原发性甲状腺功能亢进症合并甲状腺癌15例临床分析

目的探讨原发性甲状腺功能亢进症(简称甲亢)合并甲状腺癌的临床关系及诊断与治疗。方法回顾性分析我院1998年1月至2008年12月期间手术治疗的15例原发性甲亢合并甲状腺癌的临床资料,结合文献进行分析。结果本组15例均顺利恢复出院,原发性甲亢合并甲状腺癌发病率为2.56%(15/585),5例发生甲状腺结节;15例均施行了手术治疗,术后均无手术并发症发生;均获得随访,随访时间为9个月～10年,平均5.5年,均未发现甲亢或甲状腺癌复发或转移病例。结论原发性甲亢合并甲状腺癌术前诊断困难,多数靠术后病理诊断,合理的手术治疗效果较好,预后良好。     

甲状腺功能亢进合并甲状腺癌的诊断和外科治疗

目的 探讨甲状腺功能亢进合并甲状腺癌的诊断及治疗方法.方法 回顾性分析北京协和医院从1983年1月至2009年7月收治的并经外科手术治疗和病理证实的48例甲状腺功能亢进合并甲状腺癌患者的临床资料.结果 甲状腺功能亢进合并甲状腺癌患者占同期甲状腺功能亢进手术患者的2.02%(48/2378),占同期甲状腺癌手术患者的3.03%(48/1584).手术方式包括双侧甲状腺大部切除术(31例)、患侧全切对侧大部切除和区域性淋巴结清扫术(6例)、双侧全切及淋巴结清扫术(11例).术前超声诊断阳性率为61.3%,甲状腺核素显像的诊断阳性率为62.5%;48例患者中获随访40例,时间1～264个月,中位随访时间130.5个月.随访中无甲状腺功能亢进复发病例,2例患者术后第二年出现肺、骨转移.结论 超声检查和核素显像对于术前诊断有重要意义,甲状腺功能亢进合并甲状腺隐匿癌和微小癌的临床诊断较困难,多于手术后病理诊断.甲状腺功能亢进合并甲状腺乳头状癌的患者手术治疗效果良好,预后较好.     

Differentiated thyroid carcinoma and hyperthyroidism: a frequent association?

The relationship between hyperthyroidism and thyroid carcinoma remains controversial. In hyperthyroid patients the incidence of thyroid cancer varies considerably from 0.1% to 21%. We analyzed the frequency of coexisting hyperthyroidism and thyroid malignancy in our experience. From September 2002 to June 2004, 450 patients were submitted to total thyroidectomy in our surgical department. Hyperthyroidism was observed in 71 cases and thyroid carcinoma in 110 (107 differentiated). The association of hyperthyroidism and thyroid cancer was observed in 15 patients (14% of differentiated carcinomas and 21.1% of hyperthyroid patients). All patients were submitted to total thyroidectomy and are alive and disease-free. Seven cases of transitory hypoparathyroidism were observed (46.6%). There was no other morbidity. The association of thyroid cancer and hyperthyroidism is by no means rare. Careful exami- nation of hyperthyroid patients is always necessary to exclude the presence of carcinoma. These results confirm that the operation should be total thyroidectomy when surgery is performed in patients with hyperthyroidism.     

Synchronous occurrence of neoplasias of the thyroid gland and hyperthyroid nodular struma in an endemic area

The simultaneous occurrence of hyperthyroidism and differentiated carcinoma of the thyroid gland is more frequent than previously assumed. In our endemic goiter region 16.5% of patients with thyroid carcinoma have hyperthyroidism and 1.8% of patients with hyperthyroidism have a thyroid carcinoma. The tumors are predominantly located in autonomous adenomas but are also found in cold nodules. Not only scintigraphically cold nodules but also warm and hot nodules must be suspected of malignancy. Consistent preoperative cytodiagnosis of all goiter nodules, including hot nodules, is therefore recommended. Surgical treatment of toxic multi-nodular goiters should be considered more often.     

甲状腺功能亢进症并发甲状腺癌12例的临床分析

目的 探讨甲状腺功能亢进症（甲亢）并发甲状腺癌患者诊治方法。方法 对1994－2000年收治的300例甲亢病例中同时并发甲状腺癌的12例患者行手术治疗及病理学检查，并对2种疾病临床资料及诊治经验进行分析。结果 本组甲亢与甲状腺癌的并存率为4％（12／300），术前确诊率为3％（1／300）。对12例甲状腺癌患者均行双侧甲状腺大部切除，其中7例再补切患侧残余腺体，2例行功能性颈淋巴结清扫术。术后随访9个月至6年，均无甲状腺癌复发。结论 甲亢并发甲状腺癌可能与免疫缺陷和内分泌功能失调有关。甲亢患者并发甲状腺结节者应常规作冰冻切片检查。     

76例乳腺癌并发甲状腺功能亢进的围手术期治疗

目的 探讨并发甲状腺功能亢进(甲亢)的乳腺癌的围手术期处理,探讨甲亢和乳腺癌的关系.方法 对26年间76例并发甲亢的乳腺癌围手术期内甲亢的处理进行回顾性分析.结果 73例无甲亢相关并发症,3例出现甲状腺危象和甲状腺危象类似症状,全组无手术死亡.结论 并发甲亢的乳腺癌手术期前,若甲亢症状明显,应首先行甲亢手术,待基础代谢率正常后才行乳腺癌手术;若无甲亢症状,在控制心率的前提下可直接行乳腺癌手术.     

甲状腺功能亢进症伴甲状腺癌的诊断与外科治疗

目的 探讨甲状腺功能亢进合并甲状腺癌的诊断及治疗方法.方法 对1999年1月至2010年9月手术治疗的43例甲状腺功能亢进合并甲状腺癌患者的临床资料进行回顾性分析.结果 43例患者术前超声检查40例,提示甲状腺癌29例(72.5%).手术方式包括双侧甲状腺次全切除术5例、患侧全切对侧大部切除和区域性淋巴结清扫术25例、双侧全切及淋巴结清扫术11例,患侧腺叶+峡部切除术2例.术后病理报告甲状腺乳头状癌38例,滤泡状癌5例.术后暂时性低钙血症3例,饮水呛咳1例,无声音嘶哑和大出血,无再手术和死亡病例.39例获得随访,随访时间2～110个月,中位随访时间45个月,无甲状腺癌及甲状腺功能亢进复发.结论 超声检查有助于术前发现甲状腺功能亢进合并甲状腺癌.甲状腺功能亢进合并甲状腺乳头状癌的患者手术治疗效果良好,预后较好.     

原发性甲状腺功能亢进合并甲状腺癌的诊治

目的探讨原发性甲状腺功能亢进合并甲状腺癌的诊治方法及效果。方法原发性甲亢合并甲状腺癌15例,占同期手术治疗的原发性甲亢病例的4.1%(15/366)。术前经B超及细针穿刺细胞学检查确诊4例。行甲状腺全切术3例(其中1例合并颈部淋巴结肿大,行颈部淋巴结清扫术),另1例行患侧腺体+峡部切除并对侧腺体大部分切除。9例术中快速冰冻切片确诊,为甲亢并甲状腺微小癌,均行患侧腺体+峡部切除并对侧腺体大部分切除。2例仅行双侧甲状腺次全切除但术后病理发现癌变的患者,1例因是髓样癌在5 d内再次行患侧残留腺体切除术,另1例因是乳头状微小癌而未再行手术。结果随访12例,时间平均为5.3(1个月~14年),其中1例术后病理证实为滤泡状癌者术后1年内复发,再次行甲状腺全切除+颈部淋巴结清扫术,并加行放疗,目前仍存活,其余患者均无复发,存活至今。结论对某些特殊类型的甲亢患者应警惕癌变的可能,尽量在术前、术中确诊。甲亢合并的甲状腺癌预后较好,手术多以患侧全切+对侧次全切为主。     

原发性甲状腺功能亢进症合并甲状腺癌临床分析

目的 探讨原发性甲状腺功能亢进症(甲亢)合并甲状腺癌(甲癌)的诊治方法。方法 对1993年7月至2002年3月11例原发性甲亢合并甲癌临床资料进行回顾性分析。结果 发病率1．6％。术前术中甲癌漏诊率81．8％。2例首次手术为甲状腺—侧腺叶全切加峡部切除加对侧腺叶次全切除，9例首次手术为甲状腺次全切除术。术后病理均为原发性甲亢合并甲癌，滤泡状腺癌5例，乳头状腺癌4例，混合癌2例，无颈淋巴结转移。7例行二次手术，3例有甲状腺残癌，残癌率42．9％。所有病例术后均长期给予甲状腺素片治疗。10例生存良好，1例死亡。结论 原发性甲亢合并甲癌易漏诊，发现甲状腺结节应警惕合并甲癌可能性。合理的手术治疗，术后服用甲状腺素片，疗效较好。     

原发性甲状腺功能亢进症并发甲状腺癌分析

目的：探讨原发性甲状腺功能亢进症并发甲状腺癌患者诊治方法。方法对46例原发性甲状腺功能亢进症并发甲状腺癌患者行全甲状腺切除术。结果两种疾病的并存率为5．7％（46／810）。术前确诊率为10．8％（5／46）。对46例患者均行手术治疗,其中25例术中经快速冰冻切片病理学检查明确诊断,行全甲状腺切除术;21例术后病理学检查明确诊断,再次手术切除残余甲状腺。7例行颈淋巴结清扫术。术后随访6个月～10年无复发。结论原发性甲状腺功能亢进症患者需排除并发甲状腺癌可能,全甲状腺切除术治疗原发性甲状腺功能亢进症并发甲状腺癌效果良好。     

原发性甲状腺功能亢进症合并甲状腺癌的诊断与治疗：附31例报告

目的：探讨甲状腺功能亢进症（甲亢）合并甲状腺癌（甲癌）的临床病理特点。 方法：回顾性分析吉林大学第一医院甲状腺外科2010年1月—2013年8月收治的甲亢合并甲癌患者临床资料,并结合文献比较。 结果：手术治疗甲亢患者85例,其中31例（36.5%）合并甲癌。术前结合临床表现和颈部超声结果甲亢合并甲癌确诊率80.6%（25/31）。31例患者待甲亢症状得到控制、甲状腺功能经检查恢复正常后行手术治疗,并根据具体情况选择术式,术后均顺利出院,未发生永久性医源性喉返神经损伤及甲状旁腺功能减退。经术后病理证实,1例为髓样癌,30例为甲状腺乳头状癌;17例（54.8%）侵及被膜者,9例（29.1%）中央区淋巴结转移,各项病理特点与文献报道的单纯甲癌比较,差异均无统计学意义（均P>0.05）。 结论：甲亢伴甲癌发病率有增高趋势,应强调颈部超声在该病早期诊断中的重要性,确诊后尽早行手术治疗并合理选择手术方式,预后较好。

     

并发甲亢乳腺癌的围手术期处理

目的:探讨并发甲亢乳腺癌的围于术期甲亢的处理和治疗,以及甲亢和乳腺癌的关系。方法:对21年间51例并发甲亢乳腺癌的围于术期甲亢的处理和治疗进行回顾性分析。结果:49例未出现甲亢相关并发症,仅2例出现甲状腺危象和甲状腺危象相似的临床表现,全组无手术死亡。结论:并发甲亢的乳腺癌手术前,若甲亢症状明显,应首先进行甲亢的手术治疗,待基础代谢率正常后再行乳腺癌手术;若无甲亢症状,在控制心率的前提下可直接行乳腺癌手术。     

Differentiated thyroid cancer--peculiar morphological and clinical forms

The most common clinical presentation of differentiated thyroid cancer (DTC), consisting of papillary and follicular adenocarcinoma (with their histological variants), is the solitary thyroid nodule. A review of the literature is performed in order to describe particular forms of DTC, in terms of incidence, diagnosis and treatment: occult carcinoma, carcinoma on aberrant thyroid tissue, "functional" thyroid carcinoma and familial non-medullary carcinoma. A particular interest is shown to the coexistence of malignancy with benign thyroid diseases, such as goiter, hyperthyroidism and Hashimoto's thyroiditis, as well as parathyroid adenoma. In conclusion, the authors emphasize that the association of carcinoma with benign thyroid conditions is not rare and it substantiate an aggressive approach in regard to diagnosis and treatment, increasing the indication for surgery and, moreover, for total thyroidectomy.     

A report of four cases of thyroid cancer occurring in thyrotoxicosis and review of the literature

Four cases of thyroid carcinoma occurring in 140 cases of Graves' disease are presented herein. A standard workup of the patients was done to establish hyperthyroidism and all cases of cancer were diagnosed on receipt of histopathology. There were three cases of papillary carcinoma and one case of follicular carcinoma with one cancer being encountered in the 'cold' area of the thyrotoxic gland. The incidence of malignancy in thyrotoxicosis, however, was not found to be higher than that in other thyroid disorders.     

A report of four cases of thyroid cancer occurring in thyrotoxicosis and review of the literature

Four cases of thyroid carcinoma occurring in 140 cases of Graves’ disease are presented herein. A standard workup of the patients was done to establish hyperthyroidism and all cases of cancer were diagnosed on receipt of histopathology. There were three cases of papillary carcinoma and one case of follicular carcinoma with one cancer being encountered in the ‘cold’ area of the thyrotoxic gland. The incidence of malignancy in thyrotoxicosis, however, was not found to be higher than that in other thyroid disorders.     

桥本病并存甲状腺结节外科治疗的临床分析

目的探讨桥本病并存甲状腺结节的临床特征和外科诊治经验。方法对1985年 1月至2004年12月因发现甲状腺结节行外科手术,术后经病理证实为桥本病的299例患者的临床特征进行分析。结果桥本病并存甲状腺癌52例(17．4％),甲状腺腺瘤103例(34．4％),结节性甲状腺肿17例(5．7%),甲状腺功能低下11例(3．7％),甲状腺功能亢进7例(2．3％)。1995年以前桥本病与甲状腺癌并存患者6例,占同期手术治疗的桥本病65例的9．2％;1996年以后桥本病与甲状腺癌并存患者46例,占同期手术治疗桥本病234例的19．7％(P<0．05)。并存甲状腺癌中乳头状癌 35例,滤泡状癌11例,混合性癌4例,黏膜相关淋巴瘤1例,全组中隐匿性甲状腺癌17例,占并存甲状腺癌的32．7％。手术方式由患者具体情况并结合术中冰冻结果确定,包括一侧或双侧甲状腺全切除或次全切除、部分切除或活检术。结论桥本病与甲状腺癌、甲状腺腺瘤并存率高,其发病率近年来有明显增高趋势;应警惕桥本病并存甲状腺肿瘤特别是隐匿性甲状腺癌的可能性。     

甲状腺结核的诊治--附1例报告并国内87例临床分析

目的:探讨甲状腺结核的早期诊断和治疗.方法:报告1例误诊长达7月的甲状腺结核,回顾分析国内经针刺细胞学或术后病理确诊为甲状腺结核的87例患者的临床资料.结果:15例行针刺细胞学检查,余均经手术病理确诊.术前大多数误诊为甲状腺癌、甲状腺腺瘤,少数误诊为地方性甲状腺肿、结节性甲状腺肿、甲亢等.结论:甲状腺肿块伴发热及结核史者应考虑甲状腺结核的可能,细针穿刺活检是协助诊断简便有效的方法.病灶清除及抗结核抗药物局部灌洗、正规抗痨治疗预后好.     

经乳晕入路腔镜甲状腺切除术26例报道

目的探讨经乳晕入路腔镜甲状腺切除术的可行性。方法2003年3月-2005年9月，采用经乳晕入路腔镜甲状腺切除术26例。结节位于甲状腺右叶13例，左叶10例，双侧叶结节1例，原发性甲状腺功能亢进（Ⅰ度）2例；单发结节9例，多发结节15例；囊性结节5例，实性结节13例，囊实混合性6例；结节直径1-4cm。术前诊断甲状腺腺瘤9例，结节性甲状腺肿15例，原发性甲状腺功能亢进2例，无临床诊断甲状腺癌。结果镜下手术成功25例，手术时间50-210min，平均112min，行甲状腺肿瘤摘除4例，单侧甲状腺大部分切除10例，双侧甲状腺大部分切除8例，甲状腺双叶次全切除加峡部切除3例；中转开放手术1例，为术中发现甲状腺癌并侵犯气管。病理诊断甲状腺腺瘤4例，结节性甲状腺肿18例，原发性甲状腺功能亢进2例，甲状腺癌2例。术后24—48h拔除引流管，无神经或甲状旁腺损伤等并发症。26例术后住院3—6d，平均4．2d。25例随访3～33个月，平均13个月，无局部复发，美容效果满意。2例甲状腺癌随访9、11个月，无复发转移。结论经乳晕入路腔镜甲状腺手术可行，近期效果满意，切口隐蔽。     

Long term follow-up after thyroidectomy

Surgically treated Graves' patients should be submitted to long-term follow-up in order to detect early hypothyroidism, as well as relapses of hyperthyroidism which are not exceptional. The aim of the prolonged care after thyroidectomy for non toxic goiter is to detect a recurrence of the goiter and to control the prophylactic administration of thyroid hormones which should be prescribed in most cases. The follow-up after surgery for thyroid carcinoma depends on the histology of the tumor and on the type of postsurgical treatment.     

Two cases of hyperthyroidism induced by interferon-alpha therapy for renal cell carcinoma

Autoimmune thyroid disease is the result of a common side-effect of interferon-alpha (IFN-alpha) used to treat viral hepatitis C; but there have been few reports on thyroid disorders induced by IFN-a that was used to treat renal cell carcinoma. IFN-alpha therapy was conducted on two male patients, 75 and 44 years old, after radical nephrectomy. Six and five months, respectively, after this therapy, they complained of weight loss. Laboratory evaluation revealed hyperthyroidism; the thyroid stimulating hormone (TSH) level fell below normal; and the serum free T3 and T4 levels increased above normal values. Two months after the termination of IFN-alpha therapy, their thyroid hormone levels returned to normal without the help of antithyroid agents. In observational studies, thyroid dysfunction has been reported in 0.6 to 30% of the patients who had been treated with IFN-alpha. Careful observation is necessary to watch for the possible development of thyroid disorder during IFN-alpha therapy for renal cell carcinoma.