There is a notable trend of "conceptual alienation" in the current "minimally invasive" treatment of thyroid cancer, where "minimally invasive" is simplistically equated with small incisions or overemphasis on cosmetic outcomes, while neglecting its core essence: minimizing overall trauma while ensuring radical treatment. Endoscopic/robotic surgeries, though capable of hiding scars, may involve greater trauma from creating operational spaces and are suitable for strictly selected patients rather than being universally applicable. Thermal ablation techniques, while less traumatic for treating microcarcinomas, carry the risk of expanded indications beyond recommended guidelines. We emphasize that all treatments must adhere to the principle of "radical cure first, function intact second, and cosmetic result third " avoiding technological misuse, and advocating a return to radical cure-focused, individualized rational treatment based on long-term follow-up data.

Thyroid cancer is the most common malignancy of the endocrine system, with an incidence that has been steadily rising over recent years. Over the past decade, through the implementation of standardized and homogenized diagnostic and therapeutic protocols, the five-year survival rate for thyroid cancer in China has significantly improved, increasing from 67.5% in 2003 to 92.9% in 2021. Nevertheless, due to the marked heterogeneity of thyroid cancer—ranging from low-risk papillary microcarcinomas to highly aggressive undifferentiated carcinomas—there exists considerable variation in tumor biology and clinical outcomes. This article provides a systematic review of the global epidemiological trends and current treatment practices for thyroid cancer. It offers an in-depth analysis of recent updates to both domestic and international clinical guidelines, and, based on a stratified treatment approach, elaborates on key aspects of precision medicine, including preoperative risk stratification, intraoperative functional preservation, postoperative dynamic risk assessment, and long-term follow-up strategies. Furthermore, the article proposes the establishment of a multidisciplinary, thyroid surgeon-led comprehensive management system across the entire treatment continuum.

Objective:To investigate the clinical value of Delphian lymph node (DLN) metastasis (DLNM) in predicting regional lymph node involvement in patients with intrathyroidal papillary thyroid carcinoma (PTC).Methods:Clinical and pathological data from 345 consecutive patients with pathologically confirmed DLN status, who underwent initial surgical treatment at the Department of Surgical Oncology, First Affiliated Hospital of Zhejiang University School of Medicine between Jan 2020 and Dec 2022, were retrospectively analyzed.Results:DLNM was identified in 61 patients (17.7%). Univariate analysis revealed significant associations between DLNM and male sex, elevated preoperative thyroglobulin levels, larger tumor size, maximum tumor diameter >10 mm, bilateral lesions, multifocality, lymphovascular invasion, and lymph nodes metastases in pretracheal, paratracheal, and lateral cervical(all P ≤0.001). Elevated thyroglobulin antibody levels ( χ2=6.201, P=0.013) and Hashimoto's thyroiditis ( χ2=11.340, P<0.001) were protective factors for DLNM. Multivariate analysis identified male sex, lymphovascular invasion, pretracheal, and paratracheal lymph node metastases ( χ2=6.689, P=0.010; χ2=8.163, P=0.004; χ2=7.605, P=0.006; χ2=8.324, P=0.004) as independent risk indicators for DLNM. Patients with DLNM exhibited significantly higher risks of lymph nodes metastases in pretracheal ( χ2=27.307, P<0.001), paratracheal ( χ2=38.697, P<0.001), and lateral cervical ( χ2=36.459, P<0.001). Conclusion:DLNM demonstrates predictive value for both central compartment and lateral cervical lymph node metastases, warranting particular attention to meticulous dissection of the prelaryngeal region during surgery.

Objective:To analyze the risk factors of contralateral central lymph node metastasis in papillary thyroid carcinoma (PTC) patients with established ipsilateral central lymph node metastasis, and to provide a basis for clinical decision-making on whether to perform contralateral central lymph node dissection.Method:The clinical data of 348 PTC patients who underwent surgery at Jiangsu Provincial People's Hospital from Jun 2018 to Aug 2024 were retrospectively analyzed. Univariate analysis and multivariate Logistic regression analysis were used to determine the independent risk factors affecting the contralateral central lymph node metastasis of PTC with existing ipsilateral central lymph node metastasis.Results:Tumor size was positively correlated with the risk of metastasis. For every one-unit increase in the metastasis rate of the ipsilateral central lymph nodes, the risk of metastasis in the contralateral central region increases by 13.31 times ( P<0.001). Patients with ipsilateral lateral cervical metastasis have a higher risk of contralateral central metastasis ( P=0.026). The contralateral lymph node metastasis rate of patients with Hashimoto was 24%, while that of patients without Hashimoto was 76%( P<0.001). When the tumor was located at the upper pole, the metastasis rate of the contralateral central lymph nodes was 18%; when it was located at the middle pole, it was 29.6%; and when it was located at the lower pole, it was 42.6%( P=0.016). Conclusions:Tumor size, contralateral lateral cervical lymph node metastasis, and the intensity of ipsilateral central lymph node metastasis are independent risk factors for contralateral central lymph node metastasis in PTC patients with existing ipsilateral central lymph node metastasis. Tumor location at the upper pole and the presence of Hashimoto are protective factors.

Objective:To analyze the risk factors for cervical lymph node metastasis and lateral cervical lymph node metastasis, and to explore the role of serum calcitonin(Ctn) and carcinoembryonic antigen(CEA) levels in predicting lymph node metastasis in patients of medullary thyroid carcinoma(MTC).Methods:A retrospective analysis was conducted on the clinical data of 82 MTC patients who underwent primary surgery at Jiangsu Provincial People's Hospital from Nov 2016 to Mar 2024. A multivariate Logistic regression model was constructed to evaluate the association between each predictor and the outcome variable by using the least absolute shrinkage and selection operator (LASSO).Results:LASSO Logistic regression analysis showed that male gender ( OR=2.84,95% CI:1.14-2.38, P=0.065)、serum LnCEA( OR=1.64,95% CI:1.13-2.38, P=0.008)、serum LnCtn( OR=1.41,95% CI:1.01-1.97, P=0.043) were independent influencing factors for cervical lymph node metastasis in MTC. Based on the LASSO-built Logistic regression model, the model had the highest predictive value when female gender, serum CEA≈15.03 ng/ml, serum Ctn≈41.6 pg/ml. The predictive sensitivity was 0.727 (95% CI: 0.618-0.836), specificity was 0.852 (95% CI: 0.704-0.963). Further subgroup analysis for lateral cervical lymph node metastasis showed that in the LASSO-built logistic regression model, when serum CEA≈16.1 ng/ml, and central lymph node metastasis was negative, the predicted sensitivity and specificity were 0.810 and 0.700, respectively. Prognostic analysis revealed that age, Ctn and thyroid stimulating hormone were the influencing factors of the prognosis of MTC. Conclusions:When male gender, serum CEA>15.03 ng/ml and serum Ctn>41.6 pg/ml are met simultaneously in MTC patients, the possibility of cervical lymph node metastasis is the greatest. It is recommended to perform preventive lateral cervical lymph node dissection for MTC patients who has CEA>16.1 ng/ml and LN1a positive at the same time.

Objective:To investigate risk factors for permanent hypoparathyroidism (PHPP) after total thyroidectomy in patients with differentiated thyroid carcinoma (DTC).Methods:The clinical data of 316 DTC patients who underwent total thyroidectomy at our hospital from Jan 2020 to Jan 2023 were retrospectively analyzed. Patients were divided into normal parathyroid function group (284 cases) and hypoparathyroidism group (32 cases) according to whether parathyroid function was decreased. The clinical examination, intraoperative conditions and postoperative pathological data of the two groups were statistically analyzed.Results:Logistic regression analysis showed that: serum calcium on the first postoperative day ( OR=0.163, P<0.05), parathyroid hormon (PTH) on the first postoperative day ( OR=0.958, P<0.05), bilateral lymph node dissection ( OR=3.138, P<0.05), accidental resection of parathyroid (PG) ( OR=2.614, P<0.05), posterior capsule tumor invasion ( OR=3.336, P<0.05) and multiple cancer foci ( OR=2.664, P<0.05) were independent risk factors for PHPP after total thyroidectomy. Conclusion:Postoperative day 1 serum calcium, postoperative day 1 PTH, bilateral lymph node dissection, accidental resection of PG, posterior capsule invasion and multiple cancer foci are independent risk factors for PHPP after total thyroidectomy.

Objective:To analyze the clinical characteristics of pediatric, adolescent, and young adult thyroid cancer patients treated from Jan 2012 to Jul 2022.Methods:A retrospective analysis was conducted on the pathological and ultrasound features, treatment methods, and survival outcomes of thyroid cancer in three groups: the pediatric group (0-14 years), the adolescent group (15-19 years), and the young adult group (20-39 years).Results:The number of pediatric and adolescent patients showed a relatively stable growth trend, while the proportion of microcarcinomas was significantly higher in the young adult group. Significant differences were observed among the groups in T stage, N stage, M stage, extrathyroidal extension, local invasion, lymph node metastasis, number of metastatic lymph nodes, and tumor hypoechogenicity (all P<0.05). Preoperative thyroid function tests revealed differences in free triiodothyronine (FT3), triiodothyronine (T3), and thyroglobulin (Tg) levels (all P<0.05). All patients underwent thyroidectomy or lobectomy, with significant differences in contralateral neck lymph node dissection rates ( χ2=30.089, P<0.001). Postoperative lymphatic leakage incidence varied ( χ2=8.376, P=0.015), and the proportion of patients receiving postoperative 131I therapy differed significantly ( P<0.001). Significant differences were observed in postoperative recurrence and secondary surgery rates. Multivariate analysis identified FT3, T3, and pathological type as risk factors for recurrence. The three groups showed significant differences in postoperative calcium supplementation upon discharge, with insufficient attention given to bone health and cardiovascular risks. Conclusion:Pediatric, adolescent, and young adult thyroid cancer patients exhibit differences in incidence and pathological characteristics, but no significant difference was found in overall survival.

Objective:To evaluate the clinical characteristics of primary thyroid lymphoma (PTL) and the prognoses.Methods:A retrospective analysis was performed on the clinical data, prognosis and influencing factors of 18 PTL patients at the First Affiliated Hospital of Xiamen University from Oct 2012 to Aug 2021.Results:There were 12 females and 6 males, average age of (60±11.5)years. Fifteen patients were complicated with hashimoto's thyroiditis (HT). Seventeen patients received treatments including surgery, chemotherapy, radiotherapy, and targeted therapy. Median follow-up time was 35.8 months. Four cases suffered from recurrence and progression, and 3 cases died. The 3-year overall survival rate(OS) was 94%, and the 5-year OS rate was 83%. The 3-year progression-free survival(PFS)rate was 89%, and the 5-year PFS rate was 79%. The OS rate and PFS rate of patients with HT were higher than those of patients without ( P<0.05). The 5-year OS rates were 100% vs.33% ( χ2=7.681, P=0.006), and the 3-year PFS rates were 93% vs. 67% respectively( χ2=5.368, P=0.021). The OS and PFS of patients who had undergone surgical treatment were higher than those of patients without ( P<0.01). The 5-year OS rates were 100% vs.40% ( χ2=8.579, P=0.003), and the 5-year PFS rates were 100% vs.30% ( χ2=12.267, P<0.001).The PFS rate of patients aged ≤60 years was higher than that of patients aged >60 years, and the difference was statistically significant ( P<0.05). The 5-year PFS rates were 100% vs. 56% ( χ2=4.906, P=0.027). Conclusions:PTL shows a female predominance and tends to occur at a relatively advanced age. The overall prognosis of PTL patients is favorable after multidisciplinary treatment.Patients with HT or who have undergone surgical treatment tend to have relatively longer survival periods.

Objective:To investigate the therapeutic effectiveness of ultrasound-guided percutaneous catheterization for continuous negative pressure drainage combined with polidocanol in treating large thyroid cysts.Method:Clinical data of 38 patients with large thyroid cysts who were treated consecutively with catheter drainage combined with polidocanol sclerotherapy by the same doctor at Beijing Tsinghua Changgung Hospital from Jan 2021 to May 2024 were retrospectively analyzed. The effectiveness and safety were statistically evaluated, and the relationship between drainage volume and cyst volume was analyzed.Results:Among the 38 patients with thyroid cysts who completed the treatment, the median follow-up was 9 months (range: 3-24 months). The effectiveness rate was 92% (35/38), of which 32 cases (84%) met the cure standard. The maximum diameter of the cysts before treatment was (4.8±1.0) cm, and the maximum diameter of the residual nodules after treatment was (1.5±1.1) cm, the difference was statistically significant ( t=17.389, P<0.01). The amount of drainage exudate is related to the volume of the cyst and the maximum diameter before treatment ( t=-3.149, P=0.003; t=-3.057, P<0.005). 19% of patients showed transient low fever after the injection of polidocanol, with no other complications. Conclusion:For large thyroid cysts, ultrasound-guided percutaneous catheterization for continuous negative pressure drainage combined with polidocanol sclerotherapy is a safe and effective method.

Objective:The purpose of this study was to develop a dynamic prediction model for patients with gastric signet ring cell cancer (GSRCC)following laparoscopic radical gastrectomy in order to improve the precision and usefulness of prognoses prediction for overall survival and disease-free survival.Methods:From 2011 to 2018, 914 National Cancer Center patients participated in the study. To find independent prognostic indicators and create a prognostic nomogram model, univariate and multivariate regression analyses were performed. Calibration curves, receiver operating characteristic curves, and consistency indices were used to assess the model's performance. To make clinical application more convenient, two web-based prediction tools were created.Results:A training set of 639 cases and a validation set of 275 instances were randomly selected from among the patients. Important predictive variables such as age, tumor size, location, pN and pT staging, and postoperative chemotherapy were all incorporated in the model (all P<0.05). The model's consistency index and area under the receiver operating characteristic curves were both higher than 0.7, and the calibration curves demonstrated a good fit between the expected and actual values, indicating high accuracy and consistency in postoperative survival prediction for patients with gastric signet ring cell carcinoma. Conclusion:We successfully developed two dynamic prediction models in this study, which improved its clinical practicability using web-based tools and is anticipated to be crucial to clinical practice going forward.