandhavenolymph nodesmetastasis
thyroid radionuclide scan：assessmentnodulefunctionconditionstate(hotnodule、coldnodule)
CT/MRI：assessmenttumorsize、surroundingtissueinvasion、lymph nodesmetastasis
pathological biopsy：
fine needle aspiration cytology(FNAC)：gold standard，canbright确Diagnosis
molecular testing：BRAF、RASetc.gene突changeauxiliaryDiagnosis
moderntreatment“groupcombineFist”:minimally invasiveandpreciseandheavy
one旦confirmed diagnosis，notusingPanic—modern医havebecome熟of “Battleplan”,based oncancertype、staging，amounttailoredtreatmentplan：
Surgical treatment: Radical treatmentofcore
largemajoritythyroidcarcinomaofpreferredtreatment：tumorsmall、localizedinoneLateral,cancanonlyExcise the affecteddiseaseofglandular叶;tumorlarge、havemetastasis，cancanrequiringtotal resectionthyroid。presentalsohaveminimally invasive surgery，canreducecervicalScar,recoverymorefast。
I-131 therapy：thyroid特haveof“Targetedtowardradiotherapy”
minutetypethyroidcarcinoma(PTC、FTC)of “Exclusive weapon”:mouthMinimal oral administrationamountradiationtype碘posterior, Iodine will be like “Missile” oneLike,precise找toresidualofthyroidtissueor微smallmetastasislesion，usingradiation杀deathcarcinomacells。
TSH suppression therapy：postoperativelyof“Consolidate the defense line”
postoperativelymouth服thyroid激element，alreadySupplementthyroidtotal resectionposteriorbodyDeficiencyof激element，alsothroughinhibitbrain垂bodysecretionTSH, “Starvedeath”cancanresidualofcarcinomacells。
靶towardtreatment：advanced-stagepatientsof“hopeofLight”
适usinginminorityadvanced-stageor碘treatmentno效ofpatients。BRAF、RET、TRK/ALKetc.inhibit剂canpreciseblockcarcinomacellsgrowthsignal，achieve带tumorlong-termsurvival。
and“Butterfly”andPeaceful coexistence:thantreatmentmoreimportantoflong-termmanage
thyroidcarcinomanotis“Absolutelycondition”,more像isonetype“canlong-termmanageofchronicdisease”,thinkallowingthisonly“Butterfly”anewhealthFluttering,close键dogoodand belowA few points:
· 早found：annuallyonceultrasound, SpendsmallMoney on preventionlargedisease。
· 早Diagnosis：can疑noduleandtimeperformedpuncturecellsexaminationandgenetic testing。
· 早treatment: Listen to the specialistdoctorofAdvice,avoidBlindly trying everythingdegreeorlightBelieve folk remedies.
already然thinksolvingProblem,firstthenAct as early as possiblefoundProblem,youknow道inDiagnosisduring the procedure，asWhy needdogenetic testing吗?haveWhichgeneintumorinrisetoFueling the problemofeffect?Don’t worry,understageWill tell you.