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ϴ ξ(papillary thyroid carcinoma, PTC), (follicular thyroid carcinoma,FTC,Hurthle cell carcinoma Ե) ̺ȭ, C ϴ (medullary thyroid carcinoma,MTC) ְ, ξϰ ȭ ĪѴ. κ ȭ ȣ ӻ ϱ ȯڸ Ƚ ѵ ̷ ȣ ȯڿ Ǵ ƴϴ. ȭ ȯ ġ ǥ ȯ ּȭϸ鼭 ġ ۿ ÿ ּȭϴ ̴. |
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˻? |
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1.ξ
ξ ܸ λ Ǵ ̸ κ Ǹ ϰ ħ ȴ. 25% 縦 ̼ħμ˻ 缺 εDZ Ѵ. ˻翡 ξ ϰ ûϴ Ư ȭ (ground glass) , ٱ(grooving),ٳü(intranuclear inclusion body) ü(psammoma body) θ 迭 ձ ȸȭ DZ Ѵ. ξ ũ Ŀ 1cm Ǵ 1.5cm ̼() İ ȣϴ.
1)
ξ Ǵ ݵ ̸ Ѵ. 50% ȯڿ ̰ ݵǴ ˷ ̰ ̼ ̸ ϰ ϴ 85% ִ. ũⰡ 5mm ũⰡ Ѵ. Ұ Ǹ ħϴ Ұ Ư İ ڴ.
2)
ξ ȯ 5% Ͽ ̰ ߰ߵǸ, ȯ Ⱓ 20~30 ߰ 5% ȯڿ ̰ ϴ ˷ ִ. δ 50%, 25%, ̰ 15%, ٹ ̴ 12% ̴. ̰ ִ 5 50~70%, 10 30~50%̸, ̴ İ ҷؼ 5 10 ̸ ִ ȯں 10~20% .
3)̼ ξ ξ 1cm ̼ ξ̶ θ ˻ ߰ߵ Ƿ ˻ 쿬 ߰ߵ ˻縦 Ͽ ܵǰ Ǹ Ĵ ſ ȣϴ. Ϻ ȯڿ ٹ ̸ ̰ 幰 , ̰ 幰 ݵDZ Ѵ.
2.
ħ ϴ Ư¡ . ξϰ 幰, κ ̸, Ǹ ѷο ִ.
Minimally invasive FTC Ǹ ħϳ , ħ Ұ 쿡 ܵȴ.
1) ξϿ ̰ 20% 幰, ̴ ̸ Ͽ ַ Ÿ.
2)
ξϰ ̰ Ͽ δ , , ̰, Ұ 缺 븦 ϴ ִ. ̸ ȯ ξ 2 ̸, 쵵 ̸ ̴ ִ. Ϲ ũⰡ 3cm ̻ Ư ϰ Ѵ.
3)Hurthle
Hurthle ũ Ǵµ, ̴ ܵ帮ư ̿ oxiphilic, Ǵ Askanazy Ҹ. Hurthle 75% ̻ Hurthle ϸ, ϴ Ϻ İ ҷ ˷ ִ.
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ȭ ӻ |
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۵ȴ. κ ߰ϰ Ǹ, Ϸ Ǿ ǰ ϰ DZ Ѵ.
ȭ Ϻδ ϴµ κ ξ̴. ξ 5% ü 켺 ϴ ξ̴.
̱ ü 10% Ͽ 幰, 밡 ߺ . ΰ 缱 ߺ 쿬 ߰ߵǴ 쵵 ξϿ پ .
ٸ ϰ Ǵµ, Ư . ϸ ȯ 8.7% 쿬 ߰ߵȴ. ̴ κ ȣ ȴ. ̴ , Ÿ. ̵ȴ. ٹ ̸ ̴ ̺ ȣ Ͽ ߵ ų ִ. |
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ȭ ġ |
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ȭ ʱġ , 缺 , ȣ μ TSH ٰ ̷ ġ ٽ̴.
ȭ ʱġ
(1) ſ Ǹ ̵ Ҹ ϴ
(2) ġ õ ȯ ּȭϴ
(3) Ȯ
(4) 缺 ġḦ ϰ ϱ
(5)߿ (6) ߰ ּȭ
1.( )
1)
(1)
(2) Ǵ
(3)ϰ(completion thyroidectomy)
2)
3) պ պ ΰ ȸĵνŰ ջ̸, Ŀ Ѵ. ΰ Ͻ ϴ 5% ̳ Ҿƿ ϸ, ϰ Ÿ ð 鼭 ȸ ִ. ΰ ȸĵ Ű ջ 3% 2.6% ˷ õ ־ õ ܰ 쿡 ִ.
2.缺 ġ
ȭ ȯڿ 缺 ġ ߰ ҽŰ ȿ ִ ˷ ֱ ߿ ġ ϳ ̿ǰ ִ.
̻ ǽ 쿡 缺 ܿ 缺 ı ų ʿ䰡 ִ. δ
ù°, ξ 20~45% ߽ɼ ϹǷ ܿ DZ ̸
°, ܿ ۷κ ǹǷ ǥڷμ Ư̼ ɼ ְ °, ܿ ̾ 缺 븦 Ͽ ܿ DZ
3.ȣ
ϴ ڷδ ŷеǰ TSH ģ. TSH TSH ü ļ ȿ Ÿµ ξ TSH ü ִ. ȯڿ ȣ ߴϿ û TSH ϸ ϰ ڶ ȴ. ȣ ܿ ߷ Ư ̺꽺 ڱü ڱϿ ӻ ҷ ˷ ִ.
꼱 ȭ 뷮 ̻ 뷮 ȣ Ͽ μ TSH ϸ ߷ ҽŲ.
TSH ġ ۿδ ߵ ͵ ȯ ȭ, ɹ漼 , ٰ ִ.
TSH 1mU/L ̻ 0.05mU/L Ϸ Ǿ Ⱓ , ٺ м TSH ڿ. ǰǰ մ TSH ǥ ܿ Ҹ ִ ȯڿ û TSH Ư ݱ 0.1mU/L ̸ ϰ ӻ ߰ߵ 豺 5~10 0.1~0.5mU/L ̷ Ѵ. Ư 豺 쿡 TSH 0.3~2.0mU/L ϵ Ѵ.
4. ġ
ȭ ȯ ġ( 缺 ġ) ϴ ġ ȯڿ ߿θ Ȯϰ ãƳ ̴.
1) 迡 ȯ з
赵 ȯ з з ؿ .
豺; Ǵ ̰ , Ұ ŵǾ, ħ , ĸ (Űū , , ν) ƴϸ, 缺 ܿ(remnant ablation) Ŀ ù ° ġ Žĵ(post-therapeutic whole body scan, RxWBS) (thyroid bed)ܿ 밡 Ѵ.
߰豺; ˻翡 ̰ ħ Ұ ְų, ̰ų, ħ Ұ ִ 츦 Ѵ.
豺; ħϿų, Ͽų, ̰ ִ ù ° RxWBS ̿ 밡 ִ 츦 Ѵ.
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