What Is a Thyroid Neoplasm?

The thyroid gland is located below the thyroid cartilage of the human neck, on both sides of the trachea, and looks like a butterfly, like a shield, so it is called the thyroid. The thyroid is divided into left and right lobes and isthmus. The left and right leaves are located on both sides of the lower throat and upper organ. The upper end is from the midpoint of the thyroid cartilage, and the lower end to the 6th tracheal cartilage ring, sometimes reaching the upper sternal fossa or behind the sternum.

Tian Wen

(Chief physician)

Beijing 301 Hospital General Surgery

Thyroid tumors are common tumors in the head and neck and are more common in women. Symptoms are a mass in the middle of the neck, and with swallowing activity, some patients also have hoarseness, difficulty swallowing, and difficulty breathing. There are many types of thyroid tumors, both benign and malignant. Generally speaking, a single mass is more likely to grow faster, and younger thyroid tumors are more likely to be malignant. Because the symptoms are obvious, patients can usually see a doctor in time.

Western Medicine Name: Thyroid tumor
Affiliated Department: surgical-

Disease site: thyroid
The main symptoms: Generally no obvious symptoms in the early stages of onset
Contagious: Non-contagious

Thyroid tumor introduction

Anatomy of a thyroid tumor

Thyroid tumor physiology

The thyroid gland has the function of synthesizing, storing, and secreting thyroxine, and its structural unit is the follicle. Thyroxine is an organically bound iodine containing iodine tyrosine. There are two types of iodine tyrosine (T4) and triiodotyrosine (T3). After synthesis, it is combined with thyroglobulin and stored in thyroid filter In the bubble. Thyroxine released into the blood is bound to serum proteins, 90% of which are T4 and 10% are T3. The main effects of thyroxine are: to accelerate the efficiency of the whole body's use of oxygen, accelerate the decomposition of proteins, carbohydrates and fats, comprehensively increase the metabolism of the human body, increase the production of heat; .

Benign thyroid tumor

Benign thyroid tumors are common, and thyroid tumors account for about 50% of neck masses. Generally there are no obvious symptoms. When the tumor is large, it will cause breathing difficulties, dysphagia, hoarseness and other symptoms due to compression of the trachea, esophagus, and nerves. When the tumor is accompanied by bleeding and rapidly increases, local pain will occur. Because benign thyroid tumors may be malignant, although some are benign, they are hot nodules (ie, highly functional), so they need to be actively treated.

Thyroid adenoma

Thyroid adenoma (TA) is the most common benign thyroid tumor. Pathology is divided into follicular thyroid adenoma (FTA) and papillary thyroid adenoma (PTA). The former is the most common. It is common, accounting for about 70% to 80% of thyroid adenomas. The latter is relatively rare and should be distinguished from papillary carcinoma. Adenomas often have a complete envelope. The reasons are unknown, and may be related to gender, genetic factors, radiation exposure (mainly external radiation) and long-term excessive stimulation of TSH. Thyroid adenoma is more common in women under 40 years of age. Onset is concealed, with neck mass as the main complaint, and most are asymptomatic. Sudden increase (hemorrhage) in the course of the disease is often accompanied by local tenderness. On examination, nodules were found in the anterior cervical region, mostly single, round or oval, often confined to one side of the gland, with medium texture, smooth surface, no tenderness, and moved up and down with swallowing. If accompanied by cystic changes or bleeding, the nodules are mostly "stiff" due to high tension and may have tenderness. Color Doppler Flow Imaging (CDFI) showed clear mass boundaries, poor blood supply, and cystic changes. Thyroid adenomas may cause hyperthyroidism (incidence rate of about 20%) and malignant changes (incidence rate of about 10%). In principle, they should be removed early. Generally, a major resection of the affected thyroid (including adenomas) should be performed; if the adenoma is small, simple adenoma resection is feasible, but wedge resection should be performed, that is, a small amount of normal thyroid tissue should be wrapped around the adenoma. The resected specimen must be frozen sectioned immediately to determine whether it has malignant changes.

Nodular goiter

The cause of nodular goiter (NG) may be caused by a lack of iodine or thyroid hormone synthesis enzymes in the diet. The history is generally long, and it often grows unknowingly. Find. Most are multinodular and few are single nodules. Most nodules are gelatinous, among which cysts are formed due to bleeding and necrosis; there may be more fibrosis or calcification, and even ossification in some areas of chronic disease. Thyroid hemorrhage often has a history of sudden pain and cyst-like masses in the glands; those with gelatinous nodules have a hard texture; those with calcification or ossification have a hard texture. Generally conservative treatment can be used, but due to larger nodules caused by compression symptoms (dyspnea, swallowing or hoarseness), malignant tendency or hyperthyroidism symptoms should be treated surgically.

Thyroglossal cyst

Thyroglossal duct is a congenital malformation associated with thyroid development. During the embryonic period, the thyroid occurs from the bottom of the mouth to the neck of the thyroid tongue duct. The thyroid-tongue duct usually locks itself around 6 weeks after the fetus. If the thyroid-tongue duct is incompletely degraded, a congenital cyst can be formed, which becomes a thyroid-tongue duct fistula after the infection is ruptured. The disease is more common in children under 15 years of age, twice as much as men. It appears as a round mass with a diameter of 1 ~ 2cm at the midline of the anterior cervical region and below the hyoid bone. The realm is clear, the surface is smooth, and the capsule is sexy, and can move up and down with swallowing or stretching and shrinking the tongue. Treatment should be surgically removed. A segment of the hyoid bone should be removed to completely remove the cystic wall or sinus, and separated upward to the base of the tongue to avoid recurrence.

Subacute thyroiditis

Also known as De Quervain thyroiditis or giant cell thyroiditis. The size of the nodule depends on the extent of the lesion, and the texture is often hard. Often secondary to upper respiratory tract infections, with a typical medical history, including more rapid onset, fever, sore throat, and significant pain and tenderness in the thyroid area. Pain often spreads to the affected ear and temporal occipital. Often, body temperature increases and erythrocyte sedimentation increases. In the acute phase, the rate of thyroid 131I decreases, and most of them show "cold nodules", but serum T3 and T4 increase, and the basal metabolic rate slightly increases. This separation phenomenon is helpful for diagnosis. Lighter patients can use non-steroidal anti-inflammatory drugs such as aspirin, and heavier patients are often treated with prednisone and dry thyroid preparations.

Thyroid tumor

Thyroid cancer is the most common type of thyroid cancer. Thyroid cancer has a very small number of lymphomas and metastases. Thyroid cancer accounts for 1% of systemic malignancies. With the exception of myeloid carcinoma, most thyroid cancers originate from follicular epithelial cells. The incidence of thyroid cancer is related to the region, race, and gender. The incidence of thyroid cancer is high in the United States. According to statistics, from 1973 to 2002, the annual incidence of thyroid cancer in the United States increased from 3.6 / 100,000 to 8.7 / 100,000, an increase of approximately 2.4 times (P <0.001), This trend is still growing year by year. The incidence of thyroid cancer in China is relatively low. According to statistics, among them, men are about 0.8-0.9 / 100,000 and women are about 2.0-2.2 / 100,000.

Pathogenesis of thyroid tumors

The pathogenesis of thyroid malignancies is not clear, but its related factors include many aspects, mainly in the following categories:

1. Oncogenes and growth factors: Recent studies have shown that the occurrence of tumors in many animals and humans is related to the overexpression, mutation or deletion of proto-oncogene sequences.

2. Ionizing radiation: It has been found that external radiation from the head and neck is an important carcinogen for the thyroid.

3. Genetic factors: Some medullary thyroid cancers are autosomal dominant genetic diseases; in some patients with thyroid cancer, family history can often be consulted

4. Iodine deficiency: As early as the beginning of the 20th century, some people have proposed that iodine deficiency can cause thyroid tumors.

5. Estrogen: Studies in recent years suggest that estrogen can affect the growth of the thyroid gland by promoting the release of TSH from the pituitary gland, which affects the thyroid gland, because when the estrogen level in the plasma increases, the TSH level also increases. It is not clear whether estrogen directly affects the thyroid gland.

Thyroid tumor thyroid cancer

Pathological classification

1, papillary carcinoma (papillary carcinoma) accounts for about 70% of the total adult thyroid cancer, and children's thyroid cancer is often papillary cancer. Papillary carcinoma is common in young and middle-aged women, and is most common in women aged 21-40. This type has good differentiation, slow growth, and low malignancy. The disease has a tendency of polycentricity, and cervical lymph node metastasis may occur earlier. Early detection and active treatment are needed, and the prognosis is now good.

2. Follicular carcinoma accounts for about 15%, and it is more common in women around 50 years old. This type develops rapidly, is moderately malignant, and has a tendency to invade blood vessels. Cervical lymph node metastasis accounts for only 10%, so the prognosis is not as good as that of papillary cancer.

3. Anaplastic thyroid carcinoma accounts for about 5% -10%. It is more common in the elderly. It develops rapidly and is highly malignant. About 50% of patients have cervical lymph node metastasis or invade the recurrent laryngeal nerve, trachea or esophagus Often transferred by blood to distant places. The prognosis is poor, with an average survival of 3-6 months and a one-year survival rate of only 5% -10%.

4. Medullary thyroidcarcinoma is rare. Occurs in cells next to the follicle (C cells) that secrete calcitonin. The cells are arranged in a nest or bundle, without nipples or follicular structures, with amyloidosis in the stroma, and undifferentiated, but its biological characteristics are different from undifferentiated cancer. Malignant degree, may have cervical lymph node metastasis and blood metastasis.

In short, different types of thyroid cancer have different biological characteristics, clinical manifestations, diagnosis, treatment, and prognosis.

Clinical manifestation

Papillary carcinoma and follicular carcinoma are usually asymptomatic in the early stages, and the former can sometimes seek medical treatment for cervical lymphadenopathy. With the progress of the disease, the mass gradually increased, and the mass was hardened, and the mobility of the mass decreased during swallowing. The above symptoms of undifferentiated cancer develop rapidly and invade surrounding tissues. Late stage can produce hoarseness, difficulty breathing, and difficulty swallowing. Compression of the cervical sympathetic ganglia can cause Horner syndrome. When the superficial branch of the cervical plexus is violated, the patient may have pain in the ears, pillows, and shoulders. There may be cervical lymph node metastasis and distant organ metastases (lung, bone, central nervous system, etc.).

In addition to neck masses, patients with medullary carcinoma may develop symptoms such as diarrhea, palpitations, flushing of the face, and decreased blood calcium, as the tumors produce serotonin and calcitonin. For patients with family history, attention should be paid to the possibility of multiple endocrine tumor syndrome type II (MEN-II).

Diagnosis

Auxiliary inspection

1. Thyroid function test: It is mainly the measurement of thyroid stimulating hormone (TSH). Highly functional thermal nodules with reduced TSH are less malignant, so it is more important to treat their hyperthyroidism. Thyroid nodules with normal or elevated TSH and cold or warm nodules with reduced TSH should be further evaluated (eg, biopsy, etc.).

2. Nuclide scanning: Radioactive iodine or tritium isotope scanning examination (ECT) is an important means to judge the functional size of thyroid nodules. The American Thyroid Association states: "The results of ECT tests include high functional (higher uptake rate than surrounding normal thyroid tissue), isofunctional or warm nodules (same uptake rate as surrounding tissue) or nonfunctional nodules (more than surrounding Low thyroid tissue uptake rate). High-functioning nodules with low malignant rate, if the patient has obvious or subclinical hyperthyroidism, nodules need to be evaluated. If the serum TSH level is high, even only at the upper limit of the reference value Nodules should be evaluated because they have a higher rate of malignancy. " However, ECT is often not displayed for nodules or small cancers smaller than 1 cm, so it is not appropriate to use ECT for such nodules.

3. B-ultrasound: Ultrasound is an important method to find thyroid nodules and to judge its benign and malignant quality. It is a judgment standard for the possibility of fine needle aspiration biopsy (FNA), and it is also the most effective examination method. European and American guidelines all refer to suspicious malignant indications under ultrasound, including: hypoechoic nodules, microcalcifications, rich blood flow signals, unclear borders, nodule height greater than width, solid nodules, and lack of halo . Some people in China have analyzed and evaluated nodule morphology, borders, aspect ratios, peripheral stuns, internal echo, calcification, and cervical lymph node conditions, and compared the pathological results after surgery. Calcification and internal echo are more relevant in the identification of benign and malignant thyroid nodules. This aspect can be focused on (only for papillary cancer).

4. Needle aspiration smear cytology: Needle aspiration biopsy includes fine needle aspiration biopsy and thick needle aspiration biopsy. The former is cytological examination and the latter is histological examination. For the suspected malignant thyroid nodules found by B-ultrasound, this method can be used to confirm the diagnosis. At present, fine needle biopsy is generally used. The patient is lying on his back with the neck extended. Local anesthesia should be used. The importance of multi-directional puncture should be emphasized, and at least 6 punctures should be performed to ensure that sufficient specimens are obtained. During puncture, fix the nodule with the left finger and middle finger, hold the syringe with the right hand, pull the needle back to generate negative pressure, and slowly pull the needle out 2mm outwards, and then pierce it in. After several times, see the cell debris in the needle. Stop aspiration, remove the negative pressure, pull out the needle, disconnect the syringe, suck a few milliliters of air into the syringe, connect the needle, and arrange the specimen in the needle onto the glass slide. 1-2 drops of orange-red liquid are required. Cell debris inside. Then smear check.

Differential diagnosis

Thyroid cancer is often manifested as thyroid nodules. Therefore, when there are nodular goiters clinically, it is of great significance to distinguish the benign and malignant nature of the nodule. Common diseases that cause thyroid nodules are as follows:

1. Simple goiter: The most common cause of nodular goiter. The medical history is generally long, and often grows unknowingly, but because of accidental discovery during physical examination. Nodules are developed by glands during the process of hyperplasia and compensation. Most of them are multinodular goiters, and a few are single nodular. Most of the nodules are gelatinous, and cysts are formed due to bleeding and necrosis; there may be more fibrosis or calcification or even ossification in some areas of chronic patients. Due to the different pathological properties of nodules, their size, stiffness, and appearance vary. Thyroid hemorrhage often has a history of sudden swelling and pain, cyst-like masses in the glands; people with gelatinous nodules, the texture is hard; those with calcification and ossification, the texture is hard.

2. Thyroiditis: Subacute thyroiditis: The size of the nodule depends on the extent of the lesion, and the texture is often hard. Has a typical medical history, including acute onset, fever, sore throat, and significant thyroid pain and tenderness. In the acute phase, the thyroid uptake rate decreases, and the imaging is mostly "cold nodules". Serum T3 and T4 are elevated, showing a "separation" phenomenon, which is helpful for diagnosis. "Chronic lymphocytic thyroiditis: Symmetrical diffuse goiter without nodules; sometimes due to enlargement and asymmetry and lobes on the surface, it can look like a nodule, as hard as rubber, without tenderness. The onset of the disease is slow and it is a chronic development process, but it can occur at the same time as thyroid cancer, which is difficult to distinguish clinically and requires attention. Antithyroid globulin antibodies and antithyroid peroxidase antibody titers often increase. Aggressive fibrous thyroiditis: The nodules are hard and adhere to and fix adjacent tissues outside the glands. The cavalry and development process is slow, and may have local pain and tenderness, accompanied by obvious compression symptoms. Its clinical manifestations are similar to thyroid cancer, but the local lymph nodes are not large, and the I rate is normal or low.

3, thyroid adenoma: caused by thyroid adenoma or multiple glioblastoma. Single or multiple, can coexist with the goiter or appear alone. Adenomas are generally round or oval in shape and are mostly harder than the surrounding thyroid tissue without tenderness. Scanning images showed normal, increased, or decreased camera function; thyroid imaging was "warm nodules," "hot nodules," and "cold nodules." Thyroid uptake rate can be normal or high. Tumors develop slowly, and most of them are asymptomatic clinically, but some patients have symptoms of hyperfunction.

4. Thyroid cyst: The cyst contains blood or clear liquid, and it has a clear boundary with the surrounding thyroid tissues. It can be quite hard. Ultrasound B is often helpful for diagnosis. Except for goiters and nodules, most of them have no functional changes. ^[1] disease treatment

Surgical treatment is the basic treatment method for various types of thyroid cancer except undifferentiated cancer, and is supplemented with iodine 131 treatment, thyroid hormone and external irradiation.

1. Surgical treatment: Surgical treatment of thyroid cancer includes surgery of the thyroid itself, and neck lymph node dissection. The scope of thyroidectomy remains divergent, and there is no basis for prospective randomized controlled trial results. However, complete tumor resection is important, and meta-analysis data suggest that complete tumor resection is an independent prognostic factor. Therefore, even with differentiated thyroid cancer, resection smaller than the glandular lobe is not appropriate. The smallest is the resection of the glandular lobe and isthmus. Up to total thyroidectomy. The trend of thyroidectomy is more extensive. There is evidence that recurrence rates are lower after near-total or total thyroidectomy. In the low-risk group, the recurrence rate was 14% in the 30-year period after glandularectomy, and the total resection rate was 4%. Generally, for the patients in the high-risk group, the scope of the first operation is not too much controversy. There are reports of glandular lobe in TNM stage III The local recurrence rate after resection was 26%, and the local recurrence rate after total resection was 10%. There was no difference between total thyroidectomy and near total resection. The advantage of wide-range surgery is to reduce the local recurrence rate. The main disadvantage is that the short-term or long-term complications increase after the operation, while resection of the lobes rarely causes recurrent laryngeal nerve damage, and almost no severe hypoparathyroidism occurs.

Recently, many scholars believe that age is an important factor in dividing low risk and high risk, and choose treatment principles based on low and high risk grouping. For patients in the low-risk group, glandular lobe and isthmus resection are used. If the margin is free of tumor, the treatment can be achieved. For the high-risk group, it is advisable to take the ipsilateral glandular lobe, the contralateral near-total or subtotal resection. Surgery can also be designed according to the clinical characteristics of the tumor: Glandular lobe + isthmus resection is suitable for low-risk patients with tumors smaller than 1 cm in diameter and confined to the first lobe of the thyroid gland; "full resection of the thyroid gland + isthmus resection + contralateral approach Total resection, suitable for tumors larger than 1 cm in diameter, and a wide range of papillary carcinoma with lymph node metastasis on one side; Total thyroidectomy is suitable for highly invasive papillary and follicular carcinoma, which is obviously multifocal, and both sides Lymph node enlargement, tumor invasion of surrounding neck tissue or distant metastasis. In patients under 15 years or over 45 years, the lymph node metastasis rate is high, up to 90%. Total thyroidectomy should be considered in this group of cases.

The extent of cervical lymph node dissection is also controversial. It is inconclusive that routine cervical lymph node dissection or modified lymph node dissection is performed in the central area, or only accessible enlarged lymph nodes are removed. Meta-analytical data suggest that only two factors can help predict whether cervical lymph node metastasis is a lack of tumor envelope and tumor invasion around the thyroid gland. Those who did not have both factors had a cervical lymph node metastasis rate of 38%, and those who had both factors had a cervical lymph node metastasis rate of 87%.

Although the surgical effect of cervical lymph node dissection is certain, the quality of life of patients may be affected. Therefore, the decision of preventive cervical lymph node dissection is very cautious. Especially in the low-risk group, if the enlarged lymph nodes are not touched during the operation, cervical lymph node dissection may not be performed. If enlarged lymph nodes are found, a rapid pathological examination should be performed after resection, and those with confirmed lymph node metastasis can be used for central cervical lymph node dissection or modified cervical lymph node dissection. The former refers to the removal of lymph node tissues from the common carotid artery, around the thyroid gland, between the tracheoesophageal sulcus, and the upper mediastinum; the latter refers to cervical lymph node dissection that preserves the sternocleidomastoid muscle, internal jugular vein, and accessory nerves. Central lymphadenectomy is likely to damage the recurrent laryngeal nerve and parathyroid glands during reoperation. Therefore, it is argued that central lymphadenectomy is not performed in the first surgery. For patients in the high-risk group, cervical lymph node metastasis, tumor invasion outside the capsule, and those over 60 years of age should be modified for cervical lymph node dissection; if the disease stage is late and the cervical lymph nodes are extensively involved, traditional lymph node dissection should be performed . 2. Endocrine therapy: Patients with thyroid cancer after subtotal or total resection should take thyroxine tablets for life to prevent hypothyroidism and inhibit TSH. Both papillary and follicular cancers have TSH receptors, and TSH can affect the growth of thyroid cancer through its receptors. The dose of thyroxine tablets should be adjusted according to the TSH level, but there is not enough effective data to support the precise range of TSH inhibition. In general, TSH should be maintained below 0.1mU / L in patients with residual cancer or high risk of recurrence; however, TSH should be maintained near the lower limit of normal (slightly higher or lower than the lower limit of normal) in disease-free patients with low risk of recurrence. ; For low-risk patients with positive laboratory tests but no organic lesions (thyroglobulin positive, negative imaging), TSH should be maintained at 0.1-0.5mU / L; for patients with long-term disease-free survival, TSH may be maintained within normal reference values. Available levothyroxine sodium tablets (Ukraine), 75ug-150ug per day, and regularly measure blood T4 and TSH, adjust the dose according to the results.

3. Radionuclide therapy (131 iodine treatment): For papillary cancer and follicular cancer, postoperative application of iodine is suitable for patients over 45 years of age, multiple cancerous foci, locally invasive tumors and those with distant metastases. It mainly destroys the residual thyroid tissue after thyroidectomy, which is beneficial to reduce recurrence and mortality in high-risk cases. The purpose of applying iodine treatment is: to destroy the residual occult microcarcinoma in the thyroid gland; easy to detect recurrence or metastasis with nuclide; to increase the value of gonadoglobin as a tumor marker during postoperative follow-up.

4. External radiation therapy (EBRT): It is mainly used for thyroid cancers other than papillary cancer. ^[2-3]

Disease prognosis

Among malignant tumors, the prognosis of thyroid cancer is generally good. Many thyroid cancers have metastasized, but patients can still survive for more than 10 years. There are many factors involved in prognosis, such as age, gender, pathological type, extent of lesions, metastasis, and surgical methods. Among them, pathological type is the most important. 95% of well-differentiated thyroid cancer patients can survive for a long time, especially the biological characteristics of papillary cancer tend to be good, the prognosis is best, the prognosis of recessive papillary cancer is better, but a few can also become extremely malignant High undifferentiated cancer; undifferentiated cancer has the worst prognosis, and patients often die within six months. The larger the tumor volume, the greater the chance of infiltration, and the worse the prognosis. According to relevant statistical data, the presence or absence of lymph node metastasis does not affect the survival rate of patients. Uncontrolled primary tumors or local recurrence can lead to increased mortality. The degree of direct tumor spread or invasion is more important than lymph node metastasis.

Dietary attention

Patients with thyroid cancer can basically eat and work normally after surgery, properly control iodine-rich foods, avoid excessive fatigue, and avoid tobacco and alcohol. Attention should be paid to thyroid examination, including imaging and thyroid function examination.

Thyroid tumor lymphoma

Primary thyroid lymphoma is a rare malignant tumor of the thyroid gland, accounting for 1% to 2% of thyroid cancer, male: female 1: 3. Most are based on Hashimoto's thyroiditis, and most are non-Hodgkin's lymphoma. It is the only female tumor in lymphoma. It is more common in middle-aged and elderly women, mainly neck tumors. The rate of tumor growth is inconsistent. Those with higher speed are similar to the clinical symptoms of undifferentiated thyroid cancer. Occasionally invades the recurrent laryngeal nerve, causing hoarseness and local pain; some grow slowly and are not easily distinguished from nodular goiter and Hashimoto's disease. The qualitative diagnosis of this disease mainly depends on fine needle aspiration cytology and surgical biopsy, which is easily confused with small cell-based undifferentiated cancer. The treatment of primary thyroid lymphoma has developed from a single operation to a comprehensive treatment such as surgery, radiotherapy and chemotherapy.

Thyroid tumor metastases

Thyroid metastases are rare. According to autopsy data, 4% to 24% of thyroid patients who died of disseminated cancer were affected. The origin of thyroid metastases is nothing more than three aspects: direct spread of adjacent structures (such as throat, esophagus, etc.), lymphatic metastases (mostly breast cancer), hematological metastases (breast cancer, lung cancer, renal cell carcinoma, skin melanoma , Fibrosarcoma, liver and biliary tract cancer, ovarian cancer, etc.). The diagnosis mainly depends on clinical manifestations and histological methods, and the treatment measures are mainly the treatment of the primary disease.

Thyroid tumor expert opinion

Thyroid disease, especially thyroid cancer, is on the rise and requires great attention. Thyroid surgery is prone to surgical complications such as hoarseness and low calcium. The scope of surgical resection should be judged according to the patient's condition and medical technical conditions. It must comply with the principle of tumor resection, and try to retain the nerve and other functions to improve the quality of life . Improving surgical skills and comprehensive treatment are the efforts to improve the efficacy. For those who have scars and have special cosmetic requirements, thyroid surgery without neck scars under laparoscopy is also feasible.