Introduction
Thyroid carcinoma is cancer of the thyroid tissue. The incidence of thyroid carcinoma accounts for 1.3% of systemic cancers. Incidence of thyroid carcinoma, especially of poorly differentiated thyroid carcinoma, is also high in the endemic areas of nodular goiter. Thyroid carcinoma is the solid malignant tumors with the fastest growing incidence in the past 20 years and has an average annual growth of 6.2% since the mid-1980s and after the accident of Chernobyl in former USSR.
Because thyroid carcinoma has a variety of different pathological types and biological characteristics, its clinical manifestations are not the same. It can exist with multiple thyroid nodules, the majority of which are asymptomatic. A nodule or mass in the anterior cervical region is usually found by chance. Some masses that have been in existence for many years may rapidly grown or have metastasis. Some patients have no main complaints for a long time and pay no attention until cervical lymph node metastasis, pathologic fractures, hoarseness, disordered breathing, difficulty in swallowing, and even Horner syndrome exhibit at the advanced stage. Local signs are not the same. There may be asymmetric nodules or masses of thyroid or masses inside the gland, up and down after swallowing. The mass is fixed until the surrounding tissue or trachea is invaded.
General types of thyroid carcinomas are papillary carcinoma (including mixed papillary follicular carcinoma), follicular carcinoma, medullary carcinoma (solid body accompanied by amyloid thyroid tumors), undifferentiated carcinoma, and rare anaplastic carcinoma. Generally, thyroid carcinoma is not highly malignant. If appropriate treatment is conducted, the patient can achieve normal life expectancy.
Treatments
1.Surgery
Surgery is an important means for thyroid carcinoma treatment. According to the different pathological types and violation range of the cancer, methods are also different. The main form of surgery includes thyroid single leaf plus isthmus resection, subtotal thyroidectomy or total thyroidectomy, and combined radical operation of thyroid carcinoma.
2.Radiotherapy
Sensitivity to radiation varies greatly for various types of thyroid carcinoma, which is almost proportional to the degree of differentiation of thyroid carcinoma; the better the differentiation the poorer the sensitivity, whereas the poorer the differentiation the higher the sensitivity. Thyroid carcinoma radiotherapy mainly includes external radiotherapy and internal radiotherapy.
3.Chemotherapy
Differentiated thyroid carcinoma has poor response to chemotherapy. Only selective combinations with other treatments are used for some patients with locally advanced and unresectable or distant metastasis. Doxorubicin is the most effective. Its response rate can be 30%–45%, and it can prolong life. The patient can have long-term survival even when the carcinoma foci are not reduced. In contrast, undifferentiated carcinoma is more sensitive to chemotherapy, and combination chemotherapy is commonly used.
4.Endocrine Therapy
Thyroid hormone can inhibit thyroid-stimulating hormone secretion, which inhibits proliferation of thyroid tissue and differentiated cancer and has a better therapeutic effect on papillary carcinoma and follicular carcinoma. Thus, doses of thyroid hormone, which can inhibit thyroid-stimulating hormone secretion, are conventionally given after surgery for the aforementioned types of thyroid carcinoma and have some effect in preventing cancer recurrence and metastases but have no effect on undifferentiated carcinoma. Generally, in China dried thyroid tablets of 80–120 mg are applied daily to maintain a high thyroid hormone level.
5.Hyperthermia
Hyperthermia has the effect of directly killing cancers and can effectively control the growth of thyroid carcinoma. Cellular immune function is enhanced after hyperthermia, which can improve the efficacy of cancer treatment. Hyperthermia has a synergistic sensitizing effect on chemoradiotherapy and can also reduce adverse reactions of chemoradiotherapy. Clinical studies have shown that efficacy of thermoradiotherapy and thermochemotherapy for thyroid carcinoma is superior to that of chemoradiotherapy alone. Whole-body hyperthermia has a good effect on thyroid local control as well as prevention of recurrence and metastasis and can be combined with systemic chemotherapy. Neck RF local hyperthermia can be used alone, and it can also be used in combination with radiotherapy. For patients with combined distant metastasis, hyperthermia can effectively relieve symptoms, improve quality of life, and prolong survival time. Studies have shown that whole-body thermochemotherapy has higher pain relief rates for patients with thyroid carcinoma combined with bone metastasis than chemotherapy alone.
6.Chelation Detoxification Therapy
Chelation detoxification therapy can effectively inhibit cancer cell growth and metastasis and can also reduce the side effects of radiotherapy and isotope therapy. The course of treatment is once every other day, and treatment is maintained until 2 weeks after the end of radiotherapy or isotope therapy and is then changed to therapy twice a week for 3 months. Health rehabilitation can be given once a week when the condition is stable after 3 months. Ensure to arrange chelation detoxification and hyperthermia at the same time as far as possible to maximize the synergistic effect.
7.Medical Ozone Therapy
EBOO treatment or medical ozone saline intravenous injection, major autohemotherapy, and so on should be given as soon as possible to obtain synergistic anticancer effect, enhance immunity, and reduce the side effects of radiotherapy.
8. Traditional Chinese Medicine
For the syndrome of phlegm and qi stagnation, the prescriptions recommended include modified Sihai Shuyu Pill. For the syndrome of phlegm, blood, and poison stagnation, the prescriptions recommended include modified Haizao Yuhu Decoction. For the syndrome of phlegm fire and blood stagnation, the prescription recommended is modified Liver-clearing Aloe Pill. For the syndrome of deficiency of both qi and blood, the prescriptions recommended include Shengmai Powder combined with modified Huoxue Xiaoying Decoction.
9.Acupuncture
Thyroid carcinoma is mainly caused by poor emotional state, stagnation of qi due to depression of the liver, and phlegm dampness and coagulation. The therapeutic principle should focus on soothing liver qi stagnation, regulating qi, eliminating goiter, promoting blood circulation, removing phlegm, and resolving mass.
10.Medicated Diet, Nutrition, and so on
Nutrition is a major treatment for advanced cancer. In addition to necessary medicated conditioning, enough nutrients need to be supplemented. Patients with eating difficulty may be given nasal feeding of enteral nutrition or total parenteral nutrition. At the same time, include psychological adjustment, qigong, sports, music, and so on to keep the patient calm, positive, and optimistic so as to enhance self-healing ability, which can delay the progression of cancer.
11.Others
We recommend patients at the early stage to actively practice qigong, tai chi, and so on and to use TCM to regulate emotions. Guide patients to attain peace of mind and to overcome panic and desperation, so that they can face the disease with a positive, optimistic, and open-minded disposition. Also, combine music therapy and sound wave therapy to alleviate psychological pressure.
Typical Case
A 26 year old female patient discovered a mass in the left neck and hoarseness one and a half year ago. A solid and firm 3cm×4cm mass in the left thyroid area was found, also found were multiple lymph nodes in the left side of neck. The diagnosis was medullary thyroid carcinoma at clinical stageⅢ. Treatment with total thyroidectomy + lymphadenectomy and oral thyroxine tablets were carried out. Patient had repeated dry cough 3 months after surgery. Further examination revealed bilateral pulmonary multiple metastases. 5 months after surgery, patient appeared emaciated. She complained of chest tightness, breathlessness, irritability, head and neck pain, chest pain, cough, bloody sputum, shortness of breath, slightly yellow sputum in cough, hoarseness, breathing discomfort, dysphagia, as well as constipation and brown urine.
Diagnosis: medullary thyroid carcinoma and lung metastases.
Integrative treatment prescription: patient was in poor general health from advanced stage of medullary thyroid carcinoma. Her prognosis was poor due to the highly malignant tumor and lung metastasis. She immediately received Western medicine treatment of intravenous nutrient for hemostasis, relieving cough, dissipating phlegm, and anti-infection, in combination with EBOO, whole body medium-high hyperthermia, chelation and detoxification therapy, TCM, acupuncture, and other integrative treatments. After 7 days, her chest tightness, cough, sputum, headache and other symptoms improved. As treatment continued, TCM and acupuncture were appropriately adjusted as needed.
Treatment outcome: patient had been hospitalized for 60 days. Her general condition improved significantly after combined treatment. Her weight increased to 56 kg. Symptoms such as chest tightness, chest pain, cough, hemoptysis disappeared. Patient finds the occasional hoarseness manageable. Multiple lung metastases were seen by CT review. However, the metastatic lesions were narrowed compared with the original ones. The maximum lesion was 1.2cm×2.0cm with no new metastases occurred. Thyroid function: FT3 3.2pmol/L, FT4 15.4pmol/L and TSH 4.7mIU/L. Her KPS was 100. Patient insisted on treatment as an outpatient. She returned for integrative treatment once a month. Review once every 3 months. Patient remains stable condition.
