桥本病合并甲状腺结节的诊断和治疗

Diagnosis and treatment of Hashimoto disease complicated with thyroid tubercles

目的总结桥本病合并甲状腺结节的诊断和治疗的经验。方法分析该院1991年1月～2006年1月外科手术治疗的31例桥本病合并甲状腺结节的临床资料。结果31例均并发有甲状腺结节,其中合并甲状腺癌4例(12.90%),甲状腺腺瘤2例(6.45%),结节性甲状腺肿6例(19.35%),甲状腺功能亢进1例(3.22%),其余均为淋巴滤泡样结节。术前29例诊断为其他的甲状腺疾病,误诊率为93.5%。均行手术治疗,手术中根据快速病理检查采取了不同范围的手术方式。26例获得随访,随访率为83.87%;术后发生甲状腺功能减退1例。结论合并其他甲状腺疾病的桥本病临床上诊断困难,易误诊,对于并发甲状腺结节的桥本病应考虑手术治疗,手术中应尽量保留正常的甲状腺组织,以防止甲状腺功能减低。

[Objective] To sum up the experience on diagnosis and treatment of Hashimoto disease （HD） complicated with thyroid tubercles. [Method] The clinical data of HD complicated with thyroid tubercles, who were treated from Jan 1991 to Jan 2006 undergoing surgery, was analyzed. [Result] Thyroid nodules were found in all HD cases, among which 4 were with thyroid cancer, 2 with thyroid adenoma, 6 with nodular goiter, 1 with hyperthyroidism, and the other with lymphomatoid tubercles. 29 of 31 HD cases were misdiagnosed to other thyroid diseases. The preoperative misdiagnosis rate was 93.5%. All HD cases undergoing surgery of thyroidectomy of different extent were performed according to pathological results. Follow-up data, which was collected from 26 patients, showed that 1 patient developed hypothyroidism, and the follow-up rate was 83.87%. [Conclusion] The diagnosis of HD complicated with thyroid tubercles is still difficult which is easy to misdiagnose. HD cases complicated with thyroid nodules should be treated surgically. The normal thyroid tissue should be maintained as more as possible during operation in order to avoid the postoperative hypothyroidism.