ThyroidcancerreportOperationextent:

primarysiteTodifferentiatedthyroidcancer1.onelobeinvovled:lobectomy+isthmusectomy2.twolobesinvovled:preservesmallpartofinferiororsuperiorpartPostoperativemanagementofdifferentiatedthyroidcancer:1.131Iablationandthyroidhormonesuppretion2.externalradiationforresidualdisease3.Detectingthyroglobulinand131IforfollowupTreatmentprincipleofMTC:1.clinicalllyevidentMTC:totalthyroidectomyprimarytumor>1CMandcentralnodespositive,ipsilateralneckdissection2.ProphylacticcontralateralneckdissectionWhenprimarytumorisbilateralandthereisextensivelymphadenopathyandMEN2B3.postoperativeradiationforresidualdisease4.ProphylacticthyroidectomyforhereditalMTC5.elevatedbasalorstimulatedplasmacalcitoninLevelandintrathyroidalnoduleonultrasoundatotalthyroidectomyandcentralneckdissectionshouldbedone

6.persistentorrecurrentMTCshouldhaveacompletethyroidectomyandbilateralcentralandnekdissection7.bonemetastasisshouldberesectedifpossible,RTforunresectedone8.localizedpulmonarymetastasisshouldberesectedTtreatmentprincipleofanaplasticcancer

eradicationbycompletesurgicalresectionFollowedbyconcurrentdoxorubicin-basedChemotherapyandRTBonemetastasisofdifferentiatedthyroidcancer

localizedone:surgery+131IorRTmultipleones:131IINDICATIONfortotalthyroidectomy:1.cancerinvolvingtwolobes2.distalmetastasisandneed131Itherapy3.LNMintwosidesFollow–up:differentiatedthyroidcancer：thyroglobulin+131I,thyroglobulin+131I（-）In-octreotide，F(xiàn)DG-PET（Tsh)EitherbasalTglevelishighorTgAbincreases,131IisneededTgmesurementshouldbeafterthyroxineWithdrawlorrhTshstimulationrhTshissuggestedforpatientswhodonotrespondtohormonewithdrawlorcannottoleratehypothyroidismTg>2mg/LissufficientsensitiveTgmRNA

inbloodismoresensitivemakerformetastaticdiseasethanTgAndisunaffectedbyanti-TgantibodiesNoneedforthyroidwithdrawlandTshstimulationSentinelLNinthyroidcancer:MoresensitivityandspectivityLNMareofdebatableprognosticvalueSLNappearslessthanpromissingResidualLNMisassociatedwithlocalrecurrencewhereasdistantmetastasisiscorrelaredwithpoorersurvivalratesThyroidneoplasmafterradiationduringchildhoodoradolecenceIncidence:33%,1/3oftheselesionsaremalignentDose-responserelationwaslinearuntilthehighestdose(>1000cGY)Interval:6-30yearsThemajorityinanonaggressivefashion3.CyclinG2:acyclinnegativelydregulatingcellcycleprogessionlackofCyclinG2malignanttransformationofPTC4.KAL1:ametastasissuppressorgene,ralatedtotheprogressionofPTC5.COX2:up-regulationmaycontributepredominantlyintheearlyphaseofPTCprogression6.IL-4,IL-10:increaseBcl-2Bcl-xllevelspromoteprogressionandresistancetochemotherapy,newtheraputictargetsforthetreatmentofthyroidcancer

3.CD10:amembrane-boundzincmetalloproteinaseCD10wasnotdetectedinnormalthyroidtissue,benignlesionsandpurePTCHighexpressioninFTCandFollicularvariantofPTC4.Id-1:memberofIdhelix-loop-helixproteinsKeyregulatorsofcellgrowthanddifferentiationOverexpressedinPTC,5.Gadd45:Gadd45fammilyproteinshavebeenimplicatedinavarietyofgrowth-regulatorymechanism.significantlylowerleverinanaplastincanceradenovirus-mediatedreexpressionofGadd45gammasignificantlyinhibitedprolificationofanaplastincancercells-------genetherapy7.Ras-Raf-MEK-MAPKpathway:thepathwaytransmitsamitogenicsignaltothenucleus,andactivationofthepathwayisthoughttoPromoteuncontrolledcelldivision8.HS90(heatshockprotein):playsacriticalroleintumorcellgrowthandsurvivalGeldanamycin:aspecificinhibitor,9.p70S6KandAkt:arekinasesdownstreamofPI3K,activtedinthemajorityofPTCpromoteprogressionbystimulatingcellproliferationandpreventingapoptosis10.r-PTPeta(rattyrosinephosphatase