自主功能性甲状腺结节中的甲状腺乳头状癌：病例报告及文献复习。
Papillary thyroid carcinoma in an autonomous hyperfunctioning thyroid nodule: case report and review of the literature.
机构信息
Division of Pediatric Endocrinology, Metabolism, and Diabetes Mellitus, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA 15224, USA.
出版信息
Thyroid. 2010 Sep;20(9):1029-32. doi: 10.1089/thy.2010.0144.
BACKGROUND
Whereas thyroid nodules are less common among children than among adults, the anxiety generated by the finding of a thyroid nodule is high because 20% of nodules found in children contain thyroid cancer. Discovery of a nodule in the context of hyperthyroidism is usually comforting due to the presumption that the nodule represents a benign toxic adenoma.
SUMMARY
An 11-year-old girl presented with heavy menses, fatigue, and a right thyroid mass. Laboratory evaluation revealed elevated triiodothyronine and undetectable thyroid-stimulating hormone. Thyroid ultrasonography revealed a 3.5 cm nonhomogenous nodule, and scintigraphy was consistent with an autonomous hyper-functioning nodule. Fine-needle aspiration biopsy could not rule out malignancy, and patient underwent right hemithyroidectomy and isthmusectomy. Pathology was consistent with papillary thyroid carcinoma.
CONCLUSIONS
We report the discovery of papillary thyroid carcinoma in an autonomously hyperfunctioning nodule in an 11-year-old girl. Detection of an autonomously functioning thyroid nodule in children and adolescents does not exclude the possibility of thyroid carcinoma and warrants careful evaluation and appropriate therapy.
背景
虽然儿童甲状腺结节比成年人少见，但发现甲状腺结节会产生很高的焦虑，因为在儿童中发现的 20%的结节含有甲状腺癌。在甲状腺功能亢进症的情况下发现结节通常是令人欣慰的，因为假定结节代表良性毒性腺瘤。
总结
一名 11 岁女孩出现月经过多、疲劳和右侧甲状腺肿块。实验室评估显示三碘甲状腺原氨酸升高，促甲状腺激素无法检测到。甲状腺超声显示 3.5 厘米不均匀结节，闪烁显像符合自主高功能结节。细针抽吸活检不能排除恶性肿瘤，患者接受了右侧甲状腺大部切除术和峡部切除术。病理符合甲状腺乳头状癌。
结论
我们报告了一名 11 岁女孩在自主高功能结节中发现甲状腺乳头状癌。在儿童和青少年中检测到自主功能的甲状腺结节并不能排除甲状腺癌的可能性，需要仔细评估和适当治疗。
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