What is the status quo of differentiated thyroid carcinoma (papillary carcinoma, follicular carcinoma)?
Differentiated thyroid cancer accounts for more than 95% of all cases of thyroid cancer. The overall mortality rate is low, but it is still growing. In 2015, the mortality rate of thyroid cancer in China was 0.48/100000, including about 0.33/100000 men and 0.63/100000 women.
The majority of differentiated thyroid cancer have a good prognosis, with a 5-year survival rate of 84.3%, which still lags behind developed countries such as the United States (98.7%). After standardized comprehensive treatment, it can reach a clinical tumor free state.
How should armour cancer be treated?
Most patients found thyroid nodules during physical examination, which were judged by professional medical personnel as benign or malignant. When it is determined to be malignant, surgical resection is the first choice. Different conditions lead to different surgical methods.
So, how should patients with thyroid cancer manage their own diseases?
First of all, as the patients themselves, they should have a correct understanding of thyroid cancer. Although the prognosis is good, they should also pay enough attention to it.
Secondly, follow the doctor's advice. Believe in doctors. They will treat every patient seriously. They all hope to cure every patient.
How to make scientific follow-up for patients with thyroid cancer?
(1) Regular review:
Thyroid function: In general, it is necessary to recheck the thyroid function one month after the operation, so as to know whether the current dose of levothyroxine is enough; Those who need iodine-131 treatment should also evaluate whether TSH meets the requirements. Generally, for those who need iodine-131 treatment, TSH should be at least 30.
Tg, TgAb: For patients after total thyroidectomy or iodine 131 treatment, we need to pay attention to the change trend of Tg and TgAb.
If necessary, we also need to do neck color ultrasound, chest CT, MRI and other imaging examinations.
(2) Take medicine on time
For differentiated thyroid cancer, it is very important to control the value of TSH in the late inhibition treatment.
Then, what is the appropriate TSH control?
For patients at high risk of recurrence, TSH was suppressed below 0.1mU/L.
For patients with moderate risk of recurrence, TSH was suppressed between 0.1-0.5mU/L.
For patients with low risk of recurrence, whose serum Tg could not be measured (<0.2 ng/mL) after iodine-131 clearing therapy, TSH remained at the lower limit of normal reference value (0.5-2 mU/L) and continued to observe.
For patients with low risk of recurrence, the serum Tg was at a low level (<10ng/mL) after the iodine-131 clearing therapy, and the TSH was suppressed at 0.1-0.5mU/L and then continued to be observed;
For patients with low risk of recurrence, but without iodine-131 clearing therapy and high Tg level, continue to observe after TSH inhibition of 0.1-0.5mU/L;
For low-risk patients who only underwent unilateral lobectomy, TSH inhibition was continued to be observed after the middle low level (0.5-2mU/L) of the reference range. If the patient's TSH can be maintained at this level without taking drugs, no further thyroxine treatment is required.
(3) Calcium supplement
For patients with thyroid cancer who have been treated with TSH inhibition for a long time, they need to pay attention to osteoporosis regularly and take calcium supplements when necessary. For details, please refer to "The biggest problem in the late stage of nail cancer is the lack of calcium after the operation of nail cancer, which is easy to osteoporosis!"
(4) Pay attention to the "adverse reaction" of Eugal
Because the TSH inhibition treatment is to take thyroid hormone at a higher physiological dose, it is in a "subclinical hyperthyroidism" state. At this time, adverse reactions may easily occur, mainly on the cardiovascular system and the postmenopausal female skeletal system.
Should be adopted in due time β Receptor blockers and other measures are used to treat or prevent adverse reactions of cardiovascular system, and regular anti osteoporosis treatment including active vitamin D. Therefore, the setting of TSH inhibition treatment goal should take into account the risk of adverse reactions, not just low, and urge patients to return regularly, and timely adjust the control goal in follow-up and dynamic evaluation.
In principle, patients with thyroid cancer should be followed up for life.
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