内分泌系统疾病

983222儿童慢性淋巴细胞性甲状腺炎的诊断探讨/方俊敏…//中华儿科杂志一1997,35(5)一246一249 对50例弥漫性甲状腺肿患儿进行B超影像学观察、细针穿刺细胞学检查和甲状腺自身抗体测定。正常儿童109名作对比。结果:正常儿童B超显示10~14岁组甲状腺体积较小于10岁组明显增大,尸<0.01。患儿组中细胞学检测结果24例证实慢性淋巴细胞性甲状腺炎;24例为弥漫性甲状腺增生,1例为亚急性甲状腺炎,另1例取材不理想无法判断。甲状腺B超和血清抗体检查结果:患儿的甲状腺体积均大于正常组。细胞学检查证实的26例慢性淋巴细胞性甲状腺炎的异常发生率与甲…     

儿童慢性淋巴细胞性甲状腺炎76例临床分析

目的 探讨儿童慢性淋巴细胞性甲状腺炎的临床表现特点、诊断方法及预后。方法 对76例慢性淋巴细胞性甲状腺炎患儿临床资料进行回顾性分析。结果 76例慢性淋巴细胞性甲状腺炎患儿,女性占81.59％,年龄为(10.52±3.12)岁,病程为(7.63±8.15)个月;全部病例均有甲状腺弥漫性肿大。初诊时临床表现为甲状腺功能亢进10例、甲状腺功能减低14例、无症状52例;初诊时临床诊断准确率为78.94％(60/76),甲状腺针吸细胞学检查(FNAB)诊断准确率为98.68％(75/76)。随访2个月至4.5年,26例表现为甲状腺功能减低,32例甲状腺肿大消失,28例抗体降至正常;13例痊愈,痊愈病例中12例FNAB为淋巴型。结论 儿童慢性淋巴细胞性甲状腺炎临床表现不典型,易误诊;FNAB诊断准确率高,并可早期诊断;FNAB结合甲状腺自身抗体检查可作为儿童慢性淋巴细胞性甲状腺炎较可靠诊断手段;儿童慢性淋巴细胞性甲状腺炎近期预后良好,预后可能与细胞学类型相关。     

儿童慢性淋巴细胞性甲状腺炎临床特点及转归

为探讨儿童慢性淋巴细胞性甲状腺炎（CLT）的临床特点及预后，对1988年以来收治的77例患儿的临床资料进行了回顾性分析。结果：无症状弥漫性甲状腺肿大伴甲状腺自身抗体阳性者66例。甲状腺功能（简称甲功）正常者38例，代偿性甲状腺功能减低（简称代甲减）7例，甲状腺功能减低（简称甲减）22例和甲状腺功能亢进（简称甲亢）5例。随访的64例患儿中90％（27／30）原甲功正常者功能正常持续数年；5／7原代甲减、59．1％（13／22）甲减及3／5甲亢患儿，甲功恢复正常，并持续至治疗后数年。结果提示儿童CLT可存在不同的甲功状态；大部分患儿预后良好，甲状腺炎所致甲功受损并非均为永久性的，部分患儿甲功可恢复正常。     

细针吸取细胞学诊断慢性淋巴细胞性甲状腺炎82例

随甲状腺自身抗体检测和细针吸取细胞学 (FNAC)诊断技术的广泛应用 ,慢性淋巴细胞性甲状腺炎的诊断率明显上升 ,成为儿童甲状腺肿大的常见病因。FNAC检查痛苦小 ,诊断周期短。我院对甲状腺疾病已常规行FNAC检查 ,本文就82例儿童慢性淋巴细胞性甲状腺炎的细胞学结果报道如下。资料与方法一、一般资料　我院 1997年 1月～ 2 0 0 1年 7月收治儿童甲状腺弥散性肿大及结节性病变 6 5 0例。经FNAC诊断为慢性淋巴细胞性甲状腺炎 82例 ,男 10例 ,女 72例 ;年龄 6～ 13岁。肿块直径 0 .6～ 3.0cm ,其中甲状腺疾病阳性家族史 5例。 9例甲状腺局…     

小儿甲状腺炎的诊断和治疗

甲状腺炎是小儿内分泌最常见疾病之一，它包括甲状腺各种类型炎症和感染，慢性淋巴细胞性甲状腺炎（ＣＬＴ）为自身免疫疾病，是儿童和青少年甲状腺肿和甲状腺功能减低最常见原因，但其大多数患儿甲状腺功能正常。急性化脓性甲状腺炎和亚急性甲状腺炎少见；梨状窝瘘系前者主要发病因素，后者属非化脓性炎症，病程自限。     

小儿甲状腺炎的诊断和治疗

甲状腺炎是小儿内分泌最常见疾病之一，它包括甲状腺各种类型炎症和感染，慢性淋巴细胞性甲状腺炎（ＣＬＴ）为自身免疫疾病，是儿童和青少年甲状腺肿和甲状腺功能减低最常风原因，便其大多数患儿甲状腺功能正常。急性化脓性甲状腺炎和亚急性甲状腺炎少见；梨状窝瘘系前者主要发病因素，后者属非化脓性炎症，病程自限。     

甲状腺大并功能异常24例

目的探讨儿童甲状腺大并功能异常的病因、临床特点及治疗方法。方法对24例甲状腺大并功能异常患儿临床资料进行回顾性分析,部分患儿行甲状腺细针穿刺细胞学检查。结果24例患儿中弥漫性毒性甲状腺肿(Graves病)11例,慢性淋巴细胞性甲状腺炎(CLT)12例,亚急性甲状腺炎1例;首诊甲状腺功能亢进16例,甲状腺功能减退8例。结论儿童甲状腺大并功能异常的病因主要为Graves病及CLT,临床症状不典型,误诊率较高,应引起重视。     

甲状腺细针穿刺细胞学检查对桥本甲状腺炎的诊断价值

目的　探讨甲状腺非抽吸细针穿刺细胞学 (FNAB)检查对儿童慢性淋巴细胞性甲状腺炎 (HT)诊断价值。方法　对 16 9例弥散性甲状腺肿儿童进行FNAB检查、甲状腺自身抗体测定 ,分别行FNAB诊断和临床诊断 ,并进行随访。结果　 16 9例中 76例诊断为儿童HT ;FNAB初诊准确率 98.6 8% (75 /76 ) ,明显高于临床初诊准确率 80 .2 6 % (6 1/76 ) (P <0 .0 1) ;HT 76例FNAB细胞学表现可分为 3种类型 :以淋巴细胞为主型最多(37/76 ) ,以嗜酸性变型最典型 ,上皮破坏型少见。结论　FNAB检查对诊断儿童HT和细胞学分型有较好的实用价值     

甲状腺细针抽吸细胞学检查对儿童桥本病早期诊断价值探讨

目的探讨甲状腺细针抽吸细胞学检查（ＦＮＡＢ）对儿童桥本病的早期诊断价值。方法对２０例甲状腺肿大患儿进行ＦＮＡＢ检查。结果各种不同的甲状腺疾病组织,在镜下显示不同的细胞学形态。桥本病组织的细胞形态学有其特征性。２例临床诊断为甲亢的患儿经ＦＮＡＢ确诊为桥本病。结论ＦＮＡＢ对早期诊断儿童桥本病有重要价值。     

小儿弥漫性甲状腺肿大的诊断

甲状腺肿大是最常见的儿科内分泌疾患之一，其病因繁多，近年来随着对其发病机制的逐步认识和诊断方法不断进展，提高了本病的正确诊断率。本文叙述几种较为常见的小儿甲状腺疾患的诊断。小儿甲状腺肿大常见的病因有：1．慢性淋巴细胞性甲状腺炎（CLT）2甲状腺毒症①弥漫性毒性     

Ultrasonic imaging in the differential diagnosis of diffuse thyroid disorders in children

In 22 patients with suspected diffuse goiter, the diagnostic accuracy of ultrasonography was compared with that of aspiration biopsy cytology and thyroid antibody testing. Ultrasonography was abnormal in 100% (10/10) of the patients with autoimmune thyroid disease, only 90% (9/10) of whom were identified with antibody testing. All patients with diffuse colloid goiter had normal echo patterns on ultrasound imaging, whereas 29% (2/7) of them had positive results on antibody testing. Whether these are 'false positives' or represent focal thyroiditis remains unclear. Thus, ultrasound imaging stands out as a valuable diagnostic tool for the differential diagnosis of diffuse thyroid disorders in children.     

Ultrasound imaging in diffuse thyroid disorders of children

The diagnosis of diffuse thyroid disorders in children is based mainly on hormone and antibody determinations and a cytologic sample taken by aspiration biopsy. The cytologic sample is not always obtainable in small children or when the thyroid gland is not enlarged. Thyroid antibodies lead to diagnosis only in a proportion of cases. Gamma imaging is not recommended in children because of the radiation risk. The aim of this study was to demonstrate that ultrasound imaging can detect diffuse thyroid disorders in children. Ultrasound images were abnormal in 92% of all subjects; they were abnormal in 97% of cases with thyroiditis and in most cases ultrasound was diagnostic. With antibody determinations, only 60% of the cases of thyroiditis could be diagnosed. Ultrasound imaging--a risk-free method--should be included in the diagnostic investigation of thyroid disorders.     

Ultrasound Imaging in Diffuse Thyroid Disorders of Children

ABSTRACT. The diagnosis of diffuse thyroid disorders in children is based mainly on hormone and antibody determinations and a cytologic sample taken by aspiration biopsy. The cytologic sample is not always obtainable in small children or when the thyroid gland is not enlarged. Thyroid antibodies lead to diagnosis only in a proportion of cases. Gamma imaging is not recommended in children because of the radiation risk. The aim of this study was to demonstrate that ultrasound imaging can detect diffuse thyroid disorders in children. Ultrasound images were abnormal in 92 % of all subjects; they were abnormal in 97 % of cases with thyroiditis and in most cases ultrasound was diagnostic. With antibody determinations, only 60 % of the cases of thyroiditis could be diagnosed. Ultrasound imaging–a risk-free method-should be included in the diagnostic investigation of thyroid disorders.     

Thyroiditis in children. Personal observations

Enlargement of the thyroid gland, local tenderness and thyroid function disorder are common symptoms of thyroiditis. Hashimoto's thyroiditis (chronic lymphocytic thyroiditis) is the most common form of thyroiditis in children. This disease is a frequent cause of acquired hypothyroidism. Hashimoto's thyroiditis (HT) is characterised by infiltration of the thyroid gland by lymphocytes, gradual destruction of the gland and production of various thyroid autoantibodies, mainly antimicrosomal (ATM) and antithyroglobulin antibodies (ATGL). 54 children (45 girls and 9 boys) aged from 11 to 18 with confirmed or suspected HT were observed. The clinical diagnosis of HT was confirmed by fine needle aspiration biopsy (FNAB) in 27 patients. In one case HT was histologicaly confirmed after thyroid surgery. FNAB was not carried out in 19 patients and in 7 cases FNAB was thyroiditis negative. All patients were positive for ATM and/or ATGL. Initially 24 patients were euthyroid. Hypothyroidism was recognized in 8 children, subclinical hypothyroidism in 11 children. One patient was hyper- thyroid. 51 patients were treated with l-thyroxin. Ultrasonography revealed variable thyroid abnormality in all patients: hyperplasia in 38 patients, multinodular goiter or solitary nodule in 15 patients. 8 children suffered from associated disease: 5 patients from allergy, 1 patient from trombocytopenia, 1 from alopecia areata, 1 from secondary amenorrhea. Follow up examination of children with HT must be continued due to the risk of hypothyroidism or neoplastic disease of thyroid.     

甲状腺细针吸取细胞学检查对儿童甲状腺疾病的诊断价值

目的探讨细针吸取细胞学检查对儿童甲状腺疾病诊断的价值。方法甲状腺肿大患儿１６例，男２例，女１４例，用细针吸取甲状腺组织，放在玻片上经特殊染色后，于光学显微镜下观察细胞形态学的改变。结果１６例患儿共行２０次穿刺，１９次为一次穿刺成功。于光学显微镜下直接作出细胞组织学的诊断。２０次穿刺均无不良反应。结论细针吸取细胞学检查的方法同样可应用于儿童甲状腺疾病的诊断，而且这种方法操作简便，安全。     

Papillary thyroid carcinoma after total body irradiation.

Two children developed papillary thyroid carcinoma after allogeneic bone marrow transplantation (BMT) probably due to radiotherapy during remission and pretransplantation conditioning. Establishing a relationship between the cellular thyroid stimulating hormone (TSH) effect and development of carcinoma in cases with high serum TSH concentrations is difficult. After BMT, patients should be regularly followed up with thyroid ultrasound and, when nodularity is found, fine needle aspiration and/or open biopsy are recommended.     

细针吸取细胞学检查在儿童甲状腺炎诊断中的应用

目的：　探讨细针吸取细胞学 (FNAC)检查对儿童甲状腺炎的诊断价值。方法：　采用FNAC检查法诊断儿童甲状腺。结果：　经细胞学诊断为甲状腺炎共计 10 0例,经临床治疗及其它实验室检查结果相符的98例(98%),只有2例(2%)在分类上出现误差,而血清学(T3 ,T4 ,TG ,TM ,TSH)检查敏感性则相对较低,桥本氏甲状腺炎为63.1%～73.6%,淋巴细胞性甲状腺炎为26.0%～84.7%,其它血清学检查均无意义。结论：　FNAC检查法吸出细胞成分充足,几乎不含血液成分,有利于甲状腺炎的诊断及分类。     

Clinical, biochemical and cytomorphological observations in juvenile chronic lymphocytic thyroiditis

OBJECTIVE: To determine the clinical, biochemical, ultrasonological and cytomorphological features in goitrous juvenile chronic lymphocytic thyroiditis(CLT). SETTING: Tertiary referral center for thyroid disorders. SUBJECTS: A total of 455 children were evaluated for goiter. Of these 122 children had features of CLT in FNAC and were further studied. METHODS: All subjects were subjected to detailed clinical examination. The thyroid functional status was assessed by estimation of serum concentration of thyroid hormones (thyroxine and triiodothyronine) and thyrotropin (TSH). In addition the antithyroid antibody titers were measured. Ultrasonological and cytomorphological characteristics in these patients were also evaluated. RESULTS: The mean age at presentation was 12.5 years (SD 3.93). The male: female ratio was 1:7.7. Thyroid functional status as assessed by serum thyroxine and thyrotropin levels revealed, euthyroidism in 67 (54.9%), hypothyroidism in 30 (24.6%), subclinical hypothyroidism in 22 (18%) and hyperthyroidism in 3 (2.5%). Thyroid antimicrosomal antibodies were detected in significant titers in 90 (73.8%) and antithyroglobulin was positive in 71 (58.2%). The positivity of the antimicrosomal and antithyroglobulin antibodies were much higher in subjects with hypothyroidism and was detected in 86.5% and 69.2%, respectively. The mean urinary iodine excretion was 74.1 micrograms/g of creatinine (SD 31.4) indicating mild iodine deficiency. Fine needle aspiration cytoloty (FNAC) revealed features of chronic lymphocytic thyroiditis. Hurthle cell changes was seen in only 12% of the cases. The epithelium was more often hyperplastic and vacuolation of the cytoplasm and peripheral vacuolations were seen frequently. Giant cells and epithelioid cells were seen in many cases. CONCLUSIONS: In any child presenting with firm goiter, a diagnosis of CLT should be excluded. Many subjects with juvenile CLT have biochemical evidence of hypothyroidism but only few symptoms or clinical features.     

Thyrotropin binding inhibitor immunoglobulin. Its pathogenetic importance in hypothyroidism

Two patients with hypothyroidism had detectable serum levels of thyrotropin binding inhibitor immunoglobulin (TBII). Patient 1 was a newborn infant who had transient neonatal hypothyroidism due to transfer of TBII from the mother with nongoitrous autoimmune thyroiditis. Patient 2 was an 8-year-old girl with Down's syndrome who presented with signs of myxedema and central precocious puberty. She had no goiter, and the recognition of thyroid disease was delayed; the histological diagnosis of chronic lymphocytic thyroiditis was established by aspiration biopsy, and TBII had strong thyroid adenyl cyclase-inhibiting activity in vitro. It appears that TBII may be pathogenetically important for occurrence of neonatal hypothyroidism and nongoitrous autoimmune thyroiditis without goiter.