Límanová Z, Jiskra J
III. interní klinika 1. LF UK a VFN, Praha.
Cas Lek Cesk. 2005;144(8):524-8.
The authors review the most common situation concerning oncological patients with concomitant thyroid disease. In case of unknown origin of metastasis and nodular goitre the ultrasound examination with fine needle aspiration biopsy confirms or excludes the thyroid origin. The euthyroid sick syndrome is often diagnosed in oncological patient as a consequence of oncological disease and it doesn't mean hypothyroidism. If oncological patients prove to have a thyroid functional failure the endocrinologist must correct the function as fast as possible to enable oncological treatment. There is no evidence that chemotherapy can influence the thyroid function, but radiotherapy can cause thyroiditis with later hypofunction. The interferon therapy causes thyroid dysfunction in 10% of patients and the recommendation to examine not only TSH and FT4 but also thyroid antibodies is warranted. Lymphoma of the thyroid gland occurs most often on the basis of lymphocytic thyroiditis and lymphocytic thyroiditis may be a risk factor for papillary carcinoma of the thyroid as well. Women with breast carcinoma were proved to have lymphocytic thyroiditis with minor thyroid hypofunction more often than the corresponding group of women with colon cancer or control group of healthy women. In case of renal tumor (Grawitz), breast or lung carcinoma the thyroid can be attacked with metastasis, and ultrasound with fine needle biopsy can reliably differentiate between primary or secondary thyroid involvements. The thyroid can be involved in some diseases: multiple endocrine neoplasia, Carney, Cowden and Gardner's syndromes.
作者回顾了肿瘤患者合并甲状腺疾病的最常见情况。在转移灶来源不明和结节性甲状腺肿的情况下,超声检查结合细针穿刺活检可确认或排除甲状腺来源。肿瘤患者常因肿瘤疾病而被诊断为甲状腺功能正常的病态综合征,这并不意味着甲状腺功能减退。如果肿瘤患者被证明存在甲状腺功能衰竭,内分泌科医生必须尽快纠正其功能,以便进行肿瘤治疗。没有证据表明化疗会影响甲状腺功能,但放疗可导致甲状腺炎,随后出现功能减退。干扰素治疗在10%的患者中会导致甲状腺功能障碍,因此不仅有必要检测促甲状腺激素(TSH)和游离甲状腺素(FT4),还应检测甲状腺抗体。甲状腺淋巴瘤最常发生在淋巴细胞性甲状腺炎的基础上,淋巴细胞性甲状腺炎也可能是甲状腺乳头状癌的一个危险因素。事实证明,患有乳腺癌的女性比患有结肠癌的女性或健康女性对照组更常出现伴有轻微甲状腺功能减退的淋巴细胞性甲状腺炎。在肾肿瘤(肾母细胞瘤)、乳腺癌或肺癌的情况下,甲状腺可能会发生转移,超声检查结合细针活检可以可靠地区分原发性或继发性甲状腺受累情况。甲状腺可能会累及某些疾病:多发性内分泌腺瘤病、卡尼综合征、考登综合征和加德纳综合征。