慢性淋巴细胞性甲状腺炎合并甲状腺癌13例临床分析

Hashimoto's disease coexisting with thyroid cancer:a clinical study of 13 cases.

目的 探讨慢性淋巴细胞性甲状腺炎合并甲状腺癌的发病机制、诊断和治疗。方法 回顾性分析首都医科大学附属同仁医院1994～2 0 0 4年收治的13例慢性淋巴细胞性甲状腺炎合并甲状腺癌的临床资料。结果 慢性淋巴细胞性甲状腺炎合并甲状腺癌的发病率占慢性淋巴细胞性甲状腺炎的12. 15 % (13/ 10 7) ,占甲状腺癌的15. 6 6 % (13/ 83)。所有病人术前均主诉有颈前部结节,1例伴有颈部疼痛,1例有压迫症状,7例显示TSH增高,6例TGA或TMA或两者同时升高,同位素示“冷结节”8例,甲状腺超声检查13例均有低回声结节,2例伴有钙化和淋巴结肿大。12例行一期根治性手术,1例行二期根治性手术。11例随访6个月至8年不等,无复发死亡。结论 慢性淋巴细胞性甲状腺炎可能是甲状腺癌的前期病变;慢性淋巴细胞性甲状腺炎合并甲状腺癌术前诊断很困难,因此掌握对慢性淋巴细胞性甲状腺炎的手术探查指征很重要;对慢性淋巴细胞性甲状腺炎合并甲状腺癌的手术应采取甲状腺癌根治性手术的原则进行手术。

Objective To investigate the pathogenesis,diagnosis and treatment of Hashimoto's disease coexisting with thyroid cancer.Methods The clinical data of 13 cases of Hashimoto's disease coexisting with thyroid cancer admitted from 1994 to 2004 in affiliated Tongren Hospital of Capital Institute of Medical Sciences were analyzed retrospectively.Results The morbidity of Hashimoto's disease coexisting with thyroid cancer occupied 12.15%(13/107) of hospitalized patients with Hashimoto's disease in corresponding period and 15.66% (13/83) of patients with thyroid cancer.All 13 patients complained nodules in their front necks,with 1 neck pain and 1 compression feeling.Elevation of TSH was in 7 cases,elevations of TGA or TMA or the both were in 6 cases.Cold nodule detected by isotopic scan was in 8 cases.Low echo nodules were in all 13 cases with 2 calcifications and 2 lymph nodes enlargements.Primary radical thyroidectomy was performed in 12 cases and secondary radical thyroidectomy was performed in 1 case.Eleven cases were followed up from 6 months to 8 years.No recurrent and death cases were reported.Conclusion Hashimoto's disease may be the precancerous disease of the thyroid cancer.It is very difficult to diagnose preoperatively.Mastering the indications of operative exploration of Hashimoto's disease is predominant important.For the operation of the disease,the operation should be followed the principles of the radical thyroidectomy of thyroid cancer.