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Ma kahi o 1.2% o nā kānaka e ʻike ʻia me ka maʻi maʻi thyroid i ko lākou ola ʻana. I nā makahiki he 40 i hala iho nei, ma muli o ka hoʻohana nui ʻana o ke kiʻi kiʻi a me ka hoʻokomo ʻana i ka biopsy puncture needle maikaʻi, ua piʻi nui ka nui o ka ʻike ʻana i ka maʻi maʻi thyroid, a ua piʻi ka nui o ka maʻi maʻi thyroid i ʻekolu manawa. Ua holomua wikiwiki ka mālama ʻana i ka maʻi maʻi thyroid i nā makahiki 5 a 10 i hala iho nei, me nā ʻano protocols hou e loaʻa ana ka ʻae kānāwai.

ʻO ka loaʻa ʻana o ka radiation ionizing i ka wā kamaliʻi i pili nui me ka maʻi maʻi thyroid papillary (1.3 a 35.1 mau hihia / 10,000 kanaka-makahiki). ʻO kahi noiʻi cohort i nānā i nā keiki 13,127 ma lalo o 18 mau makahiki e noho ana ma Ukraine ma hope o ka ulia nuklea Chernobyl i ka makahiki 1986 no ka maʻi maʻi thyroid i loaʻa he 45 mau hihia o ka maʻi maʻi thyroid me ka nui o ka pilikia pili o 5.25/Gy no ka maʻi thyroid. Aia kekahi pilina pane ma waena o ka radiation ionizing a me ka maʻi maʻi thyroid. ʻO ka liʻiliʻi o ka makahiki i loaʻa ai ka radiation ionizing, ʻoi aku ka kiʻekiʻe o ka hoʻomohala ʻana i ka maʻi maʻi thyroid pili i ka radiation, a ua mau kēia pilikia ma kahi o 30 mau makahiki ma hope o ka hoʻolaha ʻana.

ʻO ka hapa nui o nā mea pilikia no ka maʻi ʻaʻai thyroid ʻaʻole hiki ke hoʻololi: ʻo ka makahiki, ke kāne, ka lāhui a i ʻole ka lāhui, a me ka mōʻaukala ʻohana o ka maʻi maʻi thyroid ka mea nui loa i ka wānana pilikia. ʻOi aku ka nui o ka makahiki, ʻoi aku ka kiʻekiʻe o ka maʻi a me ka haʻahaʻa o ke ola. ʻO ka maʻi maʻi thyroid he ʻekolu mau manawa maʻamau i nā wahine ma mua o nā kāne, ʻo ia ka nui o ka maʻi maʻamau a puni ka honua. ʻO ka hoʻololi genetic i ka laina germ o 25% o nā mea maʻi me ka medullary thyroid carcinoma e pili pū ana me nā maʻi maʻi maʻi endocrine lehulehu type 2A a me 2B. ʻO 3% a 9% o nā maʻi me ka maʻi maʻi thyroid i hoʻokaʻawale ʻia he heritability.

ʻO ka hahai ʻana ma mua o 8 miliona mau kamaʻāina ma Denmark ua hōʻike ʻia e pili ana ka goiter nodular non-toxic me ka piʻi nui o ka maʻi maʻi thyroid. Ma kahi hoʻopaʻa haʻawina hope loa o nā maʻi 843 e hana ana i ka ʻoki thyroid no ka nodule thyroid unilateral a bilateral, goiter, a i ʻole autoimmune thyroid maʻi, ua pili nā pae kiʻekiʻe preoperative serum thyrotropin (TSH) me ka maʻi maʻi thyroid: 16% o nā maʻi me nā pae TSH ma lalo o 0.06 mIU/L i hoʻomohala i ka maʻi thyroid, ʻoiai ʻo 52% o nā maʻi me ka maʻi thyroid m.

ʻAʻohe mau hōʻailona o ka poʻe me ka maʻi maʻi thyroid. Ua hōʻike ʻia kahi noiʻi retrospective o 1328 mau maʻi me ka maʻi maʻi thyroid ma 16 mau kikowaena ma 4 mau ʻāina i hōʻike ʻia he 30% wale nō (183/613) i loaʻa nā hōʻailona ma ka maʻi maʻi. ʻO ka poʻe maʻi me ka nui o ka ʻāʻī, dysphagia, ʻike kino ʻē aʻe a me ka hoarseness ʻoi aku ka maʻi nui loa.

Hōʻike ʻia ka maʻi maʻi thyroid ma ke ʻano he nodule thyroid palpable. ʻO ka loaʻa ʻana o ka maʻi maʻi thyroid i nā nodules palpable i hōʻike ʻia ma kahi o 5% a me 1%, i kēlā me kēia, i nā wahine a me nā kāne i nā wahi iodine-pono o ka honua. I kēia manawa, ʻike ʻia ma kahi o 30% a 40% o nā maʻi maʻi thyroid ma o ka palpation. ʻO nā ala diagnostic maʻamau ʻē aʻe e pili ana i nā kiʻi pili ʻole thyroid (e laʻa, carotid ultrasound, neck, spine, and chest imaging); ʻO nā maʻi me ka hyperthyroidism a i ʻole hypothyroidism i hoʻopā ʻole i nā nodules e loaʻa i ka ultrasound thyroid; ʻO nā poʻe maʻi me nā nodules thyroid i kēia manawa ua hana hou ʻia me ka ultrasound; Ua ʻike ʻole ʻia ka maʻi maʻi thyroid occult i ka wā o ka hoʻokolokolo pathologic post-operative.

ʻO ke kani kani ke ʻano loiloi maikaʻi loa no nā nodules thyroid palpable a i ʻole nā ​​​​ʻike kiʻi ʻē aʻe o nā nodules thyroid. He mea maʻalahi loa ka Ultrasound i ka hoʻoholo ʻana i ka helu a me nā hiʻohiʻona o nā nodules thyroid a me nā hiʻohiʻona kiʻekiʻe e pili ana i ka pilikia o ka maʻi maʻi, e like me ka marginal irregularities, punctate strong echoic focus, and extra-thyroid invasion.

I kēia manawa, ʻo ka overdiagnosis a me ka mālama ʻana i ka maʻi maʻi thyroid he pilikia ia e nānā nui ai nā kauka a me nā mea maʻi, a pono e hoʻāʻo nā kauka e pale i ka overdiagnosis. Akā paʻakikī kēia kaulike no ka mea ʻaʻole hiki i nā poʻe maʻi āpau me ka maʻi maʻi thyroid metastatic ke manaʻo i nā nodules thyroid, a ʻaʻole hiki ke pale ʻia nā maʻi āpau haʻahaʻa haʻahaʻa. No ka laʻana, hiki ke ʻike ʻia kahi microcarcinoma thyroid i kekahi manawa ʻaʻole hiki ke hōʻailona a make paha i ka histologically ma hope o ke kaʻina no ka maʻi thyroid benign.

ʻO nā lāʻau lapaʻau liʻiliʻi liʻiliʻi e like me ka ultrasound-guided radiofrequency ablation, microwave ablation a me ka laser ablation e hāʻawi i kahi koho hoʻohiki i ka ʻoki ʻana i ka wā e pono ai ka mālama ʻana i ka maʻi maʻi thyroid. ʻOiai he ʻokoʻa iki nā ʻano hana o nā ʻano ablation ʻekolu, ʻano like lākou ma ke ʻano o ke koho koho ʻana i ka maʻi tumora, ka pane ʻana o ka tumora, a me nā hoʻopiʻi postoperative. I kēia manawa, ʻae ka hapa nui o nā kauka ʻo ka hiʻohiʻona maikaʻi loa no ka liʻiliʻi o ka invasive intervention he carcinoma thyroid papillary kūloko <10 mm ke anawaena a > 5 mm mai nā hale wela e like me ka trachea, esophagus, a me ke aʻalolo laryngeal hou. ʻO ka hoʻopiʻi maʻamau ma hope o ka mālama ʻana, ʻo ia ka ʻeha wela me ka ʻike ʻole ʻia i ke aʻalolo laryngeal hou e kokoke mai ana, e hopena ai i ka haʻalulu manawa. No ka hōʻemi ʻana i ka pōʻino o nā hale a puni, ʻoi aku ka maikaʻi e waiho i kahi mamao palekana mai ka lesion i kuhi ʻia.

Ua hōʻike ʻia kekahi mau noiʻi ʻana i ka hana ʻana o ka microcarcinoma papillary thyroid i ka hopena maikaʻi a me ka palekana. ʻOiai ua loaʻa nā hopena hoʻohiki liʻiliʻi loa no ka maʻi maʻi thyroid papillary haʻahaʻa, ʻo ka hapa nui o nā noiʻi i huli ʻia a nānā ʻia ma Kina, Italia, a me South Korea. Eia kekahi, ʻaʻohe hoʻohālikelike pololei ma waena o ka hoʻohana ʻana i nā hana hoʻopiʻi liʻiliʻi a me ka nānā ikaika. No laila, kūpono wale ka ultrasound-guided thermal ablation no nā poʻe maʻi me ka maʻi maʻi thyroid haʻahaʻa ʻaʻole nā ​​moho no ka lāʻau lapaʻau a makemake paha i kēia koho lapaʻau.

I ka wā e hiki mai ana, no nā poʻe maʻi me ka maʻi maʻi thyroid koʻikoʻi, ʻoi aku ka liʻiliʻi invasive interventional therapy i kahi koho lapaʻau ʻē aʻe me ka haʻahaʻa haʻahaʻa o ka hoʻopiʻi ʻana ma mua o ke ʻoki. Mai ka makahiki 2021, ua hoʻohana ʻia nā ʻenehana ablation thermal e mālama i nā poʻe maʻi me ka maʻi maʻi thyroid ma lalo o 38 mm (T1b~T2) me nā hiʻohiʻona kiʻekiʻe. Eia naʻe, ua komo kēia mau haʻawina retrospective i kahi hui liʻiliʻi o nā maʻi (mai ka 12 a hiki i 172) a me kahi manawa hahai pōkole (mean 19.8 a 25.0 mahina). No laila, pono ka noiʻi hou aʻe e hoʻomaopopo i ka waiwai o ka ablation thermal i ka mālama ʻana i nā poʻe maʻi me ka nui o ka maʻi maʻi thyroid.

ʻO ka ʻoki ʻana ke ʻano kumu mua o ka mālama ʻana no ka carcinoma thyroid i manaʻo ʻia a i ʻole cytologically i hōʻoia ʻia. Aia nā hoʻopaʻapaʻa e pili ana i ka laulā kūpono loa o ka thyroidectomy (lobectomy a me ka thyroidectomy holoʻokoʻa). ʻO ka poʻe maʻi e loaʻa ana i ka thyroidectomy holoʻokoʻa ʻoi aku ka nui o ka pilikia ma mua o ka poʻe e loaʻa ana i ka lobectomy. ʻO nā pilikia o ke kaʻina thyroid e pili ana i ka pōʻino o ke aʻalolo laryngeal, hypoparathyroidism, nā pilikia ʻeha, a me ka pono no ka hoʻohui ʻana o ka hormone thyroid. I ka wā ma mua, ʻo ka holoʻokoʻa thyroidectomy ka lāʻau lapaʻau maikaʻi loa no nā maʻi maʻi thyroid ʻokoʻa ʻē aʻe > 10 mm. Eia naʻe, kahi haʻawina 2014 e Adam et al. ua hōʻike ʻia ʻaʻole he ʻokoʻa koʻikoʻi i ke ola a me ka hoʻi hou ʻana ma waena o nā maʻi e loaʻa ana i ka lobectomy a me ka thyroidectomy āpau no 10 mm a 40 mm papillary thyroid cancer me ka ʻole o nā hiʻohiʻona kiʻekiʻe.

No laila, i kēia manawa, makemake nui ʻia ka lobectomy no ka maʻi maʻi thyroid i hoʻokaʻawale maikaʻi ʻia ma lalo o 40 mm. Manaʻo ʻia ka nui o ka thyroidectomy no ka maʻi maʻi thyroid ʻokoʻa o 40 mm a i ʻole ka nui a me ka maʻi maʻi thyroid bilateral. Inā ua laha ka maʻi koko i nā pūnaʻi lymph āpana, pono e hana ʻia ka ʻoki ʻana o nā pūnae lymph waena a me ka ʻaoʻao o ka ʻāʻī. ʻO nā mea maʻi wale nō me ka maʻi thyroid medullary a me kekahi mau maʻi maʻi thyroid nui i hoʻokaʻawale ʻia, a me nā poʻe maʻi me waho thyroid aggression, pono prophylactic central lymph node dissection. Hiki ke noʻonoʻo ʻia ka hoʻokaʻawale ʻana o ka puʻu lymph cervical prophylactic no nā maʻi me ka maʻi maʻi thyroid medullary. I nā poʻe maʻi me ka maʻi maʻi medullary thyroid carcinoma, pono e loiloi ʻia nā pae plasma o ka norepinephrine, calcium, a me ka parathyroid hormone (PTH) ma mua o ka hana ʻana e ʻike ai i ka maʻi MEN2A a pale i ka pheochromocytoma a me ka hyperparathyroidism.

Hoʻohana nui ʻia ʻo Nerve intubation no ka hoʻopili ʻana me kahi mākaʻikaʻi aʻalolo kūpono e hāʻawi i kahi alahele ʻike ʻole a nānā i ka ʻiʻo intraoperative a me ka hana nerve ma ka larynx.

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