160例未成年人甲状腺相关疾病临床特点分析

Analysis on clinical characteristics of 160 cases of thyroid related diseases in minors

目的通过对临床上未成年人甲状腺疾病的病例特点进行总结分析,提高临床医生对未成年人甲状腺疾病的认识及诊治水平。方法回顾性分析2018年1月-2019年12月,在曲靖市第一人民医院出院,年龄小于18岁,病案诊断为甲状腺疾病的160例初诊患者的临床资料、实验室检查、彩超、病理等资料,分析总结其临床特征。结果1月龄~17岁之间各年龄段均可发病,其中占比较高的年龄包括:15岁占16.3%,16岁占13.1%,12岁占10.6%,3岁以下占10.5%,14岁占10%,17岁占7.5%。其中男性占35.6%,女性占64.4%。TGAb平均396.9±1054.7IU/mL;TPOAb平均241.8±488.3IU/mL。彩超方面甲状腺功能亢进症患者表现为甲状腺体积稍增大,或弥漫性增大,血流信号丰富,实质回声均匀。若低回声,提示炎症。双侧甲状腺实质非均质占位性病变,片状不均质回声,后期的病理检查报告提示乳头状癌。甲状腺双侧叶内多个占位性病变,伴颈部多个淋巴结,后期的病理检查报告提示滤泡性腺癌。或者表现为甲状腺囊实性占位等。其中7例完善甲状腺细针穿刺活检,6例为甲状腺乳头状癌,1例为恶性滤泡性肿瘤。结论未成年人甲状腺疾病以甲状腺功能亢进症、甲状腺功能减退症、亚临床甲减、甲状腺结节、甲状腺脓肿等多见。详细询问病史、仔细体格检查、酌情检测甲状腺功能、甲状腺彩超,必要时加做免疫学检查、针刺活检,可实现早诊早治。

Objective To improve the understanding,diagnosis and treatment of thyroid diseases in minors by summarizing and analyzing the clinical characteristics of thyroid diseases in minors.Methods The clinical data,laboratory tests,color ultrasound,pathology results of 160 newly diagnosed patients who were discharged from the First People s Hospital of Qujing from January 2018 to December 2019 and younger than 18 years old and diagnosed as thyroid disease were retrospectively analyzed and summarized.Results It could be occurred in all ages from one month to 17 years,with the highest proportion of ages including 16.3%at 15 years old,13.1%at 16 years old,10.6%at 12 years old,10.5%under three years old,10%at 14 years old,and 7.5%at 17 years old.Among them,35.6%were males and 64.4%were females.TGAb averaged 396.9±1054.7IU/mL;TPOAb averaged 241.8±488.3IU/mL.Color ultrasound showed that patients with hyperthyroidism showed a slight increase in thyroid volume,or diffuse increase,rich blood flow signals,and uniform parenchyma echo.Low echo indicated inflammation.Bilateral thyroid parenchyma heterogeneous space occupying lesions,patchy heterogeneous echo,late pathological examination reports suggested papillary carcinoma.There were many occupying lesions in bilateral lobes of thyroid gland with multiple lymph nodes in the neck,the pathological examination report in the later period suggested follicular adenocarcinoma.It might be manifested as thyroid cystic solid mass.Among them,7 cases were underwent thyroid fine needle aspiration biopsy,6 cases were papillary thyroid carcinoma,and 1 case was malignant follicular tumor.Conclusions Hyperthyroidism,hypothyroidism,subclinical hypothyroidism,thyroid nodules and thyroid abscesses are the most common thyroid diseases in minors.In clinic,detailed medical history,careful physical examination,thyroid function detection,thyroid color ultrasound as appropriate,and immunological examination and needle biopsy if necessary can achieve early diagnosis and treatment.