Clark O H
West J Med. 1980 Jul;133(1):1-8.
Patients with thyroid nodules must be treated selectively because these nodules develop far more frequently than does thyroid cancer. A thorough clinical history, family history and history of radiation, as well as an accurate physical examination, are very important in determining whether surgical treatment is indicated. Thyroid function tests, a radioactive isotope scan, a thyroid echogram and fine-needle biopsy are also useful. Although there is considerable debate concerning the amount of thyroid tissue that should be removed at operation, the minimal procedure for a "cold," solid thyroid nodule is a total thyroid lobectomy and isthmectomy. This is the treatment of choice for patients with occult papillary thyroid carcinoma. Partial lobectomy is to be discouraged. Near total or total thyroidectomy should be considered for all other patients with differentiated thyroid cancer. Many factors influence the prognosis of patients with thyroid cancer including age, sex, type of thyroid cancer, invasion, symptoms, lymph node metastasis, metastasis to distant sites, extent of the surgical procedure, and use of radioactive iodine and thyroid hormone. With adequate treatment, the prognosis for differentiated thyroid carcinoma is excellent.
甲状腺结节患者必须进行选择性治疗，因为这些结节的发生频率远高于甲状腺癌。详尽的临床病史、家族史和放射史，以及准确的体格检查，对于确定是否需要手术治疗非常重要。甲状腺功能检查、放射性同位素扫描、甲状腺超声检查和细针穿刺活检也很有用。尽管对于手术中应切除多少甲状腺组织存在相当大的争议，但对于“冷”实性甲状腺结节，最小的手术方式是甲状腺全叶切除术和峡部切除术。这是隐匿性乳头状甲状腺癌患者的首选治疗方法。不建议进行部分叶切除术。对于所有其他分化型甲状腺癌患者，应考虑行近全甲状腺切除术或全甲状腺切除术。许多因素会影响甲状腺癌患者的预后，包括年龄、性别、甲状腺癌类型、浸润情况、症状、淋巴结转移、远处转移、手术范围以及放射性碘和甲状腺激素的使用。经过适当治疗，分化型甲状腺癌的预后非常好。
