30例原发性甲状腺功能亢进症合并甲状腺癌临床特征分析

目的探讨原发性甲状腺功能亢进症（简称甲亢）合并甲状腺癌（简称甲癌）的流行病学及临床特点。方法回顾性分析2002年1月至2011年6月中南大学湘雅医院普外科手术治疗的365例甲亢中30例合并甲癌（甲亢并甲癌组）的临床资料，并与同一时段随机抽取的30例无甲亢的甲癌（对照组）对照分析。结果甲亢中甲癌发生率为8．22％（30／365）；甲亢并甲癌组与对照组的病程中位数分别为875．00d和120．00d（z=-2．501，P〈0．05）；甲亢并甲癌组、对照组术前甲癌诊断率分别为40．0％（12／30）和66．7％（20／30）（X^2=4．286，P〈0．05）；甲亢并甲癌组、对照组淋巴结转移率分别为20．0％（6／30）和46．7％（14／30）（X^2=4．800，P〈0．05）。本组均获随访，平均随访4．5年（1个月～9年半），甲亢并甲癌组1例（3．3％）术后5年甲亢复发，对照组1例（3．3％）术后1年甲癌复发再次手术切除，1例（3．3％）术后半年死于甲癌肺转移呼吸衰竭。结论原发性甲亢合并甲癌具有甲亢中甲癌发生率高、病程长、术前误诊率高、淋巴结转移率低、预后良好等特点。

Clinical features of 30 cases of primary hyperthyroidism complicated with thyroid cancer

Objective To study the epidemiological and clinical features of primary hyperthyroidism complicated with thyroid cancer. Methods Clinical data of 30 cases of hyperthyroidism complicated with thyroid cancer（ hyperparathyroidism group） were retrospectively analyzed. They were chosen from the 365 cases of primary hyperparathyroidism treated by operation from Jan. 2002 to Jun. 2011. At the same time, 30 cases of thyroid cancer without hyperparathyroidism were randomly taken out as the control group. Results The incidence of thy- roid cancer in primary hyperparathyroidism was 8.22% （ 30/365 ）. The median course, preoperative diagnostic rate of thyroid cancer, and lymph nodes metastasis rate for hyperparathyroidism group and control group was 875.00 vs 120. 00 days （z = -2. 501, P 〈 0. 05 ）, 40.0% （12/30） vs 66. 7 % （20/30） （X^2 = 4. 286, P 〈 0. 05 ）, and 20.0% （ 6/30 ） vs 46.7 % （ 14/30 ） （X2 = 4. 800, P 〈 0.05 ） respectively. All patients were followed up with the average of 4. 5 years, ranging from 1 month to 9 yeas and a half. 1 case（3.3% ）in hyperparathyroidism group recurred hyperthyroidism 5 years after surgery. 1 case（ 3.3% ）recurred thyroid cancer 1 year after surgery and received operation again, and 1 case（3.3% ）died half a year after operation from respiratory failure caused by lung metastasis of thyroid cancer in the control group. Conclusions Hyperthyroidism complicated with thyroid cancer has the characteristics of high incidence rate of thyroid cancer in the hyperthyroidism patients, long course, high preoperative misdiagnosis rate, low lymph node metastasis rate, favorable prognosis and so on.