Carli A F, Lottini M, Testa M, Neri A
UO di Endocrino Chirurgia, Policlinico Le Scotte, Università degli Studi, Siena, Italy.
Minerva Chir. 2002 Apr;57(2):117-22.
To report personal experience in the surgical treatment of Hashimoto's thyroiditis. METHODS. Eight patients (7 females, 1 male, mean age 48 years old) referred to our Institution with diagnosis of Hashimoto's thyroiditis have been studied. All patients were evaluated by determination of serum thyroid hormones and of anti-thyreoglobulin and anti-microsomal antibodies; ultrasound and scintigraphic scans of the gland were performed in all cases and a cytological examination of fine needle aspiration (FNAC) of the nodules was evaluated. Diagnosis of Hashimoto's thyroiditis was suspected on the basis of clinical and laboratory data and was confirmed by cytology and histology on surgical specimens. Preoperative FNAC showed a Hashimoto's thyroiditis with thyroid differentiated carcinoma in 3 cases (37.5%), Hashimoto's thyroiditis in 1 case and chronic thyroiditis in 4 cases (50%). Seven patients underwent surgery, while 1 patient received a medical treatment; we performed 6 total thyroidectomies and 1 hemithyroidectomy. Histology on surgical specimens confirmed the diagnosis of Hashimoto's thyroiditis in all cases; in 3 patients an associated papillary thyroid carcinoma was found.
Postoperative mortality was absent; no major postoperative complications (laryngeal nerve paralysis or permanent hypocalcemia) were recorded. Only 2 mild transient hypocalcemias have been observed.
Total thyroidectomy is the technique of choice in surgical treatment of Hashimoto's thyroiditis, a self-immune pathology which involves the whole gland and has a high correlation with differentiated thyroid carcinoma (37.5%). Total thyroidectomy warrants a radical and definitive control of the disease, without risk of relapse, with a low incidence of major complications, in experienced hands, and anyway lower than the morbility due to reinterventions.
报告自身在桥本甲状腺炎外科治疗方面的经验。方法：对8例（7例女性，1例男性，平均年龄48岁）被转诊至我院且诊断为桥本甲状腺炎的患者进行了研究。所有患者均通过测定血清甲状腺激素、抗甲状腺球蛋白和抗微粒体抗体进行评估；对所有病例均进行了甲状腺的超声和闪烁扫描，并对结节的细针穿刺抽吸（FNAC）进行了细胞学检查评估。根据临床和实验室数据怀疑为桥本甲状腺炎，并通过手术标本的细胞学和组织学检查得以确诊。术前FNAC显示3例（37.5%）为桥本甲状腺炎合并甲状腺分化型癌，1例为桥本甲状腺炎，4例（50%）为慢性甲状腺炎。7例患者接受了手术，1例患者接受了药物治疗；我们实施了6例全甲状腺切除术和1例半甲状腺切除术。手术标本的组织学检查在所有病例中均证实了桥本甲状腺炎的诊断；3例患者发现合并甲状腺乳头状癌。
无术后死亡；未记录到重大术后并发症（喉返神经麻痹或永久性低钙血症）。仅观察到2例轻度短暂性低钙血症。
全甲状腺切除术是桥本甲状腺炎外科治疗的首选技术，桥本甲状腺炎是一种累及整个腺体的自身免疫性疾病，与分化型甲状腺癌高度相关（37.5%）。全甲状腺切除术可对该疾病进行彻底且明确的控制，无复发风险，在经验丰富的医生手中，重大并发症发生率较低，且无论如何都低于再次干预所导致的发病率。
