桥本甲状腺炎诊断分析(附45例报告)

The Diagnosis of Hashimoto Thyroiditis: A Report of 45 Cases

目的 探讨桥本甲状腺炎的临床表现及诊断。方法 经甲状腺细针穿刺细胞学检查确诊 45例桥本甲状腺炎患者 ,对患者的病史、临床特点、实验室资料、甲状腺彩超检查及甲状腺细针穿刺细胞学检查进行总结分析。结果 本病主要发生在中年女性 ,常有甲状腺肿大伴咽喉部不适感 ,患者甲状腺功能可以正常、减退或亢进。 3 9例患者的抗甲状腺球蛋白抗体和抗甲状腺微粒体抗体同时增高。甲状腺声像图有一些表现 :甲状腺内部回声减低者 19例 ;腺体弥漫肿大 ,内见散在无包膜低回声结节 15例 ;稍高回声结节 3例 ;甲状腺组织中有细带状网格样改变伴颈部淋巴结肿大者 8例。结论 对桥本甲状腺炎的诊断应重视病史 ,进行必要的辅助检查 ,甲状腺自身抗体检测和甲状腺超声是诊断本病的重要方法 ;如在鉴别诊断有困难时 ,甲状腺细针穿刺细胞学检查是不可缺少的一种诊断手段。

Objective To investigate the clinical manifestation and diagnosis of Hashimoto thyroiditis (HT). Methods 45 HT patients diagnosed by fine needle aspiration cytology (FNAC) were enrolled in this study. Their medical history, clinical parameters, data of laboratory examination, colour doppler ultrasonic image and FNAC were analyzed. Results This disease was more common in women than in men, and most of cases occurred during 35～50 years old. Almost all cases had the symptoms of thyromegaly and laryngopharynx malaise. The patients had normal thyroid function, hypothyroidism or hyperthyroidism. The levels of both antithyroid globulin antibody and antithyroid microsome antibody increased in 39 cases. The ultrasonic imaging features of thyroid were such as following: diffusive nonhomogenous hypoecho pattern in 19 cases, numerous hypoecho micronodes in 15 cases, hyperecho micronodes in 3 cases, and hyperecho bandlike echo pattern with swelling of neck lymph nodes in 8 cases. Conclusion Diagnosis of HD should put emphasis on a complete medical history, physical examination and necessary laboratory tests. Antithyroid auto-antibody assay and thyroid ultrasonic examination were very important for diagnosis of HD, and FNAC may be indispensable in suspected cases.