1201例患者甲状腺细针穿刺临床病理分析

目的 评价甲状腺细针穿刺的临床应用价值.方法 回顾性分析1201例患者甲状腺细针穿刺的临床资料及其细胞病理诊断结果,临床资料包括甲状腺功能化验、甲状腺自身抗体检测以及甲状腺超声检查等.细胞病理诊断分为4类:未诊断,良性病变,可疑恶性和恶性.结果 1201例甲状腺细针穿刺的患者中,未诊断者114例(9.5%),良性病变者999例(83.2%),可疑恶性者67例(5.6%),诊断恶性者21例(1.7%).良性病变中占首位的是桥本甲状腺炎,共有468例,占良性病变的46.8%.细胞病理诊断桥本甲状腺炎的患者中,单结节占18.3%,甲状腺自身抗体阴性率为10.8%,甲状腺毒症占20.9%.在诊断恶性并行手术的17例患者中,16例手术后组织病理检查均为甲状腺癌.诊断恶性的准确率为94.1%.结论 甲状腺细针穿刺是甲状腺疾病诊断和鉴别诊断的可靠方法 .     

妊娠期甲状腺肿瘤治疗的初步分析

妊娠期甲状腺肿瘤诊治是一个较特殊的问题 ,涉及到肿瘤的良恶性 ,妊娠对肿瘤的影响 ,诊断与治疗方法对妊娠的影响及是否终止妊娠等诸多方面 ,因此关于其诊断、处理方法、处理时机及对母亲和胎儿的影响 ,已引起人们的关注。本研究就收治的妊娠期甲状腺肿瘤患者处理情况并结合有关文献讨论如下。一、临床资料一般情况 :我们两家医院从 1980年 1月至 2 0 0 0年 7月共收治甲状腺肿瘤患者 35 6 5例 ,其中妊娠期甲状腺肿瘤患者 42例 (良性肿瘤 2 9例 ,恶性肿瘤 13例 ) ;年龄 2 1～ 34岁 ,平均年龄 2 3.7岁 ;全部病例均经病理检查证实。诊断与治疗 …     

甲状腺非霍奇金淋巴瘤的临床分析

目的探讨甲状腺非霍奇金淋巴瘤的诊断及治疗。方法回顾性分析深圳市三家市级医院2005~2016年手术治疗的甲状腺非霍奇金淋巴瘤15例患者的临床资料。结果术前诊断结节性甲状腺肿8例(53.3%),诊断结节性甲状腺肿合并乔本氏甲状腺炎7例(46.7%)。误诊率100%。全部行手术治疗,术后经免疫组化诊断,其中CD20(+)15例(100%)。随访1~10年,死亡9例(60.0%)。结论对于结节性甲状腺肿和并乔本氏甲状腺炎老年患者,应高度怀疑甲状腺非霍奇金淋巴瘤。早期穿刺活检行病理免疫组化(CD20)检查很必要。     

甲状腺病变端粒酶活性的测定及其意义

最近研究表明 ,端粒酶在许多肿瘤中被激活 ,与肿瘤的发生、发展密切相关。本研究旨在通过对几种常见甲状腺病变端粒酶活性的测定 ,探讨端粒酶对于甲状腺癌的诊断价值。一、材料和方法1.一般资料 :本研究甲状腺标本均来自我院 1995年 1月～ 2 0 0 0年 6月住院手术患者 ,所有标本皆经病理切片证实。 19例甲状腺癌患者 (男性 7例 ,女性 12例 ) ,年龄 18～70岁 ,按病理分型 :乳头状腺癌 9例 ,滤泡状腺癌 5例 ,未分化癌 3例 ,髓样癌 2例 ;15例癌旁组织取自距甲状腺癌边缘1ｃｍ范围内的腺体组织 ;2 1例甲状腺瘤、17例结节性甲状腺肿均为病变实质性…     

高频超声对儿童甲状腺肿瘤的诊断与鉴别

儿童甲状腺疾病病种较多,诊断主要根据病史、体检、影像学检查、穿刺细胞学检查。随着高频探头的问世和彩色多普勒技术的发展,可通过病变数目、形态、回声特征及CDFI进行鉴别诊断甲状腺疾病的性质,高频超声因其简单、迅速、便捷、无痛苦、无创伤、价格低廉而广泛应用于临床。本研究总结了65例儿童甲状腺肿瘤的高频超声影像特点,对于临床医生正确诊断儿童甲状腺肿瘤提供依据。     

甲状腺微小癌的诊断及治疗

目的探讨甲状腺微小癌（TMC）的诊断及治疗方法。方法对136例TMC患者的临床资料作回顾性分析。结果本组136例中因甲状腺良性疾病手术而发现34例,超声检查发现102例（可疑）,超声引导下细胞学穿刺检查发现76例。行患侧甲状腺腺叶切除20例,腺叶切除＋峡部切除30例,甲状腺次全切除18例,甲状腺全切除20例,甲状腺大部切除36例,甲状腺癌改良根治术12例。130例随访5个月-10a,未见肿瘤复发和转移。结论TMC多因甲状腺良性疾病手术而发现,高分辨率彩色超声及B超引导下细针穿刺活检有助于本病的确诊。TMC需行手术治疗,主要采用患侧腺叶＋峡部切除、甲状腺次全或全切除,有颈部淋巴结转移者可行改良根治术。     

术前甲状腺结节的良恶性鉴别——附1367例甲状腺结节临床资料分析

目的探讨临床特征及术前各种辅助检查在判断甲状腺结节良恶性方面的价值。方法对1999—2004年上海交通大学医学院附属瑞金医院1367例甲状腺结节手术患者的临床资料进行回顾性分析。结果1367例甲状腺结节中良性病变1141例(83.47%),恶性病变226例(16.53%)。辅助检查中,B超检查敏感度、特异度、诊断准确度分别为2.11%,99.27%,83.19%;CT检查分别为22.58%,86.00%,70.99%;细针穿刺(FNA)细胞学检查分别为65.12%,95.08%,82.69%。多因素回归分析结果显示,患者较年轻,存在实性、质地偏硬的结节,结节伴钙化或颈部无痛性淋巴结肿大者恶性可能性较大。结论临床症状、体征、甲状腺B超及FNA对恶性甲状腺病变均有一定的提示作用,尤其是FNA在判断结节性质方面具有较高的敏感度、特异度及诊断准确度。     

经乳晕入路腔镜甲状腺切除术治疗良性甲状腺病变的疗效分析

目的分析经乳晕入路腔镜甲状腺手术对良性甲状腺病变的治疗效果。方法选取2014-03~2016-03间该院良性甲状腺病变手术患者52例,随机分为观察组26例,采取经乳晕入路腔镜甲状腺手术;对照组26例,采取开放式甲状腺手术。对两组患者的手术时间、术中出血量、引流量、住院时长及手术并发症进行比较。结果两组治疗有效率比较差异无统计学意义(P 0. 05)。观察组手术时间、术中出血量、引流量、住院时长相比对照组均明显减少,差异有统计学意义(P 0. 05)。观察组手术并发症发生率较对照组明显降低,差异有统计学意义(P 0. 05)。结论临床上对良性甲状腺病变患者采取经乳晕入路腔镜甲状腺手术,可明显减少手术并发症的发生,有利于手术伤口愈合,且能缩短住院天数,减少患者痛苦及经济负担。     

彩色多普勒超声诊断甲状腺结节100例分析

1对象和方法 1．1对象 本文100例甲状腺结节病人均经我院手术及病理证实，女性62例、男38例，年龄15～68岁，平均年龄41．5岁。其中，结节性甲状腺肿38例，甲状腺腺瘤52例，甲状腺囊肿8例，甲状腺癌2例。其中有5例多发性甲状腺腺瘤误诊为结节性甲状腺肿，3例结节性甲状腺肿误诊为甲状腺腺瘤。     

甲状腺肿瘤中p21ras、PCNA的表达及临床意义

为探讨甲状腺肿瘤中p２１ｒａｓ、ＰＣＮＡ的表达及意义,我们用免疫组化方法对８８例甲状腺肿瘤标本进行了研究,以期对甲状腺肿瘤的诊断及预后提供参考。１ 资料与方法１１ 一般资料 选取山东医科大学附属医院病理科１９８８～１９９６年间经手术切除的甲状腺肿瘤标本,从中选出病理及临床资料较完整的８８例（甲状腺癌６４例,腺瘤２４例）作为研究对象。按ＷＨＯ甲状腺肿瘤分类标准,将６４例甲状腺癌分为四型：乳头状癌（３４例）,滤泡性癌（１７例）,髓样癌（５例）,未分化癌（８例）。全部标本经１０％福尔马林固定,石蜡包埋,…     

Comparison of serum thyroid microsomal and thyroid peroxidase autoantibodies in thyroid diseases

Recent evidence indicates that human thyroid peroxidase (TPO) has most of the characteristics of the thyroid microsomal antigen. The question of whether TPO accounts for part or all of the antigenic activity recognized by circulating anti-microsomal antigen autoantibody (anti-M Ab) remains to be determined. The availability of an anti-TPO monoclonal antibody and of a highly purified TPO preparation allowed the development of specific and sensitive radioassays for anti-TPO autoantibody (anti-TPO Ab). In this study we compared anti-M Ab and anti-TPO Ab levels in serum from 128 subjects, including patients with Hashimoto's thyroiditis (n = 31), idiopathic myxedema (n = 11), hyperthyroid Graves' disease (n = 45), miscellaneous nonautoimmune thyroid disorders (n = 9), and normal subjects (n = 32). Anti-M Ab and anti-TPO Ab were measured by radioimmunological methods employing two different assay designs: 1) competitive radioassay (CR), based on the inhibition of radioiodinated antibody binding to human thyroid microsomes coated on microtiter wells, using a) [125I]immunoglobulin G (IgG) containing a high anti-M Ab titer (for anti-M Ab determinations), or b) [125I]anti-TPO monoclonal antibody (for anti-TPO Ab); and 2) sandwich immunoradiometric assay (IRMA) using microtiter wells coated with thyroid microsomes (for anti-M Ab determinations) or immunoaffinity-purified TPO (for anti-TPO Ab determinations) and [125I]anti-human IgG antibody. Anti-M Ab also was measured by passive hemagglutination. Anti-M Ab titers by PH closely correlated with anti-TPO Ab levels whether assayed by IRMA (r = 0.905; P less than 0.00001) or CR (r = 0.922; P less than 0.00001). Even closer correlations were found when anti-M Ab and anti-TPO Ab both were measured by the same type of radioassay procedure (IRMA, r = 0.945 and P less than 0.00001; CR, r = 0.957 and P less than 0.00001). No differences in the correlation between anti-M Ab and anti-TPO Ab results were found when the data in patients with different autoimmune thyroid disorders were analyzed separately. Further and more direct evidence for the identity of anti-M Ab and anti-TPO Ab was provided by the ability of purified TPO to completely inhibit the binding to thyroid microsomes of radioiodinated IgG preparations containing high anti-M Ab titers. In conclusion, our results provide strong support for the concept that TPO accounts for virtually all of the antigenic determinants reacting with the autoantibodies commonly termed anti-M antibodies.(ABSTRACT TRUNCATED AT 400 WORDS)     

Diagnosis of malignant thyroid tumors by indirect thyroid lymphography

Indirect thyroidolymphography was used for 38 patients with malignant thyroid tumors. A conclusion has been made that indirect lymphography of the thyroid is a simple and rather informative diagnostic method for malignant thyroid tumors and should be followed by spot biopsy.     

Acromegaly and thyroid disease: prevalence of thyroid cancer

The relationship between cancer and acromegaly has been subject of study for many years. From a case of differentiated thyroid carcinoma in one of our acromegalic patients, we reviewed a series of 100 acromegalics and found two others cases of thyroid cancer, which are described in this work. From that point, we have got data from the literature about this last association and its possible pathogenesis. The prevalence of thyroid disease is increased among acromegalic patients, mainly due to nodular goiter. This association will be discussed, as well as the relation between insulin-like growth factor-I and cancer, in an effort to have a better understanding of its meaning for our cases. We concluded that it would be prudent to do periodic ultrasonographic evaluation of acromegalic patients, follow by fine needle aspiration biopsies of suspect nodules.     

Binding of thyroid hormones to nuclear extracts of thyroid cells

Binding of T3 and T4 to soluble nuclear extracts of FRTL-5 cells, rabbit thyroid glands, and rat liver was studied. [125I]Iodo-T3 or [125I]iodo-T4 in concentration ranges of 100-fold (10-fold on each side of measured Kd) was incubated with extract at 4 C, pH 8.2, and the quantity of bound hormone was determined by collection on nitrocellulose filters. The results were corrected for nonspecific binding. Steady state (equilibrium) binding was achieved by 36 h. Apparent dissociation constants (Kd) were determined from Scatchard analysis of data pertaining to extent of binding at 36 h as a function of hormone concentration and were also calculated from kinetics of binding as the ratio of rate constants. A single class of saturable, high affinity hormone-binding sites was found. Kd values for T3 and nuclear extracts of FRTL-5 cells, rabbit thyroid gland, and rat liver were, respectively, 3.9 X 10(-11) M, 2.8 X 10(-11) M, and 4.3 X 10(-11) M from Scatchard analysis; when calculated from kinetics of hormone association, the value was 3.6 X 10(-11) M for both FRTL-5 cell and rat hepatic nuclear extract. No analysis of the time course of binding of T3 to rabbit thyroid nuclear extract was made. Kd values for T4 and FRTL-5 cell extract were 6.2 X 10(-10) M from Scatchard analysis and 5.0 X 10(-10)M from kinetic data. Half-times (t1/2) of dissociation of T3 from FRTL-5 cell and rat liver nuclear extract, calculated from association curves, were 7 and 5 h, respectively, while corresponding values determined directly and experimentally were 10.5 and 13 h. For T4 and FRTL-5 cell extract, the t1/2 of dissociation calculated from kinetics of association was 5 h; no direct experimental determination of the value was made. Numbers of T3-binding sites of FRTL-5 cell, rabbit thyroid gland, and rat liver nuclear extracts were, respectively, 71 X 10(-15), 62 X 10(-15), and 208 X 10(-15) mol/mg protein. For T4 and FRTL-5 cell extract, the value was 70 X 10(-15) mol/mg protein. The data indicate that the reaction of T3 and T4 with the various nuclear extracts can be described as reversible and bimolecular. The presence in thyroid cells of thyroid hormone nuclear binding sites suggests that they may be receptors that mediate cellular actions of these hormones within the gland itself.     

Recombinant alpha-interferons, thyroid irradiation and thyroid disease

Recombinant alpha-interferons are used as therapeutic agents in an increasing number of benign and malignant disorders. Long-term administration of recombinant alpha-interferon as a maintenance agent is associated with a small number of adverse side-effects which are responsible for patient intolerance of this drug. These include weight loss, alopecia and chronic fatigue, anorexia and depression syndrome. This latter syndrome needs to be distinguished from thyroid disease, which is documented in this report in a number of patients on recombinant alpha-interferon therapy.