Kumar Neeta, Ray Chetan, Jain Shyama
Department of Pathology, Maulana Azad Medical College and LN Hospital, New Delhi, India.
Cytopathology. 2002 Feb;13(1):31-9. doi: 10.1046/j.1365-2303.2002.00366.x.
Fine needle aspiration (FNA) plays a significant role in the diagnosis of thyroid lesions due to its simplicity and low cost. Hashimoto's thyroiditis (HT) is the second most common thyroid lesion next to endemic goitre diagnosed on FNA in iodine (I2) deficient areas. Data on its incidence, prevalence and clinicopathological features in I2 deficient areas is scanty compared to I2 sufficient areas. In the present study the patients presented with HT a decade earlier than reported in I2 sufficient areas. Presentation as a nodular thyroid is common. Diagnosis of HT is likely to be missed in smears showing cytological evidence of hyperplasia or abundant colloid. HT was concurrent in 20 cases of endemic goitre. Careful screening for Hurthle cell change and lymphocytic infiltration into follicular cells should be carried out. In equivocal cases multiple punctures and immunological investigations are helpful. In antibody-negative cases repeat FNA at follow-up is useful. Marked lymphocytic infiltration and Hurthle cell change may indicate a hypothyroid state but hormonal levels are required for clinical management.
细针穿刺抽吸活检（FNA）因其操作简单且成本低廉，在甲状腺病变的诊断中发挥着重要作用。桥本甲状腺炎（HT）是碘（I2）缺乏地区经FNA诊断出的仅次于地方性甲状腺肿的第二常见甲状腺病变。与碘充足地区相比，碘缺乏地区关于其发病率、患病率及临床病理特征的数据较少。在本研究中，出现HT的患者比碘充足地区报告的时间早十年。表现为结节性甲状腺较为常见。在显示增生细胞学证据或大量胶质的涂片检查中，HT的诊断很可能被漏诊。20例地方性甲状腺肿患者同时患有HT。应仔细筛查许特耳细胞变化及淋巴细胞向滤泡细胞的浸润情况。在诊断不明确的病例中，多次穿刺及免疫检查会有所帮助。在抗体阴性的病例中，随访时重复进行FNA是有用的。明显的淋巴细胞浸润和许特耳细胞变化可能提示甲状腺功能减退状态，但临床管理需要激素水平的检测结果。
