Hardy K J, Walker B R, Lindsay R S, Kennedy R L, Seckl J R, Padfield P L
Department of Endocrine and Metabolic Diseases, Western General Hospital, Edinburgh, UK.
Clin Endocrinol (Oxf). 1995 Jun;42(6):651-5. doi: 10.1111/j.1365-2265.1995.tb02694.x.
Thyroid cancer is the commonest endocrine malignancy, yet management remains controversial. Many endocrinologists advocate diagnosis by fine needle aspiration (FNA), treatment by thyroidectomy, ablative radioiodine (131I) and TSH suppression, together with follow-up with 131I scans or thyroglobulin (Tg) measurements. 131I (therapy or diagnosis) is given only when TSH is > 30 mIU/I. With this strategy in mind, the aim of the present study was to audit existing clinical practice in a large Edinburgh teaching hospital to establish whether a need existed for local guidelines for the management of thyroid cancer.
Retrospective case-note audit of 46 patients, aged 55 (range 26-86) years, admitted between 1988 and 1993 with a diagnosis of thyroid cancer.
Our FNA false negative rate was high (13%), aspiration technique varied considerably, and cytological reporting was not standardized.
Three (11%) patients received 131I despite suboptimal TSH levels because of poorly developed mechanisms to prevent this, and 7 (25%) patients had inadequate suppression of TSH as a result of poor interspecialty communication.
FOLLOW-UP: Three (11%) patients were scanned despite TSH levels < 30 mIU/I, and in 5 (18%) Tg checks were incomplete.
This audit identifies several shortcomings from what might be considered optimum management of thyroid cancer; practice was far from uniform even among the endocrinologists within a single hospital and interdisciplinary communication was poor. A locally agreed and implemented protocol should address most of these problems and improve the care of thyroid cancer patients.
甲状腺癌是最常见的内分泌系统恶性肿瘤，但其治疗方法仍存在争议。许多内分泌学家主张通过细针穿刺活检（FNA）进行诊断，采用甲状腺切除术、放射性碘（131I）消融和促甲状腺激素（TSH）抑制疗法进行治疗，并通过131I扫描或甲状腺球蛋白（Tg）测量进行随访。仅当TSH>30 mIU/I时才给予131I（治疗或诊断）。基于这一策略，本研究旨在对爱丁堡一家大型教学医院的现有临床实践进行审核，以确定是否需要制定甲状腺癌管理的本地指南。
对1988年至1993年间收治的46例年龄为55岁（范围26 - 86岁）、诊断为甲状腺癌的患者进行回顾性病例记录审核。
我们的FNA假阴性率较高（13%），穿刺技术差异很大，且细胞学报告未标准化。
由于预防机制不完善，3例（11%）患者尽管TSH水平未达最佳仍接受了131I治疗，并且由于专科间沟通不畅，7例（25%）患者的TSH抑制不充分。
3例（11%）患者尽管TSH水平<30 mIU/I仍接受了扫描，5例（18%）患者的Tg检查不完整。
本次审核发现了甲状腺癌最佳管理可能存在的几个不足之处；即使在同一家医院的内分泌学家中，实践也远未统一，跨学科沟通较差。一份本地商定并实施的方案应能解决大多数这些问题，并改善甲状腺癌患者的护理。
