甲狀腺醫者的部落格- 與甲狀腺病友的相遇

有位很投緣的年輕病友為了一顆約莫0.5cm的高度疑似甲狀腺乳突癌煩惱, 該開怎麼樣的手術很令人為難.

0.5 cm的甲狀腺乳突癌沒有明顯淋巴腺腫大而且也沒有明顯轉移屬於0期癌, 理當慶幸早期發現早期治療才是, 可偏偏有醫生說切局部性(單葉切除), 也有醫生主張全切除, 深邃的眼睛露出滿是疑問.

根據 2009 American Thyroid Assoc. Guideline, 建議甲狀腺全切除的情形包括:

(1) >1.0 cm 的甲狀腺乳突癌

(2) 對側同時有節結, 或局部或遠端轉移

(3) 頭頸曾經有放射治療病史

(4) 一等親之甲狀腺乳突癌家族史

(5) >45歲 (即使<1 cm也適用本情形)

附上原文: Near total or total thyroidectomy is recommended if the primary thyroid carcinoma is >1 cm, there are contralateral thyroid nodules present or regional or distant metastases are present, the patient has a personal history of radiation therapy to the head and neck, or the patient has first-degree family history of DTC. Older age (>45 years) may also be a criterion for recommending near-total or total thyroidectomy even with tumors <1–1.5 cm, because of higher recurrence rates in this age group ( Thyroid, Vol. 19 (11) 2009, p 1179).

另一段則說: Thyroid lobectomy alone may be sufficient treatment for small (<1 cm), low-risk, unifocal, intrathyroidal papillary carcinomas in the absence of prior head and neck irradiation or radiologically or clinically involved cervical nodal metastases.

意思是說在下列情形單葉切除"也許"就足夠了: < 1.0 cm 的甲狀腺乳突癌, 低風險, 單發性, 局限於甲狀腺, 且無頸部淋巴腺轉移也沒有放射治療病史(每條件都滿足)

 全切除好處包括降低復發率(避免一開再開以及日後可能失控變成轉移或去分化的甲狀腺癌), 另一方面很方便追蹤(只要抽血驗Tg), 但是缺點是副甲狀腺過低(低血鈣, 手腳麻)和喉返神經的傷害(聲音嘶啞)機率也較高.

真的很為難我們的病友了, 剛好她未來希望從事語言的教學, 萬一失聲怎麼辦?  而年輕的她能夠接受復發率的風險嗎?