非典型亚急性甲状腺炎11例误诊分析

Analysis of Misdiagnosis in 11 Cases of Atypical Subacute Thyroiditis

目的探讨非典型亚急性甲状腺炎(atypical subacute thyroiditis,ASAT)的临床特点及误诊原因。方法回顾性分析11例误诊为甲状腺癌的ASAT的临床资料。结果9例无明显症状且在体检行B超检查或查体时发现甲状腺结节;2例颈部轻微疼痛。4例查体阳性,即可触及无痛、质硬或质韧肿物。所有患者均行超声检查,提示患侧甲状腺直径增大1例;一叶单发结节、一叶多发结节各1例,双叶单发结节2例,双叶多发结节7例;结节直径0.3~1.7 cm;结节呈低回声9例,呈混合性回声、偏高回声各1例;结节边界模糊9例,其中无包膜3例,呈毛刺状1例;形态欠规则且结节纵横比>1、内部回声欠均匀各3例;可见点状强回声6例,结节伴钙化1例。CDFI提示结节内有丰富血流、结节内有少量血流各1例,结节周边有血流3例。11例均误诊为甲状腺癌而行手术治疗,经术中冷冻病理与术后病理检查确诊为ASAT,术后均恢复良好,其中9例口服左甲状腺素。结论临床医师应加强对ASAT的认识,及时行超声对比研究,提高诊断准确率,同时加强细针穿刺细胞学检查的使用,避免误诊及过度治疗。

Objective To investigate the clinical features and misdiagnosis causes of atypical subacute thyroiditis(ASAT).Methods Clinical data of 11 patients with ASAT who were misdiagnosed as thyroid cancer were analyzed retrospectively.Results Nine cases had no typical clinical symptoms,but thyroid nodule was found by ultrasonography or physical examination.Two cases had mild cervical pain.Four cases were positive in physical examination for painless hard or tough masses.All patients were examined by ultrasonography,which indicated enlarged thyroid gland in 1 case,a solitary nodule within one lobe in 1 case,multiple nodules within one lobe in 1 case,a solitary nodule within two lobes in 2 cases,and multiple nodules within two lobes in 7 cases,and the diameter of the nodules was between 0.3 and 1.7cm.Ultrasound examination showed hypoecho in 9 cases,mixed echo in 1 case,and hyperecho in 1 case.Nine cases had poorly defined margins,including 3 cases without capsule,and 1 case with spicular sign.Three cases had irregular shape,and aspect ratio of nodules>1 and 3 cases had uneven internal echo.In addition,there were 6 cases with punctate strong echo and 1 case with nodule with calcification.CDFI showed abundant blood flow in 1 case,little blood flow in 1 case,and peripheral blood flow of the nodules in 3 cases.And 11 cases were misdiagnosed as thyroid cancer and were treated surgically.Intraoperative cryopathology and postoperative pathological examination confirmed that they had subacute thyroiditis(SAT),and the prognosis was good.Of them,9 patients took oral levothyroxine.Conclusion Clinicians should strengthen the understanding of ASAT,carry out comparative study of ultrasound in time,improve the diagnostic accuracy,and strengthen the use of fine-needle aspiration cytology to avoid misdiagnosis and over-treatment.