甲狀腺結節(jié)診療流程-展示頁
2025-01-19 16:29本頁面
【正文】 外科三病區(qū) 王 平 國內(nèi)甲狀腺疾病治療 1. 腫瘤醫(yī)院－ 頭頸外科 2. 綜合醫(yī)院 甲乳科 五官科 普外科 內(nèi)分泌科（組）、面頜整形科 ?? 腫瘤外科（浙江省的教學或附屬醫(yī)院） 3. 甲狀腺?？漆t(yī)院 “各自為政”，參加不同的學組組織的會議，某組織的標準很難在全國范圍內(nèi)統(tǒng)一實行 國內(nèi)甲狀腺疾病治療 1. 全國內(nèi)分泌年會－ 05廣州會議 ? 分化型甲狀腺癌（ DTC） 的甲狀腺切除范圍 2. 全國內(nèi)分泌年會－ 08沈陽 2023年濟南 o 分化型甲狀腺癌（ DTC） 的淋巴結清掃范圍 o 結節(jié)性甲狀腺腫的手術治療問題 3. 耳鼻喉 頭頸外科 — 2023濟南會議 – 制定甲狀腺癌中國指南？ 4. ATA、 ETA， CTA？？ AACE/AME Guidelines Thyroid Nodule Guidelines, Endocr Pract. 2023。12 AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS AND ASSOCIAZIONE MEDICI ENDOCRINOLOGI MEDICAL GUIDELINES FOR CLINICAL PRACTICE FOR THE DIAGNOSIS AND MANAGEMENT OF THYROID NODULES AACE/AME/ETA Guidelines These guidelines are based on Endocr Pract. 2023 JanFeb。rthle cell carcinoma 4. Medullary carcinoma 5. Anaplastic carcinoma 6. Primary thyroid lymphoma 7. Metastatic malignant lesion DIAGNOSIS History and Physical Examination grow insidiously for many years discovered incidentally on physical examination, selfpalpation, or imaging studies performed for unrelated reasons. FMTC, MEN2, familial papillary thyroid tumors, familial polyposis coli, DIAGNOSIS Patients with rapid growth of a large solid thyroid mass and vocal cord paresis should undergo surgical treatment even if cytologic results are benign (grade C) DTC, however, rarely cause airway obstruction, vocal cord paralysis, or esophageal symptoms, and absence of symptoms does not rule out a malignant tumor (grade C) DIAGNOSIS Toxic MNGs hyperfunctioning (benign) areas cold (potentially malignant) lesions Thyroid nodules in patients with Graves’ disease are reported to be malignant in about 9% of cases DIAGNOSIS Remember that the vast majority of nodules are asymptomatic, and absence of symptoms does not rule out a malignant lesion (grade C) Always obtain a biopsy specimen from solitary, firm, or hard nodules. The risk of cancer is similar in a solitary nodule and MNG (grade B) 檢查手段 1. B超聲：最常用，約 50%結節(jié)由超聲檢查發(fā)現(xiàn) 2. TSH：監(jiān)測垂體甲狀腺軸對內(nèi)分泌治療的反應 3. 細針穿刺活檢 (FNA)：確定腫瘤良惡性的有效手段 4. 高分辨率超聲：對結節(jié)診療手段的有力補充 5. 甲狀腺放射性核素顯像（ ECT） 6. CT and MRI are not indicated in routine nodular evaluation(grade C) 甲狀腺 ECT檢查 甲狀腺實質(zhì)性結節(jié)（ 1cm?） 高功能腺瘤、結甲伴甲亢 胸骨后甲狀腺腫 亞急性甲狀腺炎（＋ T T4） 異位甲狀腺 全身有沒有轉(zhuǎn)移（ 131I） 再次手術前 甲狀腺 ECT檢查 甲狀腺實質(zhì)
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