首诊于耳鼻咽喉科的亚急性甲状腺炎30例报告

目的 :探讨首诊于耳鼻咽喉科的亚急性甲状腺炎患者的咽部症状以及甲状腺单光子发射型计算机断层 ( SPECT)和甲状腺细针细胞学检查 ( FN B)对亚急性甲状腺炎的诊断价值。方法 :记录 3 0例亚急性甲状腺炎患者的咽部症状 ,测定血清 T3、T4 水平 ,对患者进行甲状腺 SPECT显像 ,结合甲状腺 FNB。结果 :2 1例存在程度不同的咽痛 ,9例存在咽异感症。经 SPECT直接确诊 6例 ,SPECT结合 FNB确诊 2 2例 ,另 2例经试用泼尼松最后确诊。结论 :咽痛和咽异感症是亚急性甲状腺炎的重要症状 ,甲状腺 SPECT和 FNB对亚急性甲状腺炎的诊断具有重要价值。     

FNAC诊断甲状腺炎的临床评价

目的　评价甲状腺细针抽吸细胞学检查 (fine needleaspirationcytologyFNAC)在诊断亚急性甲状腺炎和桥本甲状腺炎中的作用。方法　对疑似甲状腺炎 12 0例采用血清T3 、T4、TSH检测加甲状腺核素扫描以及甲状腺FNAC两种方式检查 ,同时观察甲状腺针吸后的咽喉疼痛反应。结果　 12 0例甲状腺病变中 86例经FNAC确诊 ,其中亚急性甲状腺炎 4 0例、桥本甲状腺炎 4 2例、桥本甲亢 4例。甲状腺FNAC的敏感性、特异性和准确性分别为 95 .6 %、82 .6 %、92 .9%。甲状腺FNAC对甲状腺炎确诊数与同位素检查确诊数的差别有统计学意义(P <0 .0 1)。在疼痛组 4 5人和无痛组 75人中 ,针吸疼痛持续时间大于 4h的人数分别为 2 5例和 11例 ,两组针吸疼痛反应阳性人数的差别有统计学意义 (P <0 .0 1)。结论　甲状腺FNAC是诊断甲状腺炎的重要方法 ,但具有严重咽喉疼痛者不宜优先选择此法。     

颈部异位甲状腺临床分析

目的探讨颈部异位甲状腺的诊治方法,提高对颈部异位甲状腺的认识,避免误诊、误治。方法收集我院1999～2007年10例颈部异位甲状腺住院患者的临床资料,其中5例表现为舌根包块(迷走甲状腺),3例为甲状舌管囊肿(2例副甲状腺,1例迷走甲状腺),1例会厌巨大囊肿(迷走甲状腺),1例为咽旁肿块(副甲状腺)。10例患者7例经颈部彩超检查初步诊断为异位甲状腺,其中4例未探及正常的甲状腺(迷走甲状腺),3例探及正常的甲状腺(副甲状腺);3例行核素扫描初步诊断为异位甲状腺,提示核素在包块处显影,正常甲状腺部位不显影(迷走甲状腺)。结果10例患者均行手术治疗,5例全切(3例为副甲状腺,1例癌变的迷走甲状腺,1例误诊为会厌巨大囊肿的迷走甲状腺),4例次全切(迷走甲状腺),1例在行甲状舌管囊肿手术中冰冻切片证实为迷走甲状腺未作切除。随访6～12个月,除1例甲状腺癌患者和1例全切患者需终生服甲状腺素外均恢复正常,无复发。结论对颈部肿块仔细的术前检查,包括超声、CT和~(131)I扫描以及细针穿刺活检对异位甲状腺确诊至关重要,正确处理异位甲状腺,避免给患者造成严重后果。     

甲状腺结节细针穿刺细胞学检查评估

目的 探讨甲状腺细针穿刺细胞学(fine-needle aspiration,FNA)检查的临床价值.方法 回顾性分析中国医学科学院肿瘤医院2005年10月至2011年1月行甲状腺细针穿刺的474例连续病例资料.B超引导下穿刺218例(46.0％),触诊穿刺256例(54.0％).细胞学诊断结果分为六级:无法诊断、良性、不典型细胞、滤泡样肿瘤、可疑恶性及恶性.将其中157例手术患者术前细胞学诊断结果与术后组织病理学诊断结果进行比较.结果 157例手术治疗患者中91例为恶性,术前FNA诊断为无法诊断2/7、良性16.7％ (9/54)、不典型细胞3/9、滤泡样肿瘤1/3、可疑恶性83.3％( 35/42)、恶性97.6％ (41/42).甲状腺细针穿刺鉴别甲状腺结节良恶性的敏感度为85.4％,特异度为86.9％.阳性预测值90.5％.结论甲状腺细针穿刺细胞学诊断能够为甲状腺疾病提供较为准确的术前诊断.六级诊断方法有助于临床治疗方案的选择.     

核素显像鉴别颈前区包块来源的临床价值

目的:回顾分析甲状腺核素显像在颈前区包块鉴别诊断中的临床价值。方法:对69例耳鼻咽喉科门诊首诊发现颈前区来源不明包块的患者行过锝酸盐(99mTcO4-)显像,根据结果选择行99mTc-甲氧基异丁基异腈(99mTc-MIBI)肿瘤阳性显像和甲状腺灌注显像。显像结果结合随访及病理诊断结果进行分析。结果:69例中33例(47.8%)包块位于甲状腺内,36例(52.2%)包块位于甲状腺外。甲状腺包块中发现亚急性甲状腺炎12例,2例临床诊断为甲状舌管囊肿者发现为异位甲状腺;甲状腺外包块中甲状舌管囊肿27例。结论:甲状腺包块的99mTcO4-、99mTc-MIBI阳性显像及血流灌注显像对于鉴别诊断颈前区病变是否来源于甲状腺及甲状舌管囊肿与异位甲状腺的鉴别具有良好的应用价值。     

桥本甲状腺炎合并甲状腺乳头状癌外科诊治(附51例临床分析)

目的:探讨桥本甲状腺炎(HT)合并甲状腺乳头状癌(PTC)患者的临床诊断、治疗及预后。方法:回顾性分析2001-02-2008-10,经我科收治HT合并PTC患者51例临床资料。结果:28例患者术前行甲状腺相关抗体检查,甲状腺球蛋白抗体(TG-Ab)升高5例,甲状腺过氧化物酶抗体(TPO-Ab)增高15例;术前B超均发现甲状腺存在实质性肿块,发现伴有钙化灶22例,占43.14%,提示恶性者5例;3例外院行甲状腺细针穿刺细胞学检查(FNA),其中提示可疑癌细胞2例,高度怀疑恶性者1例。所有患者均行手术治疗,术后均进行随访,随访时间为8～100个月,失访2例,随访病例均未出现复发及转移发生,无瘤生存至今。结论:HT伴有甲状腺结节者应警惕恶性可能,术前结合TG-Ab、TPO-Ab、B超检查、FNA综合分析有助于HT合并PTC的诊断,手术治疗是针对HT合并PTC的有效治疗方法,其手术原则可依照PTC的治疗原则。手术治疗疗效好,预后好。     

B超等影像检查在脉络膜血管瘤诊断中的应用

目的 探讨B超等（CT和MR）影像检查对于脉络膜血管瘤的诊断价值。方法 回顾分析经临床证实的脉络膜血管瘤11例病例资料,均行B超检查,其中行CT增强扫描1例、 MR检查4例、眼底血管荧光造影2例。结果 11例B超检查呈梭形或橄榄形高回声占位,其中肿块实质均质8例,呈实质不均质占位3例; CT增强扫描示后极部球壁增厚1例,密度均匀,强化明显; MRI4例中T1WI呈等信号3例, T1WI呈高信号1例,T2WI均呈高信号,4例增强后瘤体显著强化。眼底血管荧光造影2例均显示动脉早期窦状强荧光,静脉期荧光渗漏,晚期瘤体高荧。结论 B超、增强CT和MRI对脉络膜血管瘤可作出定位的影像学诊断,B超（＋眼底血管荧光造影）在早期诊断方面有一定优势,MRI对该病的诊断及鉴别诊断较具特征性。     

甲状腺Hurthle细胞瘤11例

目的探讨甲状腺Hurthle细胞瘤的临床病理特点及诊治原则。方法对11例Hurthle细胞瘤患者资料进行回顾性分析。结果11例Hurthle腺瘤均为良性。所有患者均行术前细针穿刺细胞学检查(Fine-needle aspiration cytology,FNAC),确诊7例,确诊率为63.6％;术中冰冻切片检查11例,确诊9例,诊断准确率达81.8%。11例患者均经手术切除,随访16～80个月,无复发、死亡病例。结论术前FNAC检查结合术中冰冻检查,能提高Hurthle细胞瘤的术前、术中确诊率,有助于手术方式的选择。     

原发性甲状旁腺机能亢进症并发甲状旁腺危象的诊治

目的 探讨原发性甲状旁腺机能亢进症并发甲状旁腺危象的诊断及治疗方法.方法 回顾性分析2005年1月至2008年5月西安交通大学医学院第一附属医院收治的6例原发性甲状旁腺机能亢进症并发甲状旁腺危象患者的临床资料,均依临床表现、实验室检查确诊,术后经病理结果证实;6例均行甲状腺区B超及颈部CT扫描,3例次行99Tcm-甲氧基异丁基异腈(methoxy isobutylisonitrile,MIBI)甲状旁腺核素扫描检查进行定位诊断,5例次在积极内科治疗3～5 d后进行手术,1例次在内科治疗7 d后进行手术;术中6例均行冰冻切片检查,5例行快速甲状旁腺素测定.结果 6例患者中有5例经及时甲状旁腺探查切除手术加内科治疗后痊愈,随访1个月至3年无并发症及复发,中位随访时间19.5个月;1例并发多脏器功能衰竭而死亡.结论 经过短暂的内科治疗后及时行甲状旁腺探查切除术是抢救原发性甲状旁腺机能亢进症并发甲状旁腺危象患者的有效方法.术前明确诊断及准确定位、术中进行冰冻切片和快速甲状旁腺素测定是手术成功的有力保障.     

99mTc锝-甲氧基异丁基异睛亲肿瘤显像对甲状腺单发结节的鉴别诊断价值

目的 探讨99mTc锝-甲氧基异丁基异睛(99mTc-MIBI)亲肿瘤显像对甲状腺单发结节的诊断价值.方法 41 例甲状腺单发结节并甲状腺99mTc-高得酸盐(99mTcO4)显像示为"冷"或"凉"结节的患者,行99mTc-MIBI亲肿瘤显像.测定99mTc-MIBI亲肿瘤显像早期相(20 min)及延迟相(2 h)...     

Technetium Tc 99m sestamibi sensitivity in oxyphil cell-dominant parathyroid adenomas

OBJECTIVE: A subset of parathyroid adenomas contains a relative overabundance of oxyphil cells that are capable of greater technetium Tc 99m sestamibi tracer uptake and retention than other cell types. We examined whether the presence of oxyphil cells augments the sensitivity of technetium Tc 99m sestamibi preoperative localization and whether the histologic findings of a lesion could be predicted based on the adenoma mass and serum calcium and parathyroid hormone levels. DESIGN: Retrospective, single-blinded comparison of technetium Tc 99m sensitivity rates, lesion mass, and preoperative serum calcium and parathyroid hormone values of patients with chief and mixed cell-dominant adenomas and those with oxyphil-dominant parathyroid adenomas. SETTING: Tertiary care university hospital. PATIENTS: Sixty-three patients diagnosed as having a parathyroid adenoma. INTERVENTION: All patients underwent resection of a parathyroid adenoma following a preoperative technetium Tc 99m sestamibi localization study and serum calcium and parathyroid hormone level analysis. MAIN OUTCOME MEASURE: Technetium Tc 99m sensitivity rate. RESULTS: The overall technetium Tc 99m sestamibi sensitivity rate was 76.2%. The sensitivity within the chief and mixed cell-dominant (n = 52) and oxyphil cell-dominant groups (n = 11) were 71.2% and 100%, respectively (P = .04). There was no correlation between histologic findings of the lesion and its size or serum calcium and parathyroid hormone levels. CONCLUSIONS: Oxyphil cell predominance within an adenoma augments technetium Tc 99m sestamibi scan sensitivity in a statistically significant manner. The use of technetium Tc 99m sestamibi preoperative localization may therefore be differentially greater in patients with these types of lesions.     

舌异位甲状腺的诊治

目的　探讨舌异位甲状腺临床特点、诊断及治疗。方法　回顾性分析6例舌异位甲状腺患者临床资料,分析其临床特征、影像学特点、治疗方案及预后。结果　6例舌异位甲状腺经Tc-99m甲状腺静态显像确诊,均位于舌根部。1例甲状腺素替代治疗,1例未行任何治疗。3例行舌根异位甲状腺转位术,术后均口服左旋甲状腺素片,咽部异物感和睡眠打鼾症状消失。1例舌根异位甲状腺乳头状癌行支撑喉镜下舌根肿物切除术,失访。结论　甲状腺静态显像对舌异位甲状腺诊断具有特异性。其手术适应证为异位甲状腺致气道阻塞、睡眠打鼾及咽部异物感等症状明显者,肿物出血、囊性变及癌变。治疗原则是尽量保留甲状腺功能,综合运用手术、甲状腺激素替代及碘放疗等方法改善症状、预防及治疗甲状腺功能减退。     

Dual ectopic thyroid mimicking as a thyroglossal cyst – A case report and review of literature

Ectopic thyroids are very rare condition. However, they can be confused with more common conditions like colloid cyst or thyroglossal cysts. We present the case of a 15-year-old Indian female who was clinically diagnosed with thyroglossal cyst and was posted for surgery. However, on further investigation, the condition was found out to be a dual ectopic thyroid following computed tomography and was confirmed by Tc-99m thyroid scan. The patient was put on follow up and no surgical intervention was performed. Hence midline swellings of neck should be thoroughly examined before performing surgery, keeping the possibility of ectopic thyroids in view.     

Multifocal hyperfunctioning thyroid carcinoma without metastases

Hyperthyroidism due to thyroid carcinoma is rare, and most cases are caused by hyperfunctioning metastatic thyroid carcinoma rather than primary carcinoma. Among primary hyperfunctioning thyroid carcinoma, multifocal thyroid carcinoma is exceedingly rare, with the only one case being reported in the literature. Here, we describe the case of a 62-year-old woman with multifocal functioning thyroid carcinoma. Technetium-99m (99m Tc) scintigraphic imaging showed four hot areas in the thyroid gland. Histopathological examination of all four nodules revealed papillary carcinoma, corresponding to hot areas in the 99m Tc scintigram. DNA sequencing of the thyrotropin receptor (TSH-R) gene from all nodules revealed no mutation, indicating that activation of TSH-R was unlikely in the pathophysiogenesis of hyperfunctioning thyroid carcinoma in the present case.     

Lateral ectopic thyroid: a case diagnosed preoperatively

Ectopic thyroid is an uncommon condition defined as the presence of thyroid tissue at a site other than the pretracheal area. When the process of embryologic migration is disturbed, aberrant thyroid tissue may appear. In most cases, ectopic thyroid is located along the embryologic descent path of migration as either a lingual thyroid or a thyroglossal duct cyst. In rare cases, aberrant migration can result in lateral ectopic thyroid tissue. Approximately 1 to 3% of all ectopic thyroids are located in the lateral neck. Ectopic tissue frequently represents the only presence of thyroid tissue; a second site of orthotopic or ectopic thyroid tissue is found in other cases. The presentation of ectopic thyroid as a lateral mass should be differentiated from metastatic thyroid cancer; other differential diagnoses include a submandibular tumor, branchial cleft cyst, carotid body tumor, and lymphadenopathy of various etiologies. In addition to the history and physical examination, the workup for a patient with a submandibular mass suspicious for ectopic thyroid should include (1) technetium-99m or iodine-131 scintigraphy, (2) ultrasonography and either computed tomography or magnetic resonance imaging, (3) fine-needle aspiration biopsy, and (4) thyroid function testing. No treatment is required for asymptomatic patients with normal thyroid function and cytology, but hypothyroid patients should be placed on thyroid hormone replacement therapy. Most cases are diagnosed postoperatively. Surgical treatment of ectopic thyroid should be considered when a malignancy is suspected or diagnosed, when the patient is symptomatic, or when thyroid suppression therapy fails.     

Dual ectopic thyroid

Ectopic thyroid is an uncommon embryological aberration characterized by the presence of thyroid tissue in a site other than in its usual pre-tracheal region. It occurs along the path of descent of the developing thyroid primodium from the foramen cecum. It most commonly presents itself as a lingual thyroid and is the only thyroid in 70% of all cases. It is extremely rare for two ectopic foci of thyroid tissue to be present simultaneously. The authors report a recent case of dual ectopic thyroid present in the lingual and infrahyoid areas with no thyroid tissue in the pre-tracheal area in a 15-year-old girl. The patient had originally been scheduled for surgery under the impression of thyroglossal duct cyst; however, a pre-operative computed tomography scan of neck and thyroid scans revealed the presence of dual ectopic thyroid, thus preventing unnecessary surgery. Therefore, thyroid scan, along with either neck CT or neck ultrasonogram, should be performed routinely to avoid unnecessary surgery if the clinical picture is at all compatible with thyroid ectopia. Received: 11 June 2001 / Accepted: 31 August 2001     

Dual ectopic thyroid: report of a case

Dual ectopic thyroid is very rare. We report a case of dual ectopic thyroid in the lingual and infrahyoid areas in a 20-year-old female patient with no thyroid gland in its normal anatomical location. On physical examination, there was a 7 x 5 cm anterior midline neck swelling just below the hyoid bone and a 2 x 2 cm mass in the base of the tongue. Triiodothyronine (T(3)), thyroxine (T(4)), and thyroid-stimulating hormone (TSH) levels were normal. A thyroid scan with technetium-99m sodium pertechnate confirmed dual ectopic thyroid with no iodine uptake in the normal anatomical location of the thyroid gland. The infrahyoid ectopic thyroid was surgically removed for cosmetic reasons, and the lingual thyroid, which was symptomatic, was left untouched. The importance of thyroid scanning in the evaluation of anterior midline neck swellings and treatment options are discussed.     

Management of the undescended thyroid

Ectopic thyroid can occur throughout the neck but is found most commonly at the tongue base. Management includes Tc99m radionuclide scanning to confirm the presence and location of the thyroid tissue. Dysfunction should be assessed by T4, TSH, and thyroid antibody testing. Hormonal therapy is the primary treatment but surgery may be necessary in cases of airway obstruction. Six children with undescended thyroid are presented and a management protocol based on the presence or lack of symptomatology is proposed.     

Intraoperative gamma probe localization of parathyroid adenomas

OBJECTIVES/HYPOTHESIS: In an effort to reduce operative time, improve diagnostic accuracy, and decrease perioperative morbidity, we combined preoperative technetium Tc 99m-sestamibi localization with the use of the gamma probe intraoperatively. This report examines our experience with the gamma probe for rapid intraoperative localization of parathyroid adenomas. STUDY DESIGN: A retrospective chart review was performed to identify all patients who underwent parathyroid exploration with the aid of the gamma probe at Lenox Hill Hospital (New York, NY). METHODS: Charts were reviewed for operative details, radiological findings, and pathological diagnoses. RESULTS: Between November 1, 1998, and June 30, 2000, 35 parathyroid explorations were performed with the aid of the gamma probe. The preoperative localization study was accurate in 34 of 35 cases. The gamma probe successfully identified the parathyroid adenoma in 33 of 35 cases. There were two false-positive cases in which the gamma probe mistakenly identified a thyroid adenoma rather than a parathyroid adenoma. In 11 of 35 cases, the gamma probe was judged essential for rapid localization of the parathyroid adenoma. These cases included patients with multiple or ectopic adenomas and patients who had previous parathyroid surgery. Average operative time to remove parathyroid disease was 80 minutes (range, 45-140 min), which included 20 to 40 minutes waiting for frozen-section results. All patients became normocalcemic, and there were no major complications in this series. CONCLUSION: The gamma probe is a useful tool that complements a well-performed localization study. It is most useful in patients who have multiple or ectopic adenomas or have had prior parathyroid surgery.