慢性淋巴细胞性甲状腺炎的诊断和治疗

The Diagnosis and treatment of Chronic Lymphotic Thyroiditis

目的:降低慢性淋巴细胞性甲状腺炎的误诊率,选择适宜治疗。方法:回顾性总结1981年—1998年间收治的非典型桥本病64例。结果:64例仅12例未手术,余52例均手术。术后病理结果:单纯桥本病31例,桥本病合并甲状腺腺瘤4例,桥本病合并结节性甲状腺肿12例,桥本病合并甲状腺机能亢进症3例,桥本病合并癌2例。结论:本病误诊率较高,检测TGAB和McAB、细针穿刺活检和甲状腺干制剂诊断性治疗三者结合有助于提高本病的正确诊断率。对有压迫症状或合并其他甲状腺疾病者,可予手术治疗。术中行冰冻病理可明确诊断并确定手术方式,术中应尽量保留正常甲状腺组织,以防术后产生甲状腺功能减低。

Obiective To reduce the misdiagnostic rate of chronic lymphotic thyroiditis and choose proper treatment. Method Retrospectively analysis was made on the 64 cases of chronic lymphotic thyroiditis treated from 1981 to 1998. Results Among 64 cases, only 12 cases had not been operated, while the other 52 cases received operation. The postoperative pathological results showed that simple Hashimoto's disease were in 31 cases, Hashimoto's disease coexistent with thyroid adenoma, nodular goiter, hyperthy-roidsm and carcinoma of thyroid were in 4, 12,3 and 2 cases respectively. Conclusions testing thyroid globulin antibody and thyroid microsome antibody, fine needle aspiration biopsy combined with thyroxin diagnostic therapy is beneficial to improve the corrective diagnostic rate of Hashimot's disease. The patient should need to be operated for Hashimot's disease with pressure symptom or coexistent with other thyroid disease. The intraoperative freezing biopsy can define the diagnosis and decide the operation precedures. but the normal thyroid tissue should be maintained as far as possible in order to avoid the hypothyroidism.