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探讨原发性甲状腺功能亢进症合并甲状腺癌的临床发病关系及其诊断,治疗和预后。方法对１９７３－１９９９年收治的经外手术后病理证实为原发性甲亢合并甲状腺癌（甲癌）２５例,结合文献复习进行临床分析。结果 本组发病率约３．５６％。结论近年来原发性甲亢合并甲癌发病率有上升趋势,临床诊断较困难。多数病例靠术后病理诊断 。例题的手术治疗效果良好,预后较好。     

Breast cancer concurrent with hyperthyroidism: A case report

A case of breast cancer concurrent with hyperthyroidism was reported and the relation between breast cancer and thyroid dysfunction was reviewed. It has been frequently suggested that the incidence of breast cancer is decreased in patients with hyperthyroidism and breast cancer co-incidental with hyperthyroidism is rare.     

结节性甲状腺肿合并甲状腺癌15例临床分析

目的 探讨结节性甲状腺肿合并甲状腺癌的诊断.方法 回顾分析1999年8月至2007年8月治疗的15例结节性甲状腺肿伴甲状腺癌病例.结果 15例患者中术前确诊4例,第2次手术患者9例,术中怀疑癌变而快速冰冻病理证实2例.结论 结节性甲状腺肿并甲状腺癌临床诊断困难,病理诊断是减少误诊率与再手术率的有效方法.     

多发性甲状腺结节伴甲状腺癌23例的临床分析

目的 探讨多发性甲状腺结节中甲状腺癌的诊断。方法 回顾分析1988年5月至2000年12月治疗的23例多发甲状腺结节伴甲状腺癌病例。结果 23例患者中术前确诊仅6例，第2次手术患者13例，良性疾病与甲状腺癌并存20例。结论 多发性甲状腺结节中的甲状腺癌多与良性疾病并存，临床诊断困难，病理诊断是减少误诊率与再手术率的有效方法。     

甲状腺功能亢进症患者行食管癌根治术后并发甲状腺危象

甲状腺危象是甲状腺功能亢进症（简称甲亢）恶化时的严重表现。甲状腺危象的发生与感染、机体内环境改变、手术应激等因素有关。一旦发生可危及患者生命,故应积极救治。报道1例甲亢患者行食管癌根治术后发生甲状腺危象的分析、处理及转归.     

Thyroid carcinoma with hyperthyroidism as the major clinical manifestations]

Twenty-two patients (17%) with thyroid cancer evidenced by major clinical features of hyperthyroidism were encountered out of 129 patients with thyroid cancer operated on. Clinical complains consisted of palpitation, dyspnea, nervousness, increased appetite, and weight loss. Preoperative BMR of 12 patients ranged from +17% to +41%, averaging +31.4%. Definite diagnosis was made by preoperative biopsy in two patients, the remainder was misdiagnosed as having primary hyperthyroidism (12), nodular goiter (6), and adenoma (2). The causes of misdiagnosis, coexistence of thyroid cancer and hyperthyroidism, and prognosis were discussed. we conclude that fine needle biopsy is the most effective way to establish correct preoperative diagnosis.     

原发性甲状腺功能亢进症合并甲状腺微小癌:附32例报告

目的　探讨原发性甲状腺功能亢进症 (甲亢 )合并甲状腺微小癌的诊断和治疗。方法　回顾性分析 1994年 1月～ 2 0 0 2年 12月收治的经外科手术及病理证实为原发性甲亢合并甲状腺微小癌 3 2例的临床资料。结果　全组微小癌发病率为 1.0 7%。术前无 1例确诊。 3 2例均行双侧甲状腺次全切除术。术中见双侧甲状腺弥漫性肿大 ,11例发现有小结节或星状疤痕样改变。均无淋巴结转移 ,均末行二次手术。全组病例术后随访 1～ 10 (平均 5 .5 )年均未见甲亢或甲状腺癌复发。结论　甲亢合并甲状腺微小癌的临床诊断较困难 ,多于手术后病理诊断。手术治疗效果良好 ,预后较好 ,但术后仍需长期随访     

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。     

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.     

Thyroid disorders. Part I: hyperthyroidism.

The significant thyroid disorders that may be found in dental patients are presented in a series of 3 articles. This article (part I) deals with hyperthyroidism, part II with hypothyroidism and thyroiditis, and part III with neoplastic lesions of the thyroid. The signs and symptoms, laboratory tests used to diagnoses hyperthyroidism, and the medical management of patients with hyperthyroidism are presented in this paper. The dental management of patients with hyperthyroidism is discussed in detail. The dentist, by detecting the early signs and symptoms of hyperthyroidism, can refer the patient for medical diagnosis and treatment and avoid potential complications of treating patients with uncontrolled disease. These complications include the rare thyrotoxic crisis (thyroid storm) that may be precipitated by dental treatment, acute infection, or trauma in the patient with uncontrolled hyperthyroidism. Also, the use of epinephrine or other pressor ammines can cause a hypertensive crisis in the patient with uncontrolled hyperthyroidism. Patients will benefit from the early detection and referral by reducing the risks of the medical complications such as hypertension, cardiac arrhythmias, and congestive heart failure.     

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。     

Thyroid cancer

The management of patients with thyroid cancer can be optimized by developing multidisciplinary groups of highly specialized individuals. The completeness of surgery and its morbidity are mostly surgeon-dependent. Similarly, the decisions regarding selection of adjuvant treatments, doses, follow-up schemes, and so forth require depth of knowledge and understanding of the disease; its variables; factors that govern its course; and the values, limitations, and side effects of alternative therapies.     

Thyroid cancer in patients with Grave's Disease

OBJECTIVE: To evaluate the incidence of thyroid carcinoma in patients operated on for Graves' disease, to identify criteria which may predict malignancy, and to develop a practical approach to determine the extensiveness of thyroidectomy. PATIENTS AND METHODS: Retrospective study of all patients who underwent thyroidectomy for Graves' disease between 1995 and 2005. RESULTS: 547 patients underwent subtotal thyroidectomy for Graves' disease during this period. Post-operative pathology examination revealed six cases of thyroid cancer (1.1%). All six cases had differentiated thyroid carcinoma (papillary carcinoma in 3 cases, follicular carcinoma in 2 cases and papillo-follicular carcinoma in 1 case). The indication for initial thyroidectomy was a palpable thyroid nodule in 3 cases (50%), failure of medical treatment for Grave's disease in 2 cases (33%), and signs of goiter compression in 1 case (17%). Five patients underwent re-operative total thyroidectomy. CONCLUSION: This study shows that while malignancy in Grave's disease is uncommon, the presence of thyroid nodule(s) in patients with Grave's disease may be considered as an indication for radical surgery. The most adequate radical surgery in this situation is to perform a total thyroidectomy.     

Coexistence of hyperthyroidism and thyroid cancer

Among 702 patients who underwent surgery for hyperthyroidism, thyroid cancer was demonstrated histologically in 18 patients (2.6%). A higher incidence of cancer occurred in patients with multinodular toxic goiter (3.3% of 317 patients) and uninodular toxic goiter (2.9% of 207 patients), whereas only 1.1% of 178 patients operated for Graves' disease had coexistent thyroid cancer. In addition, 5 patients who underwent surgery for thyroid cancer were found preoperatively to be hyperthyroid, increasing the total number of patients with coexistent thyroid cancer and hyperthyroidism to 23. Among 554 patients with thyroid cancer operated upon during the same period, 4.2% were hyperthyroid (8.6% of patients with papillary thyroid carcinoma, 4.5% with follicular thyroid carcinoma, and only 0.5% with undifferentiated thyroid carcinoma). Thyroid cancer was identified within a toxic nodule in 6 patients, in surrounding tissue suppressed by solitary toxic nodules in 4 patients, in cold nodules coexisting with multinodular toxic goiters in 8 patients, and microscopically disseminated in diffuse toxic goiters in 2 patients; 3 patients presented large inoperable and metastatic tumor masses. Although in 8 of the 23 patients (35%) the thyroid cancer was advanced (extrathyroid growth of the primary tumor and/or regional metastases and/or distant metastases), cancer was diagnosed preoperatively in only 5 patients (22%). This study demonstrates that hyperthyroidism does not prevent thyroid cancer and that patients with nodular toxic goiters in particular must be carefully evaluated with regard to risk factors, history, and clinically suspicious signs. Needle biopsy should not be restricted to cold nodules. Surgery rather than radioactive iodine or antithyroid therapy is the treatment of choice in toxic nodular goiter.

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Résumé Parmi 702 malades qui ont été opérés pour une hyperthyroïdie, 18 (2.6%) présentaient des lésions cancéreuses à l'examen histologique. Le taux du cancer est plus élevé chez les malades opérés pour un goître multi nodulaire toxique (3.3% pour 317 malades) ou pour un goître uninodulaire toxique (2.9% pour 207 malades) que chez les malades opérés pour une maladie de Basedow (1.1% pour 178 malades). A ces 18 malades s'ajoutent 5 cas de cancer thyroïdien qui s'accompagnaient d'hyperthyroïdie reconnue avant l'intervention. Le nombre total de cas d'association hyperthyroïdie—cancer thyroïdien s'élève donc à 23.Parmi un groupe de 554 malades opérés pour cancer thyroïdien pendant la même période, 4.2% présentaient également une hyperthyroïdie le taux atteignant 8.6% pour les malades qui présentaient un cancer papillaire, 4.5% pour ceux qui étaient atteints d'un cancer folliculaire, et seulement 0.5% pour les malades porteurs d'un cancer indifférencié.Le cancer fut décelé au niveau de 6 adénomes toxiques solitaires, de la périphérie de 4 adénomes du même type, de 8 nodules froids coexistant avec des goîtres multi nodulaires toxiques, de 2 goîtres toxiques diffus et chez 3 malades qui présentaient des métastases volumineuses inopérables.Bien que 8 de ces 23 malades (3.5%) fussent porteurs d'un cancer avancé (extension thyroïdienne de la tumeur primitive par métastases régionales et par métastases à distance, le diagnostic ne fut porté seulement que 5 fois avant l'intervention.Cette etude démontre que l'hyperthyroïdisme ne s'oppose pas au développement du cancer et qu'il convient de penser à la présence de lésions néoplasiques associées chez tous les sujets porteurs d'un adénome toxique et de rechercher par l'interrogatoire et l'examen clinique les éléments qui caractérisent le processus tumoral. La biopsie à l'aiguille ne doit pas être réservée au nodule froid.En conclusion, le traitement chirurgical mieux que le traitement par l'iode radioactif ou les antithyroïdiens est le traitement de choix du goître nodulaire toxique.

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Presented at the annual meeting of the International Association of Endocrine Surgeons, Montreux, Switzerland, September, 1981.