桥本甲状腺炎合并甲状腺癌的临床特点

Clinical features of Hashimoto's thyroiditis complicated with thyroid carcinoma

目的总结桥本甲状腺炎(HT)合并甲状腺癌的临床改变特点。方法收集2005年1月至2009年12月我院HT合并甲状腺癌病例24例,回顾性分析24例患者临床资料、影像学和病理改变特点。结果 HT合并甲状腺癌病例占同期手术治疗HT患者的27.0%(24/89),高于同期未合并HT甲状腺患者中甲状腺癌的发病率(13.0%,P<0.01),除1例滤泡状癌外余23例患者均为乳头状癌。甲状腺功能异常9例,抗甲状腺球蛋白抗体(TGAb)升高14例,甲状腺过氧化物酶抗体(TPO-Ab)升高16例。超声检查均发现甲状腺结节样病变,特征与甲状腺癌的超声影像类似,病理改变特征也与一般甲状腺癌类似。随访23例,无甲状腺癌复发及转移病例。结论对伴有甲状腺结节的HT患者应警惕甲状腺癌可能。其治疗措施可参照甲状腺癌的处理。

Objective To analyze the imaging appearance and pathologic diagnosis in patients with Hashimoto＇s thyroiditis （HT） complicated with thyroid carcinoma（TC） and to explore the diagnosis and surgical treatment. Methods The clinical and pathological data of patients with HT complicated with thyroid carcinoma were reviewed retrospectively. The preoperative US characteristics and postoperative histopathologic features in patients with and without HT were compared. Results The prevalence of TC in the HT patients was 27.0%. In contrast, it was 13.0% in patients without HT （P〈 0.01）. The US characteristics of thyroid carcinoma were similar in the group with HT compared with the group without HT. The histopathologic characteristics of thyroid carcinoma in patients with and without HT were compared, there was no significant difference. All patients received surgical treatment. Twenty three patients underwent routine follow-up, and they had no recurrence or metastasis. Conclusions Nodules in patients with HT goiter need close observation of neoplastic changes because HT may predispose to the development of TC. Surgical treatment is effective for patients of HT complicated with TC is effective, and the measures of treatment may be in accordance with the principle of TC without HT.