原发性甲状腺功能亢进症合并甲状腺癌临床分析

Clinical analysis of primary hyperthyroidism and concurrent thyroid carcinoma

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 2 0 0 2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一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 。

Objective To discuss incidence,cause,diagnosis and treatment of primary hyperthyroidism and concurrent thyroid carcinoma.Method The clinical data of 11 cases of primary hyperthyroidism and concurrent thyroid carcinoma from July 1993 to March 2002 were retrospectively analyzed.Results The incidence was 1.6%.The rate of failure to diagnose concurrent thyroid carcinoma before and during operation was 81.8%.The initial operation for 2 cases was ipsilateral lobectomy and isthmectomy plus contralateral subtotal lobectomy.The initial operation for 9 cases was subtotal thyroidectomy.The postoperative pathologic diagnosis was primary hyperthroidism and concurrent thyroid carcinoma,5 follicular cases,4 papillary cases,2 mixed papillary-follicular cases.Cervical lymph node metastasis was not found.The second operation was performed on 7 cases and among them 3 cases had the residual cancer in thyroid.The incidence of residual cancer in thyroid was 42.9%.All patients were treated with thyroxine postoperatively for a long term.Ten cases were alive and in good health today. One case died.Conclusion Primary hyperthyroidism and concurrent thyroid carcinoma was easily misdiagnosed,and its diagnosis should be improved.The possibility of concurrent thyroid carcinoma should be thought of when nodule in thyroid gland was found.Rational surgical treatment and postoperative treatment with thyroxine could obtain satisfactory effects.