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接受手术治疗的不同形式甲状腺功能亢进合并分化型甲状腺癌患者的结局:意大利一家内分泌中心的经验

Outcome of patients surgically treated for various forms of hyperthyroidism with differentiated thyroid cancer: experience at an endocrine center in Italy.

作者信息

Cappelli Carlo, Braga Marco, De Martino Elvira, Castellano Maurizio, Gandossi Elena, Agosti Barbara, Cumetti Davide, Pirola Ilenia, Mattanza Chiara, Cherubini Laura, Rosei Enrico Agabiti

机构信息

Department of Internal Medicine, Division of Endocrinology, University of Brescia, c/o 2 Medicina Spedali Civili di Brescia, Piazzale Spedali Civili n 1, 25100, Brescia, Italy.

出版信息

Surg Today. 2006;36(2):125-30. doi: 10.1007/s00595-005-3115-3.

Abstract

PURPOSE

The incidence and aggressiveness of thyroid cancer associated with hyperthyroidism remains a subject of much controversy. The aim of this study was to analyze the frequency of coexisting hyperthyroidism and thyroid cancer, and to determine whether cancer becomes more aggressive with different forms of hyperthyroidism.

METHODS

We retrospectively studied 2,449 patients assessed for hyperthyroidism between 1985 and 2001. All patients with a "cold" nodule on scintigraphy, such as those with Graves' disease and a concomitant solid nodule, underwent fine-needle aspiration biopsy (FNAB). Criteria for surgery were cytological findings indicative of malignancy, goiter with signs of tracheal or esophageal compression, side effects of antithyroid drug therapy, or Graves' disease with multiple relapses after therapy withdrawal or responsiveness to antithyroid drugs.

RESULTS

Thyroid cancer was diagnosed more frequently in patients with Graves' disease (6.5%) than in those with uninodular toxic goiter (UTG) (4.4%) or multinodular toxic goiter (MTG) (3.9%). Lymph node involvement was found in 56% of the patients with Graves' disease, in 23% of those with MTG, and in none of those with UTG. Distant metastases were found in one patient with Graves' disease.

CONCLUSIONS

Cancers associated with Graves' disease seems to be more aggressive than those associated with MTG or UTG. Thus, we suggest that patients with Graves' disease be carefully monitored for the detection of thyroid nodules. Ultrasonography seems to be the best modality to detect such nodules.

摘要

目的

与甲状腺功能亢进相关的甲状腺癌的发病率和侵袭性仍是一个备受争议的话题。本研究的目的是分析甲状腺功能亢进与甲状腺癌并存的频率,并确定不同形式的甲状腺功能亢进是否会使癌症更具侵袭性。

方法

我们回顾性研究了1985年至2001年间接受甲状腺功能亢进评估的2449例患者。所有甲状腺闪烁显像显示为“冷”结节的患者,如患有格雷夫斯病并伴有实性结节的患者,均接受了细针穿刺活检(FNAB)。手术标准为细胞学检查结果提示恶性、有气管或食管压迫体征的甲状腺肿、抗甲状腺药物治疗的副作用、或治疗停药后多次复发或对抗甲状腺药物有反应的格雷夫斯病。

结果

格雷夫斯病患者中甲状腺癌的诊断率(6.5%)高于单结节毒性甲状腺肿(UTG)患者(4.4%)或多结节毒性甲状腺肿(MTG)患者(3.9%)。格雷夫斯病患者中有56%发现有淋巴结受累,MTG患者中有23%发现有淋巴结受累,UTG患者中未发现有淋巴结受累。在1例格雷夫斯病患者中发现有远处转移。

结论

与格雷夫斯病相关的癌症似乎比与MTG或UTG相关的癌症更具侵袭性。因此,我们建议对格雷夫斯病患者进行仔细监测以检测甲状腺结节。超声检查似乎是检测此类结节的最佳方法。

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