慢性淋巴细胞性甲状腺炎的鉴别诊断:附108例报告

The differential diagnosis of chronic lymphocytic thyroiditis:a report of 108 cases

目的探讨慢性淋巴细胞性甲状腺炎(CLT)的诊断及鉴别诊断方法。方法回顾性分析20年间治疗的108例CLT患者的临床资料,诊断手段包括甲状腺功能测定、抗甲状腺抗体测定、影像学检查、细胞学穿刺、药物诊断性治疗及手术病理诊断;将94例手术患者的术前诊断与术后病理结果进行对比分析。结果108例中有14例未手术,其中9例经B超引导下行细胞学穿刺检查确诊,5例经泼尼松药物试验治疗而确诊。行手术治疗的94例中术前诊断为结甲57例,甲癌16例,结甲伴甲亢13例,CLT伴结甲8例。术后病理诊断为CLT 59例(62.7%),CLT伴结甲19例(20.2%),CLT伴甲亢10例(10.6%),CLT伴甲癌6例(6.3%)。术前误诊率91.5%(86例)。结论CLT临床表现多样,容易发生误诊。对甲状腺功能、抗甲状腺抗体测定及影像学检查结果的仔细分析有助于CLT的确诊。细胞学穿刺检查和药物诊断性治疗是CLT确诊的较好方法。术前明确诊断可减少对CLT的不必要手术处理。

Objective To evaluate the diagnosis and differential diagnosis methods for chronic lymphocytic thyroiditis （CLT）. Methods One hundred and eight patients with CLT were treated in our department during recent 20 years, the clinical data were analyzed retrospectively. The diagnostic methods included thyroid function measurement, anti-thyroid antibody measurement, image detection, fine needle aspiration, diagnostic drug therapy and biopsy exam during operation. The preoperative examinations and diagnoses of 94 patients, who had received operation, were compared with postoperative pathological results. Results Forteen of the 108 cases did not receive any operation, of whom, 9 had a definite diagnosis of CLT by fine needle biopsy under color ultrasound and 5 by drug （prednisone） diagnostic treatment. Before operation, 57 patients were diagnosed as nodular goiter, 16 as thyroid cancer and 13 as nodular goiter associated with hyperthyroidism. Only 8 patents were diagnosed as CLT with nodular goiter. Postoperative pathological reports were simple CLT in 59 cases （62. 7%）, CLT with nodular goiter in 19 （20. 2%）, CLT with hyperthyriodism in 10 （ 10.6 % ） and CLT with thyroid cancer in 6 （ 6.3 % ）. The preoperative misdiagnosis rate reached 91. 5% （86cases）. Conclusions It is easy for CLT to be misdiagnosed because of the complex clinical manifestations. Careful analysis of examination results, especially thyroid function measurement, anti-thyroid antibody measurement and image detection is significant for confirming the diagnosis. The fine needle biopsy and diagnostic drug treatment are better methods for CLT diagnosis.Unwarranted operation should be avoided in patients with CLT.