桥本甲状腺炎误诊16例分析

Analysis of Misdiagnosis for Hashimoto's Thyroiditis:Experience on 16 Cases

目的探讨桥本病误诊的原因及减少误诊的策略。方法回顾分析剑阁县人民医院普外科自1999年3月至2009年3月经手术治疗618例甲状腺手术中，术后病理证实为桥本病16例，结合文献进行分析。结果误诊率2．58％（16／618），术前诊断单侧甲状腺瘤8例（1．29％），双侧甲状腺瘤6例（0．97％），甲状腺功能亢进伴甲状腺瘤1例（0．16％），可疑甲状腺癌1例（0．16％），10例（1．61％）术后2～3年内出现不同程度的甲状腺功能减退表现。结论临床外科医师应重视对桥本病的认识，细针穿刺活捡和术中冰冻、病理切片有助于诊断和确定手术方式，避免盲目扩大手术减少术后甲状腺功能减退的发生。

Objective To discuss why misdiagnosis of Hashimoto＇s thyroiditis happened and how to avoid it. Methods From March 1999 to March 2009, 618 patients underwent thyroidectomy in department of general surgery, Jian＇ge people＇s hospital, and 16 cases were confirmed to be Hashimoto＇s thyroiditis by pathological analysis after surgery. We analyzed the causes of misdiagnosis referring to relative literatures. Results Misdiagnosis rate was 2.58% （16/618）. 8 cases unilateral thyroid adenoma, 6 cases bilateral thyroid adenoma, 1 case thyroid adenoma with hyperthyroidism, and 1 case suspected thyroid cancer were diagnosed preoperatively and were proved to be Hashimoto＇s thyroiditis postoperatively. 10 cases displayed clinic manifestation of hypothyroidism 2 to 3 years after surgery. Conclusion Surgeons should pay more attention to Hashimoto＇s thyroiditis. Fine needle biopsy and intraoperative rapid pathological analysis would help to the diagnosis of Hashimoto＇s thyroiditis and the selection of modus operandi, which would reduce the occurrence of postoperative hypothyroidism by avoiding blind extension of surgery.