核医学检测在亚急性甲状腺炎中的应用价值

目的 :探讨亚急性甲状腺炎 (亚甲炎 )的核医学检查方法的临床意义。方法 :对 3 8例初诊亚甲炎患者 ,按先后顺序进行游离三碘甲状腺原氨酸 (FT3) ,游离甲状腺素 (FT4 ) ,甲状腺吸碘率 (ARIU) ,99mTc甲状腺平面显像。结果 :3 8例亚甲炎初诊时甲状腺双叶肿大 2 7例 ( 71 0 5 % ) ,单叶肿大 10例 ( 2 6 3 2 % ) ,双叶不显像 17例 ( 4 4 74% ) ,双叶稀疏 9例 ( 2 3 68% ) ,双叶局部稀疏 5例( 13 16% ) ,单叶不显像 5例 ( 13 16% ) ,ARIU <10 %者 3 3例 ( 86 84% ) ,10～ 2 0 %者 2例 ( 10 5 3 % ) ,FT3、FT4 增高 2 7例( 71 0 5 % ) ,正常 9例 ( 2 3 68% )。99mTc甲状腺显像结果与ARIU有良好的相关关系 ,与FT3、FT4 水平增高之间有良好的负相关关系 ,ARIU与FT3、FT4 之间有良好的负相关关系。结论 :对初诊的可疑亚甲炎病人的确诊指标是首选99mTc甲状腺显像或ARIU ,同时测定血清FT3、FT4 。     

摄99mTc率在甲状腺疾病中的临床应用价值

目的评价摄99mTc率在甲状腺疾病中的应用价值。方法对67例正常人和188例不同甲状腺疾病患者行甲状腺显像,比较各疾病组与正常组甲状腺摄99mTc率,分析摄99mTc率与甲状腺功能的关系。结果①Graves病组、单纯性甲状腺肿大组甲状腺摄99mTc率显著高于正常组(P=0.000,0.038),甲状腺功能减退组、亚急性甲状腺炎组摄99mTc率显著低于正常组(P=0.000)。Graves病患者功能与摄99mTc率呈一致性增高,亚甲炎患者功能与摄99mTc率呈“分离现象”。②摄99mTc率高低与甲状腺功能强弱呈中等程度一致性(Kappa值=0.618,P=0.000),二者不存在一一对应关系。③摄99mTc率在区别Graves病与正常人、亚甲炎的诊断以及Graves病与亚甲炎的鉴别诊断方面具有较高的准确性。结论摄99mTc率在Graves病、亚甲炎的诊断与鉴别诊断中具有重要价值。     

核医学检查对亚急性甲状腺炎的早期诊断价值

目的 探讨核医学检查对亚急性甲状腺炎(简称亚甲炎)的早期诊断价值。方法 用放免法(RIA)对235例早期亚甲炎病人进行血清T_3、T_4、促甲状腺激素(TSH)、甲状腺球蛋白抗体(TGAb)、过氧化物酶抗体(TPOAb)检测,同时进行甲状腺吸~(131)Ⅰ率(RAIU)测定,并与健康对照组和甲亢组(Graves’病)病人进行对比分析。结果 早期亚甲炎组血清T_3和T_4值均高于正常对照组(P<0.01),与甲亢组差异均无显著性(P<0.05);甲亢组RAIU 2 h、6 h、24 h均高于对照组(P<0.01),而亚甲炎组2 h、6 h、24 h却明显低于对照组和甲亢组(P<0.01),与血清T_3、T_4呈分离现象。结论 血清T_3、T_4值高,而甲状腺吸~(131)Ⅰ率降低呈分离现象是亚甲炎早期诊断特异性指标。     

甲状腺血流和静态显像对亚急性甲状腺炎的诊断价值

亚急性甲状腺炎(简称亚甲炎)是临床上常见的甲状腺疾病,对典型亚甲炎的诊断和治疗后随访主要根据病史、甲状腺吸碘试验和血清激素浓度测定等。然而对于部分病人尤其是单侧或局灶性病变及仅以结节为主要表现者,上述指标却不能准确反映病情改变及甲状腺受累情况,甲状腺血流和静态显像相结合有助于诊断该病。我们对经我院病理科细针抽吸细胞学检查确诊的118例亚甲炎患者进行了99mTc甲状腺血流和静态显像,现将结果报道如下。     

无痛亚性甲状腺炎、Graves′病、激素合成不足性甲肿的核医学特征

目的：探讨无痛性亚急性甲状腺炎（PST）,Gravea'病（GD),激素合成不足性甲状腺肿（HIG)核医特征,方法：用IMMULITE法测定正常对照组,PST,GD和HIG患清TT3,TT4,TSH,并进行甲状腺^99mTcO^-4,平面显像,用感兴越区分析法计算甲状腺与三对唾液腺的放射性比,结果：PST患TT3,TT4升高,TSH降低,摄^99mTc功能降低,GD患TT3,TT4升高,TSH降低,摄^99mTc功能增高,HIG患TT3,TT4降低,TSH增高,摄^99mTc功能增高,结论：TT3,TT4,TSH激素水平与摄^99mTc功能的不同分离现象是鉴别诊断PST,GD和HIG的核医学特征。     

亚急性甲状腺炎并发甲状腺脓肿1例报告

1　病历简介女 ,2 6岁。因感冒 1周后出现左颈部疼痛、增粗 ,疼痛向左颈部放射 ,伴有发热。体检 :左侧甲状腺 度肿大 ,压痛明显 ,B超示左侧甲状腺肿大、无液平 ,第 1小时末血沉5 8m m/ h。诊断为“亚急性甲状腺炎”(简称亚甲炎 ) ,予以强的松治疗 3个月后甲状腺缩小 ,疼痛消失后停用。 10个月后再次因感冒出现上述症状。体检 :左侧甲状腺 度肿大 ,压痛明显 ,第 1小时末血沉 2 6 m m/ h,血清游离 T3(FT3) 4 pmol/ L,游离 T4 (FT4 ) 7pmol/ L ,促甲状腺激素 (TSH ) 3m U / L ,甲状腺球蛋白抗体 (TGA) 1% ,甲状腺微粒体抗体 (TMA ) 2…     

^99mTcO4-动态显像对亚急性甲状腺炎临床诊断价值

目的探讨甲状腺^99mTcO4-动态显像对亚急性甲状腺炎（亚甲炎）的临床诊断价值。方法对37例经临床证实的亚甲炎病人行^99mTcO4-动态显像,根据就诊时血清FT3、FT4水平分为甲状腺功能亢进（甲亢）期组（25例）和甲状腺功能减退（甲减）期组（12例）;依显像后甲状腺单叶或双叶显像异常分为单叶显像异常组（11例）和双叶显像异常组（26例）,分别对其动态显像中的血流相、血池相和延迟相结果进行分析。结果 11例单叶显像异常和26例双叶显像异常的亚甲炎病人血流相、血池相和延迟相显像结果差异无统计学意义（P〉0.05）;25例甲亢期和12例甲减期亚甲炎病人血流相、血池相和延迟相显像结果差异有显著性（P=0.00～0.03）,甲亢期甲状腺血流灌注相多表现为血流灌注增强（13/25）,血池丰富（17/25）;延迟相甲状腺轮廓不清、放射性分布明显稀疏（18/25）。甲减期动态显像多表现为血流灌注减低（7/12）,血池减少（9/12）;延迟相甲状腺隐约显影、局部明显稀疏、缺损（9/12）。结论 ^99mTcO4-动态显像不仅能反映亚甲炎病人的甲状腺血流灌注情况,还可判断甲状腺受累的程度和范围及功能变化,有助于亚甲炎的临床诊断。     

^131I治疗甲亢致永久性甲低与TGA、TMA的关系

对我院甲亢^131I治疗后永久性甲低80例治疗前的甲状腺球蛋白抗体(TGA)、甲状腺微粒体抗体(TMA)测定结果进行回顾性分析，并与同期行^131I治疗后未发生永久性甲低的甲亢100例作为对照，旨在探讨TGA、TMA与甲亢^131I治疗后永久性甲低的关系如下。     

甲状腺外伤出血误诊为肿瘤1例

患者男,13岁。主诉,颈部疼痛1天余,否认外伤。查体:甲状腺右叶Ⅱ度肿大,压痛。超声所见:甲状腺右叶下极有一2 3cm×3 5cm×4 3cm混合性肿块。99mTcO4甲状腺功能显像:甲状腺右叶下极见一约3 0cm×2 3cm的放射性分布减低区,甲状腺摄锝功能正常。次日行99mTc MIBI肿瘤阳性显像:甲功显像所示的减低区没有明显填充。半个月后B超复查,患者重诉病史:患病前颈部撞到课桌上,后来颈部肿大,疼痛。B超提示混合性囊性肿块,结合病史,考虑为甲状腺外伤血肿。经治疗,病人很快康复。　　讨论　甲状腺放射性核素显像可显示甲状腺肿块及其位置、大小。…     

甲状腺外伤出血误诊为肿瘤1例

患者,男,13岁。主诉,颈部疼痛1天余,否认外伤。查体:甲状腺右叶Ⅱ度肿大,压痛。超声所见:甲状腺右叶下极有一2 3cm×3 5cm×4 3cm混合性肿块。99mTcO4甲状腺功能显像:甲状腺右叶下极见一约3 0cm×2 3cm的放射性分布减低区,甲状腺摄锝功能正常。次日行99mTc MIBI肿瘤阳性显像:甲功显像所示的减低区没有明显填充。半个月后B超复查,患者重诉病史:患病前颈部撞到课桌上,后来颈部肿大,疼痛。B超提示混合性囊性肿块,结合病史,考虑为甲状腺外伤血肿。经治疗,病人很快康复。　　讨论　甲状腺放射性核素显像可显示甲状腺肿块及其位置、大小。…     

Differential diagnosis of transient destructive thyroiditis from hyperthyroid Graves' disease]

It is clearly important to distinguish transient destructive thyroiditis such as subacute thyroiditis and silent thyroiditis from hyperthyroid Graves' disease to treat patients with thyrotoxicosis appropriately. In patients with hyperthyroid Graves' disease, TSH receptor antibody (TRAb) is positive and thyroidal radioactive iodide uptake (RAIU) is markedly elevated. In contrast, TRAb is negative and RAIU is suppressed less than 5% in patients with transient thyroiditis. Further, we demonstrated that the measurement of erythrocyte zinc concentration is quite useful to distinguish transient thyroiditis from hyperthyroid Graves' disease. Thus, combination of the measurement of TRAb, RAIU and erythrocyte zinc concentration helps us distinguish transient thyroiditis from hyperthyroid Graves' disease.     

38例亚急性甲状腺炎结节外科诊治和病理分析

目的探讨提高外科对亚急性甲状腺炎结节的诊治水平。方法复习38例亚甲炎的临床诊治和病理资料,重新阅读临床和病理切片、确诊,并对2例合并甲状腺乳头状微小癌加作免疫组化标记,并参考文献进行分析。结果男3例,女35例,30~60岁28例（73.68%）,病程2 d~2年8个月。均以主诉甲状腺肿物/结节而就诊。28例单纯亚甲炎者无（或未记录）临床表现;10例亚甲炎合并结甲肿者均出现过颈前疼痛/压痛、咽喉疼痛、甲亢症状,以及发热、呛咳等。术前临床诊断:亚甲炎症1例（2.63%）,疑甲癌2例,甲瘤6例,结甲肿11例,甲状腺肿物18例;术中冰冻诊断:亚甲炎38例（准确率100%）,其中10例亚甲炎+结甲肿（含2例伴微小乳头状癌）;病理诊断:亚甲炎28例（73.68%）;亚甲炎+结甲肿8例（21.05%）;甲状腺乳头状微小癌+亚甲炎+结甲肿2例（约5.26%）。治疗:38例均行病变甲状腺组织切除术,10例术后适当加用药物治疗,愈后良好。术后有33例随访1年2个月~9年6个月,其中:28例单/双侧亚甲炎者,正常生活、工作,5例双侧亚甲炎+结甲肿者,出现甲功低下需长期服药维持。结论亚甲炎缓解/恢复期患者,多因甲状腺肿物/结节于外科就诊,易误诊误治。术中进行冰冻切片诊断,对掌控手术切除病变组织范围,避免过治疗,极为重要,且可使治疗取得良好疗效      

Thyroiditis: differential diagnosis and management

Thyroiditis is a group of inflammatory thyroid disorders. Patients with chronic lymphocytic thyroiditis (also referred to as Hashimoto's thyroiditis) present with hypothyroidism, goiter, or both. Measurement of serum thyroid autoantibodies and thyroglobulin confirms the diagnosis. Subacute granulomatous thyroiditis (sometimes referred to as de Quervain's disease) is a self-limited but painful disorder of the thyroid. Physical examination, elevated erythrocyte sedimentation rate, elevated thyroglobulin level and depressed radioactive iodine uptake (RAIU) confirm the diagnosis. Subacute lymphocytic thyroiditis (silent thyroiditis) is considered autoimmune in origin and commonly occurs in the postpartum period. Symptoms of hyperthyroidism and depressed RAIU predominate. Acute (suppurative) thyroiditis is a rare, infectious thyroid disorder caused by bacteria and other microbes. The rare, invasive fibrous thyroiditis (Riedel's thyroiditis) presents with a slowly enlarging anterior neck mass that is sometimes confused with a malignancy.     

Thyroid diseases in reproductive-age women living in Shoria mountains

AIM: To analyze prevalence and structure of thyroid pathology in women of reproductive age living in Shoria mountains. MATERIAL AND METHODS: The examination of 409 women aged 18 to 40 living in mountain Shoria included assessment of social status, heredity, actual nutrition, visit to endocrinologist, ultrasound investigation of the thyroid, tests for thyroid hormones (TTH, T3, T4) in the serum, antibodies to microsomal fractions, iodine concentrations in the morning urine. RESULTS: Significant prevalence of thyroid diseases (62.3%), high rate of diffuse nontoxic goiter of the second degree (18.0%), nodular nontoxic goiter (11.8%), autoimmune thyroiditis (6.3%), hypothyroidism (5.5%), low median of iodine excretion with urine in women refer mountain Shoria to the zone of goiter endemia. CONCLUSION: Among migrants thyroid morbidity is significantly higher than among the native population. Eradication of goiter endemia will promote reproductive health in this region.     

Radioiodine imaging in the primary care of thyroid disease

There are few indications for ordering a RAIU or a thyroid scan in a primary care setting. In suspected hyperthyroidism, a sensitive thyrotropin assay should be the initial test ordered. If the thyrotropin level is low or suppressed, and the diagnosis of thyroiditis vs Graves' hyperthyroidism is not clear, a RAIU test is appropriate. In the case of a euthyroid nodular goiter, fine-needle aspiration is the most accurate initial test to evaluate for malignancy. The primary indication for a scan in the case of a euthyroid nodular goiter is a low or suppressed thyrotropin level, because malignancy is rare in a hot nodule. If thyroid cancer or congenital hypothyroidism is encountered, referral to an endocrinologist is probably the most expedient and cost-effective way to proceed.     

声辐射力脉冲成像声触诊组织定量技术在诊断弥漫性甲状腺疾病中的应用

目的探讨声辐射力脉冲成像(ARFI)声触诊组织定量(VTQ)技术在诊断弥漫性甲状腺疾病中的应用价值.方法应用ARFI弹性成像VTQ技术定量检测44例弥漫性甲状腺疾病组(包括Graves病组11例、桥本甲状腺炎组7例和亚急性甲状腺炎组26例)和15名正常人的甲状腺组织(健康对照组)硬度,以横向剪切波速度(SWV)表示,并将弥漫性甲状腺病变与正常甲状腺组织的SWV进行比较.结果健康对照组正常人的SWV平均值为(1.8±0.5)m/s(1.1~2.7 m/s),Graves病组患者的SWV平均值为(2.2±0.5)m/s(1.2~2.9 m/s),桥本甲状腺炎组患者的SWV平均值为(2.4±0.8)m/s (1.2~4.6 m/s),亚急性甲状腺炎组患者的SWV平均值为(4.9±2.8)m/s(2.8~9.0 m/s),弥漫性甲状腺疾病各组与健康对照组SWV平均值比较差异均有统计学意义(t=-2.092、-2.825、-2.967, P均<0.05).弥漫性甲状腺疾病各组之间SWV平均值比较,亚急性甲状腺炎组与Graves病组和桥本甲状腺炎组比较差异均有统计学意义(t=2.76、2.55,P均<0.05),Graves病组与桥本甲状腺炎组比较差异无统计学意义(t=0.21,P>0.05).结论 ARFI弹性成像VTQ技术能定量反映弥漫性甲状腺疾病的弹性特征,能对弥漫性甲状腺疾病尤其对亚急性甲状腺炎的诊断提供帮助.     

B超诊断弥漫性甲状腺肿的临床意义

本文对单纯性甲状腺肿、毒性弥漫性甲状腺肿、亚急性甲状腺炎和桥本甲状腺炎引起的112例弥漫性甲状腺肿的B超显像、临床表现和实验室检查结果进行了综合分析。研究结果表现,B超结合临床及实验室检查对弥漫性甲状腺肿有鉴别诊断价值。     

高频超声诊断结节性甲状腺肿

目的 探讨结节性甲状腺肿及合并症声像图的特征。方法 对576例结节性甲状腺肿的病人进行手术前后对照分析。结果 本组576例结节性甲状腺肿声像图、病理结果提示：单纯结节性甲状腺肿516例，结节性甲状腺肿合并桥本氏甲状腺炎28例，结节性甲状腺肿合并甲亢5例，结节性甲状腺肿合并乳头状瘤、癌16例，结节性甲状腺合并亚甲炎11例。结论 用高频超声诊断结节性甲状腺肿可靠性强，但要观察合并症的表现。     

Thyroiditis. Acute, subacute, and chronic

Inflammatory diseases of the thyroid are collectively the commonest thyroid disorder. Individually, they range from the rare case of acute bacterial thyroiditis to the other end of the spectrum, the even rarer Riedel's thyroiditis. Relatively common thyroid inflammatory diseases include the subacute thyroiditis syndromes. Of particular interest to endocrinologists is that both subacute granulomatous (painful) thyroiditis and subacute lymphocytic (painless) thyroiditis are very similar in terms of clinical course, although most likely have different etiologies. Nevertheless, their similarities suggest the possibility that there may be etiologic heterogeneity for the syndromes. From a clinical standpoint, it is essential to differentiate subacute painless thyroiditis from Graves' disease, because these two disorders also may mimic each other, yet only Graves' disease requires specific therapy. Chronic lymphocytic (Hashimoto's) thyroiditis, the commonest of the thyroiditides, presents with goiter and either hyperthyroidism (uncommon), hypothyroidism (common), or euthyroidism (most common). When L-T4 therapy is used in the treatment of Hashimoto's thyroiditis, the physician must be alert to the possibility of excess thyroid hormone administration. Sensitive TSH measurements help to avoid this therapeutic pitfall.