Diaconescu M R, Lazăr C, Chifan M, Dobrescu Gioconda
Clinicile I Chirurgie, Universitatea de Medicină şi Farmacie Gr. T. Popa Iaşi.
Chirurgia (Bucur). 2004 May-Jun;99(3):143-50.
The association between thyrotoxicosis and thyroid cancer is a classical, rare and controversial entity. Within their series of eleven such cases the authors dissociate two distinct groups from clinical and pathological viewpoint. The first category is represented by one case of follicular thyroid cancer with clinically and biologically confirmed hyperthyroidism. The second group includes ten patients with thyrotoxicosis (three cases with Graves' disease, four with toxic multinodular goiter and three with toxic adenoma) and associated unsuspected occult or nodular carcinoma. None of these patients had received previous treatment with radioiodine. In all cases the diagnosis was established by pathological examination of the surgical specimen. Surgery is the treatment of choice in these lesions, the presence of carcinoma imposing the extent of operation. Five near total thyroidectomies and three near total lobectomies with ablation of the isthmus was performed in our cases associated with appropriate additional measures: TSH suppression or 131I treatment. Post surgical results were satisfactory without morbidity or mortality. The long-term survey was good (seven cases alive after 5 years).
甲状腺毒症与甲状腺癌之间的关联是一个经典、罕见且存在争议的情况。在作者所报道的11例此类病例中，从临床和病理角度区分出两个不同的组。第一类由1例滤泡状甲状腺癌组成，伴有临床和生物学上均得到证实的甲状腺功能亢进。第二类包括10例甲状腺毒症患者（3例格雷夫斯病、4例毒性多结节性甲状腺肿和3例毒性腺瘤），并伴有未被怀疑的隐匿性或结节性癌。这些患者均未接受过放射性碘的治疗。所有病例均通过手术标本的病理检查确诊。手术是这些病变的首选治疗方法，癌的存在决定了手术范围。在我们的病例中，进行了5例次近全甲状腺切除术和3例次近全叶切除术并切除峡部，同时采取了适当的额外措施：促甲状腺激素抑制或¹³¹I治疗。术后结果令人满意，无并发症或死亡。长期随访情况良好（7例患者5年后仍存活）。
