That is patient HVN (30 years old) who went for a routine health check-up and was discovered by Dr. Nguyen Khiem Thao, Deputy Head of the Arrhythmia Department, Cardiovascular Center, Tam Anh General Hospital, Ho Chi Minh City, to have ventricular ectopic beats (a type of arrhythmia). But then, seeing that the patient's neck was abnormally swollen, the doctor felt and found many hard nodes on the left side of the neck. The patient said that a few months ago he felt hard nodes in his neck, they were painless and had no other unusual signs, so he thought it was normal and did not go to the doctor. The doctor ordered an ultrasound of the thyroid gland and neck nodes for the patient.
The results showed that the patient had a left lobe thyroid tumor measuring 29x23x35mm, with a cluster of 27 cervical lymph nodes of various sizes, the largest lymph node up to 18mm.
The doctor determined that the patient had a long-standing risk of developing thyroid cancer. The results of ultrasound-guided fine needle aspiration cytology (FNAC) of the thyroid gland confirmed papillary thyroid carcinoma with lymph node metastasis. The patient was scheduled for total thyroidectomy and neck dissection.
Before surgery, the patient is treated with medication for ventricular ectopic beats to stabilize the heart rate and avoid the risk of arrhythmia during surgery.
Doctor Hang (second from left) performs thyroidectomy and lymph node dissection for a patient.
Dr. Le Thi Ngoc Hang (Department of Cardiovascular and Thoracic Surgery) assessed this as a difficult surgery because the disease was discovered in the late stage, had metastasized to the neck lymph nodes, and was stuck close to the trachea. The patient was quite young, and needed to preserve the recurrent laryngeal nerve so as not to affect the voice.
During the surgery, the doctors dissected the recurrent laryngeal nerve, removed the entire thyroid gland, and cleared the cervical lymph nodes. There were a total of 27 lymph nodes, of which 15 were malignant.
After surgery, the patient will continue to receive radiation therapy to reduce the risk of cancer recurrence. It is expected that when the thyroid condition is stable, ablation will be performed to treat ventricular premature beats.
"The patient was fortunate to have a cardiologist who discovered the abnormality in the neck area and coordinated with other specialists to promptly handle it. If there was a delay, the cancer cells would have metastasized far away, invading important organs such as the trachea, esophagus, nerves, etc. At that time, even with surgery, there would still be many potential risks as well as reduced treatment effectiveness," said Dr. Hang.
Papillary thyroid carcinoma (also known as papillary thyroid cancer) accounts for 80-85% of all thyroid cancers. It has the best prognosis among thyroid cancers. More than 90% of patients survive more than 10 years if treated at an early stage.
Depending on the metastasis of cancer cells, patients will be assigned to have surgery to remove part or all of the thyroid gland, preventative neck lymph node dissection, then combine radiotherapy, chemotherapy, and radioactive iodine to prevent recurrence.
After thyroidectomy and radioactive iodine treatment, patients need to take thyroid hormone medication for life. Patients need to have regular check-ups so that doctors can closely monitor and detect early recurrence of tumors, lymph nodes or signs of distant metastasis.
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