甲狀腺結(jié)節(jié)診療流程-在線瀏覽
2025-02-14 16:29本頁面
【正文】 性結(jié)節(jié)（涼、冷結(jié)節(jié)） 甲狀腺實(shí)質(zhì)性結(jié)節(jié)（溫結(jié)節(jié)） 親腫瘤顯像 FNAC、手術(shù) FNA： Results of Literature Survey Feature Mean(%) Range(%) Sensitivity 83 6598 Specificity 92 72100 Positive predictive value 75 5096 Falsenegative rate 5 111 Falsepositive rate 5 07 FNA is now considered safe, useful, and costeffective 其他檢查的意義 Thirdgeneration TSH（ ） T3 、 T4 TPOAb Thyroglobulin (TG) Routine assessment is not remended (grade C). CalcitoninMTC (not routine testing) FNAPositive Thyroid Nodule 按照 NCCN的有關(guān)標(biāo)準(zhǔn)治療 FNANegative Thyroid Nodule Levothyroxine Suppressive Therapy (TSH μIU/mL) 1. a controversial therapeutic practice 2. Efficacy ： 20％ effective In Small, recently diagnosed thyroid nodules In lesions with colloid features at FNA evaluation in geographic regions with iodine deficiency 3. A 5year prospective randomized study nodule growth, new nodule appearance, and the growth of the thyroid gland as a whole may be decreased (grade A) The use of LT4 should be avoided 1. large thyroid nodules or longstanding goiters 2. the TSH level is 1 μIU/mL In postmenopausal women in men older than 60 years 3. Osteoporosis 4. cardiovascular disease 5. systemic illnesses. Facts to remember 1. LT4 treatment induces a clinically significant reduction of thyroid nodule volume in only a minority of patients (grade B) 2. Longterm TSH suppression may be associated with bone loss and arrhythmia in elderly patients and menopausal women (grade B) 3. LT4 treatment should never be fully suppressive (TSH ?IU/mL) (grade C) Facts to remember 4. Nodule regrowth is usually observed after cessation of LT4 therapy (grade C) 5. If nodule size decreases, LT4 therapy should be continued long term (grade D) 6. If thyroid nodule grows during LT4 treatment, reaspiration and possibly surgical treatment should be considered (grade D) Surgical Treatment Surgical indications Associated local symptoms Hyperthyroidism from a large toxic nodule, or hyperthyroidism conitant MNG Growth of the nodule Suspicious or malignant FNA results Surgical Treatment 1. Total or neartotal lobectomy, with or without isthmectomy 2. Completion thyroidectomy should require patience 3. For a solitary benign nodule, lobectomy plus isthmectomy is sufficient。rthle細(xì)胞腫瘤或 TSH低的結(jié)節(jié)
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