14例异位甲状腺疾病临床诊治分析

Analysis on Diagnosis and Treatment of 14 Cases of Ectopic Thyroid Gland Disease

目的探讨异位甲状腺疾病的临床特点及诊治方法，减少对该疾病的误诊误治。方法回顾性分析2002～2010年期间笔者所在医院14例经外科手术及病理学检查证实的异位甲状腺疾病患者的临床和病理资料。结果14例中男4例，女10例；5例有临床症状；8例为术前明确诊断，6例为术后经病理学检查明确诊断。病变为恶性4例，良性10例。术后接受TSH抑制治疗4例，其中3例为分化型异位甲状腺癌，1例为单纯异位甲状腺但正常位置甲状腺为乳头状癌；4例良性及1例异位甲状腺髓样癌患者接受左旋甲状腺素替代治疗；另外5例良性患者未接受其他治疗。9例患者随访1～10年，平均5．5年，均正常生活；恶性患者无肿瘤复发和转移。结论异位甲状腺一般无特殊临床表现，对于舌根至纵隔内的包块，尤其是颈部包块，应仔细检查正常位置是否存在甲状腺，以排除异位甲状腺的可能。彩超、甲状腺核素扫描、甲状腺功能检查、CT及细针穿刺细胞学检查是重要的检查手段。异位甲状腺可发生与正常位置甲状腺一样的病变，一旦确诊，应根据患者年龄、异位甲状腺类型、位置、大小和病变性质来选择随访观察、手术治疗、左旋甲状腺素替代治疗或TSH抑制治疗以及^131I治疗。

Objective To explore the clinical characteristics, diagnosis and treatment of ectopic thyroid gland （ETG） so as to reduce the misdiagnosis and improper treatment. Methods According to the patients who were definitely diagnosed ETG by pathology from 2002 to 2010 in our hospital, their clinical and pathological data were retrospectively analyzed. Results There were 14 patients, 4 cases of male and 10 cases of female. Five patients had clinical symptoms. Eight cases were diagnosed before operation and six cases were diagnosed by pathology after operation. There were 4 cases were malignancy and 10 were benign. Three cases of differentiated ectopic thyroid carcinoma patients and 1 normal position＇s thyroid had papillary carcinoma patient accepted TSH suppression treatment after operation, 4 benign patients and 1 ectopic thyroid medullary carcinoma patient accepted levothyroxine substitution treatment after operation, and the other 5 benign patients did not accept any treatment after operation. Nine patients who accepted follow-up in 1-10 years had orthobiosis, and the malignancy patients without recurrence and metastasis. Conclusions ETG usually reveal no any special clinical features. For any masses from root of tongue to mediastinum, especially cervical masses, should be carefully check whether there are thyroid in normal position, and to exclude ETG. The color Doppler ultrasound, thyroid radioactive scanning, thyroid function tests, computed tomography, and fine needle aspiration cytology are all important examination measures. Due to the ETG may occur the same lesions as the normal position＇s thyroid, so once it is be definitly diagnosed, the treatment should be based on patient＇s age, position, size, and type of ETG, and nature of the lesions to select follow-up observation, operative treatment, levothyroxine replacement or therapeutic inhibition of TSH, and ^131I therapy.