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.

Surgical therapy for hyperthyroidism and concurrent thyroid carcinoma

Objective To evaluate the diagnosis and surgical treatment of primary hyperthyroidism concurrent with thyroid carcinoma.Methods The clinical data 48 cases with hyperthyroidism complicating with thyroid carcinoma,confirmed by pathology in Peking Union Medical College Hospital from January 1983 to July 2009 was retrospectively analyzed.Results The incidence of thyroid carcinoma was 2.02% (48/2378) in hyperthyroidism,and the incidence of hyperthyroidism was 3.03% (48/1584) in thyroid carcinoma.The diagnostic accuracy of ultrasound and radionuclide imaging were 61.3%and 62.5% respectively.Thyroidectomy was performed in 48 patients (37 women and 9 men),including 43 papillary carcinomas,4follicular carcinomas and 1 follicular papillary carcinomas.Subtotal thyroidectomy (31 patients),homolateral total thyroidectomy and contralateral subtotal thyroidectomy with neck dissection (6 patients),and total thyroidectomy with neck dissection or radical neck dissection (11 patients) were performed.Lung metastasis and bone metastasis were found in 2 cases in the second year after surgery.40 cases were followed up from 1 to 264 months (mean 130.5 months) postoperatively and there was no hyperthyroidism recurrence.Conclusions The diagnosis of occult thyroid cancer complicated with hyperthyroidism is very difficult,most of which were diagnosed by pathology.Ultrasound and radionuclide imaging are of much importance for the establishment of diagnosis.The postoperative prognosis of thyroid papillary carcinoma complicated with hyperthyroidism is satisfactory.