Treat thyroid cancer , beware of over-treatment
For thyroid cancer, especially micro-cancer, the problem of overdiagnosis and over-treatment is mentioned internationally. We say that cancer should be diagnosed and treated early, which is the most basic principle of preventing and treating cancer. However, thyroid cancer is relatively special for differentiated thyroid cancer. Early screening is not recommended in clinical practice, because ultrasound technology is now well developed, and the two-millimeter thyroid nodules can be seen. However, the ease of use of these technologies and the abuse of these technologies have led to the occurrence of some overdiagnosis and overtreatment.
thyroidectomy is expensive and may cause serious complications, mainly manifested as recurrent laryngeal nerve injury and hypoparathyroidism . Patients who undergo total thyroidectomy must take thyroxine replacement therapy for the rest of their lives, which has health risks. Taking levothyroxine tablets for a long time may cause cardiovascular diseases ( atrial fibrillation and arrhythmia), osteoporosis and other problems.
Can medication alone maintain all the functions of thyroid ?
The thyroid gland plays an important role in childhood, especially in growth and development, and is crucial for human metabolism and human growth. After adulthood, the main function of the thyroid gland is to secrete thyroxine. If the thyroid gland is cut, it means that the thyroxine is gone and it requires exogenous supplementation.
However, over time, both domestic and internationally, it has been found that long-term use of levothyroxine has an impact on the human body. Therefore, doctors are also doing dual-risk assessments for patients in terms of the dosage and intensity of thyroxine, which means that the possible dose to inhibit or reduce its recurrence is achieved, but not too high, because after the dose is maintained for a long time, for example, women during menopause can cause osteoporosis, and some patients respond to this drug, such as some allergic reactions, and they have to look for other drugs to replace it.
So, does thyroid surgery require complete resection?
Many surgeons advocate that total thyroidectomy is performed in thyroid cancer surgery, which is conducive to postoperative recurrence risk assessment and iodine 131 treatment. However, Professor Xu does not agree with this approach. He believes that if it is a very limited thyroid cancer, there is no need to cut off the entire thyroid gland during surgery, especially many very early micro cancers, single nodules, and half of the thyroid gland is surgically removed. In this way, the thyroid function is still there and the impact on the patient is not great. Moreover, low-risk patients do not need subsequent iodine 131 treatment. But if all thyroid glands are removed, the patient needs to take medicine for life. For advanced lesions, patients with obvious capsular extracellular invasion, lateral cervical lymph node metastasis, distant metastasis, childhood history of radio contact, and family history of thyroid cancer treatment still need to undergo total thyroidectomy. In addition, the surgical complications caused by total thyroidectomy are higher than those of partial total thyroidectomy, so it is necessary to decide based on the patient's specific condition. If the condition does require a complete resection, it should be fully removed; and some patients do not need it, so they should still retain some functions for the patient to improve their quality of life.
Can patients with thyroid nodules or thyroid cancer still consume iodized salt?
Can eat foods containing iodine is one of the most concerned issues for patients with thyroid cancer. In fact, the iodine content in normal iodine salt is not very high, so there is no need to pay special attention. Professor Xu reminds everyone that it is not good to have too high or too low iodine content. You can eat foods with a higher iodine content, such as seaweed, kelp, etc., but it should be stopped in moderation. If you want to know the level of iodine in your body, the scientific method is to monitor urine iodine .
In addition, Professor Xu particularly emphasized that you must pay attention to the issue of obesity in daily life. Some studies have found that obesity has a certain relationship with thyroid cancer. Clinical findings are related to many types of cancer, such as colorectal cancer and breast cancer. Because obese patients often have other diseases, such as diabetes, they should pay appropriate attention to diet control to reduce the occurrence of obesity.In addition to dietary control, you should also strengthen exercise, consume excess calories, and control your weight.
[Expert Profile]
Xu Zhengang , chief physician, director of the head and neck surgery department, director of the Department of Major Surgery and Teaching and Research Department, director of the hospital ethics committee, and deputy director of the Department of Clinical Surgery of the Union Medical College; chairman of the thyroid surgeons committee of the Chinese Medical Association Surgeons Branch, deputy chairman of the thyroid surgery committee of the Chinese Anti-cancer Association, and deputy chairman of the thyroid professional committee of the Chinese Research Hospital Association.
is good at: various surgeries in head and neck surgery, including various types of tumor radical surgery, rescue surgery, functional retention surgery, palliative surgery, various phase one repair surgery, and various non-standardized surgeries for recurrence, difficult and critically ill patients.
Discussion time: Every Thursday morning (special requirement)
Interviewed experts: Xu Zhengang, chief physician of the Department of Head and Neck Surgery, Cancer Hospital of Chinese Academy of Medical Sciences,
(Editors: Zhao Peng, Zhang Xi)
