One Tuesday afternoon at the clinic, a young patient, accompanied by his family, entered the clinic with a folder in his hand.
"Dr. Lu, I have only been undergoing thyroid cancer surgery at the local hospital on October 4, 2021, and now that I have found cancer cells in the thyroid gland on the right side of the color ultrasound and nail puncture, what should I do?" The patient had a dignified expression and handed me the folder as he spoke.
I looked up and the scar on the patient's neck was very noticeable.
I carefully flipped through the examination materials brought by the patient, and recorded while drawing pictures, roughly understanding the "ins and outs" of the patient's condition.
It turned out that the patient was 53 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 October 2021, the patient went to the local hospital to review the color ultrasound prompt: bilateral thyroid multiple nodules, of which one nodule on the left lobe of the thyroid gland is not in good shape, and the right lower lobe pole knot saves 2.4 cm, and the cyst is solid. Doctors at local hospitals recommend direct surgery.
On October 24, 2021, the patient underwent surgery at the local hospital, and the surgical plan was: first remove the left and right thyroid nodules and send frozen slices, and the result of the frozen slices during the operation was "papillary carcinoma of the left thyroid gland and nodular goiter on the right side".
Then, the doctor gave the patient a "total resection of the left lobe of the thyroid gland, partial resection of the right thyroid gland, bilateral central lymph node dissection", and the patient developed "low calcium and hoarseness" after surgery, and after a period of treatment, the above symptoms slowly recovered.
Nearly 2 weeks after the operation, the final pathological results were reported as: bilateral thyroid papillary carcinoma, lymph node metastases in the central area of the double neck.
It is worth reminding that the patient's right lobe of the thyroid gland is not completely resected, but only partially removed, which means that the remaining right lobe of the thyroid gland may still be at risk of cancerous nodules!
The patient spent three months in nervous worry.
In January 2022, the patient went to a number of hospitals to review the thyroid ultrasound prompt: the middle and upper part of the right lobe of the thyroid gland near the dorsal membrane has a knot saving 0.6 cm, the boundary is not clear, the morphology is irregular, and it is calcified.
Thyroid aspiration biopsy suggests papillary carcinoma of the right lobe of the thyroid gland.
The patient is very frustrated to get the results and does not know how to be good.
In February 2022, the patient came to me for a consultation at the recommendation of a friend and hoped to hear my advice.
My advice: wait more than half a year after the first surgery and need to operate again. The main reason is that there is adhesion in the thyroid area of the neck after the first operation, and the adhesion is slightly reduced for more than half a year after the operation, but the second operation is more difficult
The patient and family accepted my advice.
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.
The formulation of preoperative surgical plans and the standardization of surgical treatment must be important!
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.