异位甲状腺诊断和治疗

Diagnosis and treatment of ectopic thyroid

目的：探讨异位甲状腺临床特点、诊断和治疗，以减少误诊误治。方法结合国内外文献报道，回顾性分析2000年1月至2011年10月南京军区福州总医院收治的6例异位甲状腺患者临床资料。结果6例中位于颈部3例，舌根部2例，胆囊1例。其中迷走甲状腺2例，因影像学检查提示颈部甲状腺区域未见甲状腺组织，未发生误诊，1例无症状者未予治疗，1例主诉咽部异物感者口服甲状腺素片后肿块缩小，症状缓解；副甲状腺4例，术前均被误诊而行手术切除，病理示3例为异位甲状腺组织，1例为结节性甲状腺肿，术后未出现甲状腺功能减退。结论异位甲状腺少见，缺乏特异性临床表现，特别是副甲状腺误诊率较高。异位甲状腺好发部位如舌根和颈前出现的肿物，应考虑到该病的可能，对可疑病变进行必要辅助检查。根据临床特征、具体类型及甲状腺功能状况及有无恶变等，决定是否采取治疗及选择保守还是手术治疗。另外，应重视甲状腺功能的检测和密切随访。

Objective To investigate the clinical features , diagnosis and treatment of ectopic thyroid in order to avoid misdiagnosis and mismanagement .Methods Six cases of ectopic thyroid admitted to Fuzhou Gen-eral Hospital from Jan .2000 to Oct.2011 were retrospectively analyzed and the literatures were reviewed .Re-sults Three cases of ectopic thyroid were located in the anterior cervical area , 2 cases were at the base of the tongue and 1 case in the gall bladder .Two cases of aberrant thyroid were confirmed preoperatively in patients whose gland wasn＆#39;t discovered by imaging examinations at the normal position of the thyroid gland .A symptomless individual of aberrant thyroid did not need other treatment but follow-up.One case with foreign body sensation in pharynx had a good response to thyroxine therapy .Four cases with accessory thyroid were operated because of misdiagnosis .Three cases were ectopic thyroid tissue and one was nodular goiter confirmed by pathology .None of these patients developed hypothyroidism after surgery .Conclusions Ectopic thyroid gland is a rare disease fre-quently misdiagnosed and mistreated .Goiters in the commonly location of ectopic thyroid gland such as the anteri-or cervical area and the base of the tongue should be paid special attention .Hormonal therapy or surgical inter-vention should be chosen according to clinical features , type of the goiter , thyroid function and whether it is be-nign or malignant .Long term follow-up and thyroid function tests are absolutely necessary .