两型甲状腺炎的咽喉症状和甲状腺核素显像的比较

收集经甲状腺细针抽吸活检证实的亚甲炎 (SAT)和桥本甲状腺炎 (HT)各 30例。记录两型甲状腺炎的咽症状学类型和持续时间 ,采用 SPECT检查患者的甲状腺病变状态。结果显示 :主诉咽痛者 SAT组为 70 % (2 1/ 30 ) ,HT组为 16 .7% (5 / 30 )。主诉咽异感症者 SAT组 30 % (9/ 30 ) ,HT组为 83.3% (2 5 / 30 ) ,两组甲状腺炎的咽症状学的差别有统计学意义 (P<0 .0 5 )。甲状腺核素显像显示 :SAT患者甲状腺放射性分布显著减少 ,甲状腺显影暗淡 ,而 HT患者甲状腺显像形态多样。 SAT组聚 99m Tc功能受损程度比 HT组重 (P<0 .0 5 ) ,在咽症状学和甲状腺显像方面 ,SAT与HT有着明显区别 ,据此可对两病进行鉴别诊断     

亚急性甲状腺炎的鉴别诊断进展

亚急性甲状腺炎占就诊甲状腺疾病患者的5%,为最常见的甲状腺疼痛原因,是由病毒感染或感染后的炎症过程所致的自限性疾病.其典型临床表现有发热、明显的颈部疼痛和触痛、轻中度弥漫性甲状腺肿以及甲状腺功能的演变过程.但不典型病例的临床表现各异,常需与多种疾病进行鉴别诊断,以防误诊误治.该文以临床表现为主线,结合辅助检查对亚急性甲状腺炎的鉴别诊断进行阐述.     

Intrathyroidal T cell activation and HLA-DR antigen expression on thyroid follicular cells in autoimmune thyroid diseases]

Thyroid specimens from 19 patients with Hashimoto's thyroiditis (HT), 11 with Graves' disease (GD), 4 with nontoxic goiter (NTG), 1 with subacute thyroiditis (SAT), 1 with thyroid adenoma and 4 from normal thyroids were investigated by alkaline phosphatase anti-alkaline phosphatase (APAAP) immunocytochemical technique. A group of monoclonal antibodies against the corresponding T cell activation antigens were used. The positive rates of all the four activation antigens in thyroid gland mononuclear cells (TG-MNC) were significantly higher in HT than in NTG (P less than 0.05-0.01). However, the differences between HT and GD were insignificant (P greater than 0.05) except for HLA-DR antigen. The activation antigen-positive (especially TLiSA 1+) TG-MNC were often seen intruding into thyroid lumens of HT. All the abnormal specimens expressed HLA-DR antigens on thyroid follicular cells (TFC) in different degrees (+/- to +3), and the degree in HT was significantly higher than that in GD (P less than 0.01) or NTG (P less than 0.05). The level of DR expression on TFC correlated significantly with the infiltrating degrees of T-activation-antigen-positive cells (P less than 0.01). This indicates that aberrant DR expression in vivo is closely related to the activation of intrathyroidal T cells.     

Report of a case of papillary thyroid carcinoma in association with Hashimoto's thyroiditis

Hashimoto thyroiditis (HT) is an autoimmune disease, known to be the most common cause of hypothyroidism in nonendemic goitrous areas. It is usually characterized by symmetric, painless, and diffused but sometimes localized swelling of the thyroid gland with features of hypothyroidism. Papillary thyroid carcinoma (PTC), on the other hand, is the most common yet less aggressive form of thyroid cancer, especially in iodine-deficient areas. The coexistence of the two diseases is possible but not common. This case study reports a 50-year-old female with a 10-year history of a huge goiter, which was essentially symptom-free until about 3 months prior to presentation when the patient started complaining of neck pain, dysphagia, productive cough, and cold intolerance. Physical examination revealed focal cystic and tender area in the multinodular swelling and associated cervical lymphadenopathy on the left side of the neck. The serum thyroid stimulating hormone was high, sub-normal T3, and the T4 was low. The fine needle aspiration cytology yielded 10 ml of aspirate of pus admixed with altered blood which on microscopy showed a few suspicious follicular epithelial cells with open nuclei admixed with mainly neutrophil polymorphs, siderophages, and foam cells in a hemorrhagic background. The patient had an incision biopsy that showed areas displaying PTC and HT.     

桥本氏和亚急性甲状腺炎临床诊断及外科手术治疗的探讨

目的 :总结分析桥本氏、亚急性甲状腺炎临床诊断和治疗经验及影响诊断的相关因素。方法 :回顾 1994～ 2 0 0 0年我院及内蒙古医学院附属医院收治的桥本氏甲状腺炎 (HT) 5 2例 ,亚急性甲状腺炎 (SAT)4 8例 ,对其发病、临床表现、诊断以及外科手术治疗进行分析。结果 :5 2例HT和 4 8例SAT各有 2例临床作出甲状腺炎诊断。除 2例HT和 3例SAT活检术外 ,其余病例均接受手术治疗。与病理检查对照 ,术前误诊率很高 ,HT为 96 15 % ,SAT为 95 83% (P >0 0 5 )。术后甲低功发生率HT为 2 0 % ,SAT为 17 14 %(P >0 0 5 )。HT并发甲亢 (GD) 5例 (占 12 5 % ) ,甲状腺癌 (TC) 2例 (占 5 % ) ,SAT并发GD和TC均为 0例 (0 0 1

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营养因素对桥本甲状腺炎患者甲状腺自身抗体滴度的影响

桥本甲状腺炎（HT）是最常见的自身免疫性甲状腺疾病,也是导致患者甲状腺功能减退（甲减）的最主要因素,甲减会增加患者精神疾病的发病率,甚至会诱发黏液性水肿、昏迷,但有关HT的临床疗法研究目前较少。由于HT患者自身免疫系统紊乱,机体会分泌甲状腺自身抗体,因此甲状腺自身抗体在桥本甲状腺炎的诊断和预后中发挥着重要作用。研究表明,控制营养元素的摄入（如补硒、适碘）对治疗HT具有积极意义,可有效降低甲状腺自身抗体滴度,从而改善患者的甲状腺功能,然而临床对营养因素能否影响HT的治疗尚存争议。本文通过回顾治疗HT的相关研究成果,总结了不同营养因素在HT治疗过程中的作用,发现在治疗HT时,对硒、碘、铁及维生素D等营养因素的调控及干预不仅可发挥降低甲状腺自身抗体滴度的作用,更利于提高治疗HT的效果,能为未来临床治疗HT提供更多参考。     

桥本甲状腺炎与Th1/Th2细胞因子

桥本甲状腺炎(HT)是一种常见的器官特异性的自身免疫性疾病,实验性自身免疫性甲状腺炎(EAT)是研究HT的动物模型。在HT与EAT的发病过程中,Th1/Th2细胞免疫失衡发挥着重要作用,表现为Th1细胞因子亢进占优势。Th1细胞可加重炎性反应,而Th2细胞发挥抗炎作用,纠正HT患者体内失衡的细胞因子可以起到一定的治疗作用。     

cNOS mRNA在格雷夫斯病和桥本甲状腺炎的表达及意义

目的：研究cNOSmRNA在格雷夫斯病（GD）和桥本甲状腺炎（HT）甲状腺组织中的表达及与血管形成的关系。方法：应用原位杂交技术检测46例GD、41例HT和15例正常甲状腺组织中cNOSmRNA的表达情况,并用免疫组织化学CD34染色测量组织的微血管密度。结果：GD和HT中甲状腺上皮细胞、血管内皮细胞及单核／吞噬细胞上均可见cNOSmRNA表达,阳性表达率明显高于正常甲状腺组织。GD在甲状腺上皮细胞cDODmRNA表达,阳性表达率明显高于正常甲状腺组织。GD在甲状腺上皮细胞cNOSmRNA的表达明显高于HT。GD和HT中血管内皮细胞上cNOSmRNA的表达与微血管密度呈正相关。结论：GD和HT甲状腺组织中cNOSmRNA的表达与血管形成有关,cNOS可能参与GD和HT的发病机制。     

亚急性甲状腺炎诊治研究进展

亚急性甲状腺炎在甲状腺疾病中发病率为0.5%～2.0%,典型表现为甲状腺疼痛,伴有甲状腺功能亢进症状、促甲状腺素水平降低、甲状腺摄碘率降低和红细胞沉降率升高等。临床诊断主要依据病史、临床表现、实验室检查等,超声、CT、甲状腺体外显像等影像学检查可为临床确诊进一步提供依据,细针抽吸活组织检查及病理学检查可确诊。目前治疗上主要为非甾体类抗炎药、糖皮质激素,必要时甲状腺激素治疗。     

人乳头瘤病毒疫苗接种后亚急性甲状腺炎1例报告

亚急性甲状腺炎（SAT）是最常见的自限性甲状腺疼痛疾病,病因尚不明确,多与病毒感染或病毒感染后的变态反应有关,疫苗接种后出现SAT极为罕见。本例患者接种第1剂九价人乳头瘤病毒疫苗（Gardasil 9）0.5 mL约8 h后无明确诱因出现发热,最高体温37.8 ℃,伴颈部疼痛、疲惫乏力,吞咽时疼痛加剧,入院后查体发现甲状腺Ⅱ°肿大,质硬,触痛明显,未闻及血管杂音,疫苗接种处无红肿、破溃,余查体未见明显异常,实验室检查:C-反应蛋白25.20 mg/L,血沉55 mm/1 h,白细胞4.94×109 L?1,促甲状腺激素0.137 mU/L,游离甲状腺素22.32 pmol/L,抗甲状腺球蛋白抗体69.18 IU/mL,抗甲状腺过氧化物酶抗体21.66 IU/mL。甲状腺彩超示:双侧甲状腺弥漫性肿大,内回声不均。诊断为SAT。予以布洛芬对症治疗,经治疗5 d后患者未再出现低热,颈部疼痛症状缓解。随访至今,已完成3剂九价人乳头瘤病毒疫苗的接种,复查甲状腺功能正常,未见SAT复发。     

Post-partum thyroiditis can be painful

A patient with post-partum thyroiditis is described. She was a 22 year old with a negative family history of autoimmune thyroid disease who was noted to have a high titre of antithyroid microsomal antibody during pregnancy. She developed mild hyperthyroidism 8 weeks post-partum but at 12 weeks she had a mildly painful enlarged thyroid gland. At 20 weeks post-partum she had severe thyroidal pain with dysphagia. The thyroid was exquisitely tender to palpation. She was treated with L-thyroxine and the pain resolved within 4 weeks. This is the first report documenting pain in the thyroid as a feature of post-partum thyroiditis.     

自身免疫性甲状腺疾病Bcl-2和Bax蛋白的表达

目的 研究格雷夫斯病（GD）和桥本甲状腺炎（HT）和HT合并甲状腺癌组织中细胞凋亡有关的自身基因bcl-2和bax的表达情况，探讨它们在自身免疫性甲状腺疾病发病机制中的作用。方法 采用二步法免疫组织化学技术检测Bcl-2及Bax在GD 65例、HT47例、HT并甲状腺癌12例和正常甲状腺组织15例的表达情况。结果 （1）Bcl-2在GD、HT和HT合并甲状腺癌的甲状腺组织中的表达程度均明显低于在正常甲状腺中的表达。在HT中的表达程度明显高于GD，在HT合并甲状腺癌中明显减弱。（2）Bax在GD、HT和HT合并甲状腺癌中的表达程度逐渐增强，组间差异有显著性，且均明显高于在正常甲状腺中的表达。（3）正常甲状腺中Bcl-2表达占绝对优势，不表达Bax;GD和HT中Bcl-2及Bax蛋白表达存在一定的平衡关系，而在HT合并甲状腺癌中Bcl-2／Bax表达明显失衡，Bax表达占绝对优势。结论 Bcl-2和Bax的表达变化可能在自身免疫性甲状腺疾病发病机制中起重要作用，Bcl-2/Bax表达比例改变在病情发展中起重要作用，可能作为相关病理演变的参照指标。     

Subacute Thyroiditis as Seen Initially in ENT Deoartment——A Report of 30 Cases

To assess the pharyngeal presentations and the diagnostic value of thyroid SPECT and thyroid fine needle aspiratory biopsy (FNAB) in subacute thyroiditis (SAT) as seen initially in ENT department, 30 patients, during the course of SAT, were examined for pharyngeal symptoms and tested for serum Ts, T4 level. The thyroid SPECT imaging or thyroid FNAB were performed. Our results showed that, of the 30 patients, 21 had sore throat of various degrees, and 9 had abnormal sensation of throat. Six were diagnosed as having SAT by only SPECT, in the remaining 24, the final diagnoses was established by SPECT combined with FNAB. Two of them were finally diagnosed as having SAT by trial treatment with oral prednisone. It is concluded that sore throat and abnormal sensation of pharynx are the important presentations of SAT, and thyroid SPECT imaging and thyroid FNAB are valuable in diagnosing SAT.     

Painless giant cell thyroiditis

We describe an atypical case of subacute thyroiditis affecting a 50 year old patient with long lasting fever, weight loss, malaise and a high erythrocyte sedimentation rate. Cytological examination of the thyroid gland showed the classic granulomas with giant cells. However, the patient had neither painful enlargement of the gland nor thyrotoxicosis. This case, as well as others previously described, probably represents a new subtype of subacute thyroiditis, painless giant cell thyroiditis. The presence of painless giant cell thyroiditis should be considered in any patient with undiagnosed pyrexia, weight loss and elevated ESR.     

Hypothyroidism due to Hashimoto thyroiditis post struma ovarii excision

Struma ovarii is a rare ovarian teratoma that may produce hyperthyroidism. The association with Hashimoto thyroiditis HT, however is rare and has been reported in only one case. We report a case of HT following the resection of struma ovarii tumor, after which the patient became frankly, hypothyroid with elevated thyroid stimulating hormone and low thyroxin levels. Her thyroid peroxidase antibodies were positive. She improved after initiation of levothyroxine replacement therapy. We believe her euthyroid status preoperatively was due to thyroid hormone secretion by struma ovarii itself.     

超声检测气管旁淋巴结对自身免疫甲状腺炎的诊断价值

［摘要］目的　探讨超声检测气管旁淋巴结对自身免疫甲状腺炎（autoimmune thyroiditis,AIT）的诊断价值．方法　选取101例AIT患者,同期选取毒性弥漫性甲状腺肿患者（Graves’disease,GD）35例为GD组、亚急性甲状腺炎患者（subacute thyroiditis,SAT）31例为SAT组、正常人群60例为对照组,进行实验室检查（TSH、TGAb、TPOAb）,观察甲状腺二维超声表现及彩色多普勒血流特征;同时观察气管旁两侧淋巴结是否显示及显示淋巴结纵横比、皮髓质分界及彩色多普勒血流特征．结果　AIT组、GD组、SAT组在实验室检测指标（TSH、TPOAB、TGAB）方面差异有统计学意义（P＜0.05）;AIT组、GD组、SAT组和正常组在气管旁淋巴结显示率、气管旁淋巴结数目、淋巴结纵径、淋巴结横径、淋巴结纵横比、彩色多普勒血流等方面存在统计学差异（P＜0.05）,皮髓质分界未见统计学差异（P＞0.05）．结论　超声检测气管旁淋巴结对自身免疫甲状腺炎鉴别诊断有一定价值,可以辅助判断弥漫性甲状腺病变的性质．     

核医学与超声检查对亚急性甲状腺炎的诊断价值

目的利用核医学检查与超声诊断技术提高亚急性甲状腺炎（SAT）的诊断准确率。方法实验组随机选择61例SAT患者,核医学实验室检测血清FT3、FT4、TSH,甲状腺6h摄碘率（RAIU/6h）,并进行甲状腺核素扫描,所有患者均行超声检查。另设30例正常人作为对照组仅行甲状腺超声检查。结果以TH与RAIU/6h呈分离现象或核素显像阳性为依据,核医学实验室诊断SAT阳性率为95.1%（58/61）,超声诊断阳性率为81.9%（50/61）,核医学诊断阳性率明显高于超声检查（P〈0.05）,两种检查方法相结合诊断率达100%.甲状腺超声测定结果表明实验组甲状腺明显大于正常对照组（P〈0.05）。结论核医学检查与超声检查相结合,有利于提高SAT的诊断准确率。     

慢性淋巴细胞性甲状腺炎与外科的关系

目的：探讨慢性淋巴细胞性甲状腺炎的外科治疗。方法：总结95例慢性淋巴细胞性甲状腺炎，并对其发病、临床表现、症状、体征、诊断及治疗进行分析。结果：术前21例临床作出慢性淋巴细胞性甲状腺炎诊断，51例诊断为结节性甲状腺肿，1例诊断为甲状腺功能亢进，13例诊断为甲状腺功能减退，9例诊断为甲状腺癌，术后病理均诊断为慢性淋巴细胞性甲状腺炎，慢性淋巴细胞性甲状腺炎确诊率22．11％（21／95），慢性淋巴细胞性甲状腺炎伴发甲状腺癌22．11％（21／95），结论：慢性淋巴细胞性甲状腺炎以中年女性多见，可并发甲状腺恶性肿瘤，甲状腺功能亢进症及甲状腺功能减退症，正确掌握其临床特征，结合FT3，FT4、促甲状腺素（TSH），甲状腺球蛋白抗体（TGAb)，微粒体抗体（TMAb)，甲状腺过氧化物酶抗体（TPOAb)及细针穿刺细胞学检查（FNAB），可提高其诊断准确率，术中常规做冷冻病理检查，有利于正确选择手术方式。     

CK19、Ret/PTC在桥本恶变中的表达及其意义

目的 :从免疫组织化学角度初步探讨桥本甲状腺炎恶变的发生、发展以及演进的可能机制 ,寻找敏感而又特异的检测指标 ,以助于桥本甲状腺炎恶变的诊断。方法 :采用免疫组化S -P法检测 2 0例甲状腺瘤旁的正常甲状腺组织 ,2 5例桥本甲状腺炎组织以及 2 1例桥本甲状腺炎恶变的标本中CK19、Ret/PTC的表达和分布情况。结果 :CK19、Ret/PTC蛋白在癌旁正常甲状腺组织中无阳性表达 ,而在桥本甲状腺炎以及桥本甲状腺炎合并甲状腺癌组织中均有不同程度的表达 ,两组之间比较 ,CK19、Ret/PTC蛋白阳性表达率差别均无显著性 (P >0 .0 5 )。但其染色形态及强度存在明显差异 (P <0 .0 5 )。CK19、Ret/PTC在桥本甲状腺炎组织中均表现为弱灶性染色。而在桥本甲状腺炎合并甲状腺癌组织中CK19、Ret/PTC多表现为强而弥漫性染色。Ret/PTC的异常表达与乳头状甲状腺癌的淋巴结转移有关 (P <0 .0 5 )。结论 :检测CK19、Ret/PTC的表达 ,有助于桥本甲状腺炎恶变倾向的判断和甲状腺癌的早期诊断 ,Ret/PTC的异常表达对乳头状甲状腺癌的发生、发展、淋巴结转移有密切关系和重要临床意义