老年人桥本甲状腺炎临床分析

Clinical analysis of Hashimoto's thyroiditis in 40 elderly patients

目的 探讨老年人桥本甲状腺炎的临床特点，以助早期诊断。 方法 对４０ 例老年桥本甲状腺炎患者的临床资料进行回顾性分析，并与同期４０ 例该病非老年患者进行对比。 结果 入院误诊：老年组２９ 例（７２５％ ），其中１３ 例（３２５％ ）误诊为甲状腺癌；非老年组１４ 例（３５０％ ），其中２例（５０％ ）误诊为甲状腺癌；两组比较，差异有显著性（Ｐ＜ ００１）。行甲状腺球蛋白抗体（ＴＧＡ）、甲状腺微粒体抗体（ＴＭＡ）检查者老年组２７ 例，ＴＧＡ 阳性２５ 例（９２６％ ），ＴＭＡ阳性２６ 例（９６２％ ），２ 项均阳性２５ 例（９２６％ ）；非老年组３０ 例中分别为２７ 例（９００％ ）、２８ 例（９３３％ ）及２７ 例（９００％ ）。老年组２２ 例及非老年组２１ 例经病理学检查证实为桥本甲状腺炎。 结论 老年人一旦发现甲状腺肿大，无论有无相关症状，均要考虑桥本甲状腺炎的可能性，应及时行甲状腺功能及ＴＧＡ、ＴＭＡ 检查。必要时可进行甲状腺针吸或病理检查确诊。

Objective To find the clinical features of Hashimoto's thyroiditis in the aged so as to increase the diagnostic accuracy of Hashimoto's thyroiditis. Methods The clinical data of 40 elderly patients suffering from Hashimoto's thyroiditis were retrospectively analysed and compared with those of 40 non elderly patients with Hashimoto's thyroiditis selected in the same period. Results Twenty nine elderly patients (72 5%) were misdiagnosed and 13 of them ( 32 5%)were misdiagnosed as thyroid cancer. Fourteen non elderly patients (35.0%) were misdiagnosed and only 2 (5 0%)were misdiagnosed as thyroid cancer. The thyroid antiglobulin antibody(TGA)and thyroid antimicrosomal antibody (TMA) were determined in the 27 elderly patients and 30 non elderly patients. The positive rate of TGA and TMA in the aged was 92 6% and 96 2% respectively;the positive rate of TGA and TMA in the non elderly patients was 90 0% and 93 3% respectively. The positive rate for both the TGA and TMA in the aged and the non elderly patients was 92 6% and 90 0% respectively. Twenty two elderly patients and 21 non elderly patients suffering from Hashimoto's thyroiditis were diagnosed by biopsy pathologically. Conclusions Once a goiter is found in elderly people, Hashimoto's thyroiditis should be considered and examinations of TGA and TMA should be done immediately in order to make a correct diagnosis. Biopsy of thyroid gland is necessary to avoid misdiagnosis.