Intrauterine diagnosis and management of fetal goiter: A case report

Fetal goiter can be the result of maternal hyperthyroidism treated with antithyroid drugs. Polyhydramnios may be the presenting symptom and can be diagnosed prenatally by sonography. We report a case of fetal goiter diagnosed at 30 weeks of gestation and fetal hypothyroidism confirmed by cordocentesis. Intra‐amniotic levothyroxine was administered. Onset of preterm labor could not be prevented. The risks and benefits of intrauterine treatment of fetal goitrous hypothyroidism are discussed. © 2010 Wiley Periodicals, Inc. J Clin Ultrasound 38:503–505, 2010     

老年甲状腺结节性病变96例临床分析

目的：分析老年人甲状腺结节性病变的特点。方法：回顾分析96例因非甲状腺疾病就诊的住院老年患者的临床资料,患者于入院后次日清晨抽空腹静脉血测游离三碘甲状腺原氨酸（free triiodothyronine,FT3）、游离甲状腺素（free thyroxine,FT4）及促甲状腺素（thyroid—stimulatinghormone,TSH）等指标,行甲状腺B超检查,并对手术患者进行随访。结果：（1）老年人甲状腺结节的患病率67．71％,其中男女患病车有显著差异;（2）在甲状腺结节患者中,慢性支气管炎及恶性肿瘤的患病率明显增加（P〈0．05）。（3）TSH越高,骨密度（bonemineraldensity,BMP）越低,两者呈负相关。（4）11例甲状腺结节患者进行手术治疗,病理诊断为：甲状腺乳头状癌1例,腺瘤3例,结节性甲状腺肿7例,9例术后甲状腺过氧化物酶抗体（thyroid peroxidaseantibody,TPOAb）升高,均需长期应用左旋甲状腺素。结论：老年人甲状腺结节的患病率较高,女性患病率更高;甲状腺结节患者中慢性支气管炎及恶性肿瘤的患病率明显增加;TSH与骨密度呈负相关;老年人甲状腺结节绝大多数为良性,应以内科随访及治疗为主,手术则需谨慎。     

甲状腺良性结节样病变的CT诊断

目的：探讨甲状腺良性结节样病变的CT表现,重点研究CT检查对良性病变定性诊断准确率和鉴别诊断。方法：总结36例经手术病理证实的甲状腺良性结节样病变。甲状腺腺瘤21例,结节性甲状腺腺肿15例,全部病例行CT平扫,21例做增强扫描。结果：甲状腺腺瘤CT诊断与病理符合准确率为95.2%(20/21);结节性甲状腺肿准确为73.3%（11/15）。单发类圆形均匀低密度结节是甲状腺腺瘤的特征性表现,结节性甲状腺肿以多发不规则形混杂密度病灶为特征。结论：CT在甲大辩论腺腺瘤与结节性甲状腺肿的诊断和鉴别诊断上个有较高准确性,但极少数鉴别仍有困难。     

Intraoperative gamma probe guidance with 99mTc-pertechnetate in the completion thyroidectomy

Aim  Intraoperative gamma probe (GP) guidance with ^99mTc-pertechnetate in the completion total thyroidectomy after a first thyroidectomy was investigated in this prospective study. Methods  The study group comprises of fourteen consecutive patients (14 females, age mean 50.2 ± 12.0 years, age range 29–73 years). All patients underwent a second thyroidectomy due to inadequate (5/14 patients) and complementary (9/14 patients) interventions. Serum-free three iodothyronine, free thyroxin and thyroid stimulating hormone measurements, a neck ultrasonography (USG) and thyroid scintigraphy (TS) were performed in the preoperative and postoperative period. After a 185 MBq (5 mCi) injection of ^99mTc-pertechnetate, background (BG), left thyroid lobe (LTL), right thyroid lobe (RTL) and pyramidal tyroid lobe (PTL) regions were counted in time before and after resection of thyroid remnants by intraoperative GP. All resection materials were evaluated by histopathologic examination. Results  Preoperative TSH was less than 30 mIU/mL (mean 21 ± 7) in all patients. Functioning thyroid remnants were shown in 13/14 patients on the preoperative TS and USG, which were diagnosed by USG in one but by TS in other one. We calculated that percentage median (minimum–maximum) values were 220.90% (56.00–411.11%) in LTL, 80.43% (11.54–471.05%) in RTL and 66.60% (−3.33 to 158.33%) in PTL for counts before resection, on the other hand, 15.96% (−20.55 to 47.62%) in LTL, 17.59% (−15.07 to 38.46%) in RTL and 17.59% (−1.96 to 57.14%) in PTL regions for counts after resection. There were statistically significant differences between these values belonging to before and after resection for LTL (p = 0.001), RTL (p = 0.001) and PTL (p = 0.008). Bilateral small foci in a patient and unilateral focus in other patient were observed in postoperative TS. Unilateral focus was detected on the RTL by GP, but not bilateral foci. Postoperative TSH levels increased to 30 mIU/mL (mean 69 ± 26) at least. There was a statistically significant difference between preoperative and postoperative TSH values (p < 0.001). Histopathologic confirmation revealed that all removed materials were the thyroid tissues. Conclusions  Gamma probe guidance with ^99mTc-pertechnetate seemed to be a good option and easy available method in patients undergoing the completion total thyroidectomy.     

结节、斑疹双相型皮肤淀粉样变一例

患者女,40岁,腰、腹部结节14年,无自觉症状,进行性加重;上背部色素性斑疹,痒十余年,于1989年来我院首诊,给予手术切除并行病理检查,诊断为结节型皮肤淀粉样变.最近因腰、腹部出现新的结节、斑块,背部出现褐色斑疹,痒,再次来我院就诊.既往体健,家族中无类似病史.皮肤科检查:双肩胛间见片状褐色斑疹,轻度肥厚(图1);腰、腹、臀部数个大小不等的结节、斑块,黄豆粒至红枣大小,呈黄红色,具蜡样光泽,部分区域有萎缩、紫癜及色素沉着,质硬,无触痛(图2).     

甲状腺实性小结节的超声与病理对照研究

 目的  分析甲状腺实性小结节(直径＜10 mm)的超声及病理学表现, 以提高超声定性诊断水平。  方法  对照分析50例甲状腺乳头状微小癌(papillary thyroid microcarcinoma,PTMC)和34例结节性甲状腺肿(nodular goiter,NG)的声像图表现,包括结节的位置、形态、大小、内部及后方回声、钙化、边界和血流情况,并与病理学表现相对照。  结果  PTMC多表现为低回声结节(89.3%),纵横比≥1(71.4%),伴有后方回声衰减(64.2%),可见微小钙化(37.5%);NG结节表现为中高回声(64.7%),纵横比＜1(73.5%),后方回声无衰减(88.2%)。良恶性结节的回声强度及后方回声、纵横比、微小钙化、形态、边界、血流阻力指数的差异有统计学意义。PTMC的病理基础为不同比例组成的癌细胞和纤维间质呈乳头状或滤泡状结构排列,可有纤维假包膜、砂粒体和肿瘤血管。NG的病理基础为形态规则,边界清晰,由大小不等滤泡结构组成,伴薄层纤维组织包裹分隔滤泡组织,滤泡腔内含多量胶质。  结论  PTMC和NG的病理构成差异决定其超声图像特征的不同。     

腹腔镜单侧肾上腺切除术治疗肾上腺结节样增生性原发性醛固酮增多症的效果评价

目的 探讨经腹腔途径腹腔镜单侧肾上腺切除术治疗肾上腺结节样增生性原发性醛固酮增多症的效果。方法 2004年4月至2010年8月间,我科共收治114例肾上腺结节样增生性原发性醛固酮增多症患者,其中105例为单侧,9例为双侧,均行经腹腔途径腹腔镜单侧肾上腺切除术。回顾性分析患者的临床资料,并随访其术后血压恢复情况及血浆醛固酮、血钾的变化。结果 所有手术均获成功,无中转开放手术患者。平均手术时间为（32.4±8.3）min,平均术中出血量为（10.5±5.2）mL,平均术后住院时间（7.9±3.1）d,术中及术后无重大并发症。术后病理均为肾上腺结节样增生,结节大小在2~16mm间。在中位时间为31(6～82)个月的随访期内,55例(48.2%)患者高血压治愈,57例(50%)改善,2例(1.8%)无效,1例患者术后醛固酮仍高出正常,其余患者的血浆醛固酮及血钾均在正常范围内。结论 腹腔镜单侧肾上腺切除术是治疗肾上腺结节样增生性原发性醛固酮增多症的一种安全、有效的方法。     

2011年商丘市睢阳区饮用水碘含量调查分析

目的了解睢阳区饮用水碘含量情况,为科学指导补碘提供依据。方法2011年睢阳区按照每个行政村分东、南、西、北、中5方位,每方位采集2份水,集中式供水采集1份末梢水,用砷铈催化分光光度测定法测定饮用水碘含量。结果 2 678份水碘含量均数为161.1μg/L,中位数为131.6μg/L,范围在7.7μg/L～752.0μg/L之间。结论睢阳区属于适碘和高碘村并存地区。