One Tuesday morning at the clinic, a young patient entered the clinic with a folder in his hand.
"Dr. Lu, I have only been operating on one side of the thyroid cancer for 4 months, and recently I found that there are cancer cells in the thyroid gland on the other side of the ultrasound and nail piercing, what should I do?" The patient had a dignified expression and handed me the folder as he spoke.
I looked up and saw that the scar on the patient's neck was more obvious.
I carefully went through the examination materials brought by the patient to understand the "ins and outs" of the patient's condition.
It turned out that the patient was 31 years old. 5 years ago, the patient's physical examination found that there were multiple thyroid nodules, and because the nodules were not large at that time, the patient did not take it seriously and never went to the hospital for further review.
In the blink of an eye, in August 2021, the patient participated in the physical examination again, and the color ultrasound still suggested that the bilateral thyroid nodule was not in good shape, and the physical examination doctor recommended that the patient go to the top three hospitals for re-examination.
In mid-August 2021, the patient came to a famous third-class hospital in Beijing for examination, and What Cai Chao saw:
Bilateral thyroid echoes are not uniform, multiple cystic solid nodules are visible in the right lobe, the largest nodule is located in the uppermost deep side, about 1.7x1.1 cm, the boundary is clear, and multiple strong echoes are visible in the solid part;
Low-echo nodules are visible in the middle of the left lobe of the thyroid gland, about 0.9x0 .6cm in size, and the borders are still clear;
Multiple eccentric target ring lymph nodes can be seen in the 11 and 1I1 areas of the double neck, with the most about 2.3x0.7 cm on the right side and about 1.9 x0 .8cm on the left side.
From this ultrasound examination, it can be preliminarily judged that the bilateral thyroid gland is not in good shape and cannot be discharged malignant.
Subsequently, the patient underwent only a right lobe nodule biopsy at the hospital, the results of which suggested "papillary carcinoma of the right lobe of the thyroid gland".
It is worth mentioning that from the results of this color ultrasound examination, it can be seen that the left lobe of the thyroid gland is saved by 0.9 cm, the boundary is still clear, and the possibility of "papillary carcinoma of the left thyroid gland" cannot be ruled out.
According to common sense, the left lobe nodule of the thyroid gland should also be underpaged. However, the hospital doctor did not do a left nodular puncture biopsy, the reason for which is unknown
In late August 2021, the patient underwent "right thyroid and isthmus resection, central lymph node dissection, and retention of the left lobe of the thyroid gland" in the hospital, and the postoperative pathology was reported as: papillary carcinoma of the right lobe of the thyroid gland, lymph node dissection of the central cervical area 5/5).
Why is only one side of the adenous lobectomy performed on the patient's preoperative surgical regimen? Later, after questioning, it was learned that on the one hand, the patient wanted to preserve one side of the thyroid gland; on the other hand, the patient did not undergo a left thyroid nodule biopsy before surgery. Whether the left nodule is benign or malignant is unknown.
However, the attending physician judges that the left lobe nodule is benign based on color ultrasound alone
The patient had a smooth operation and recovered well after surgery.
In December 2021, four months after the operation of right lobe of thyroid cancer, the patient went to the hospital to review thyroid ultrasound.
When the patient got the color ultrasound results, the mood was heavy, and the results were described as follows:
After right thyroidectomy, no significant mass is seen in the thyroid area;
The size and morphology of the left thyroid gland are acceptable, the echo is not uniform, the strong echo scattered in the gland is scattered in the gland, and the low echo nodule can be seen in the middle and upper parts, the size is about 0.9x0.6x0.9cm, the boundary is not clear, the morphology is irregular, and multiple dot-like strong echoes can be seen inside.
Judging from this postoperative ultrasound result, the left lobe nodule of the thyroid gland is a typical malignant form.
In January 2022, the patient underwent left lobe nodule nail puncture suggesting: papillary carcinoma of the left lobe of the thyroid gland.
The patient was very frustrated and confused when he got the nail piercing results, so he came to the outpatient clinic to see me for treatment, hoping to hear my opinion.
After reading the results, I gave the treatment advice: surgery again!
The patient is silent and in a dilemma
Reminder: If the color ultrasound suggests multiple thyroid nodules, and the shape of the nodules on both sides is not good, malignancy cannot be ruled out, and a bilateral nodule puncture biopsy must be done before surgery, and do not puncture only one side of the nodule.
Of course, perhaps it is difficult to judge the benign and malignant nodules, at this time, it must be combined with the color ultrasound for comprehensive judgment, and the chief surgeon and the patient discuss the surgical plan together.
About Dr. Lu Yao
Dr. Lu Yao is the chief physician and professor of the Department of General Surgery of China-Japan Friendship Hospital.
In Sino-Japanese Hospital, it has taken the lead in carrying out cervical scar-free endoscopic thyroid surgery, endoscopic radical thyroid cancer resection, endoscopic hyperthyroidism and parathyroid surgery, and has accumulated more than 10,000 cases of thyroid surgery, more than 2,000 cases of endoscopic thyroid surgery, and more than 600 cases of primary and secondary hyperparathyroidism surgery.