Diaconescu M R, Glod M, Costea I, Grigorovici M, Diaconescu S
Clinica IV-a Chirurgie, Universitatea de Medicină şi Farmacie Gr T Popa, Iaşi, România.
Chirurgia (Bucur). 2012 May-Jun;107(3):337-42.
Inflammatory processes of the thyroid represents a main proportion of the gland's pathology but the majority of them are treated by medical methods, surgery being indicated.
In 14 cases (3%) from 464 operations for different thyroid conditions we have encountered authentic inflammatory lesions in 9 cases of Hashimoto's thyroiditis (two associated with papillary thyroid carcinoma and one with malignant lymphoma), two cases of Riedel's thyroiditis and respectively de Quervain thyoiditis, tuberculous thyroiditis and actynomicosis one case each. The common lymphoplasmacytic infiltration in Basedow's disease was not considered likewise as the inflammatory nespecific lesions encountered in benign and malignant pathology of the gland. The clinical and imagistic data, biological evaluation and titer of anticorps but particularly the paraffine examination together with intraoperative estimations are decisive for the diagnosis.
Firm diagnosis of thyroiditis was rarely affirmed before operation, surgical indication being formulated on clinical criterions dominated by cancer suspicion. Among these are diffuse or (multi)nodular thyromegaly with a dominant nodule with recent appearance and rapid growing in temporal and geographic proximity of Chemobyl disaster, with hard consistence, celsian or compressive features and adenopathy. More added the imagistic signs but especially suspect aspects of the FNAB (follicular or with Hürthle cells smears) and also of the frozen sections. Certainty diagnosis was established by paraffine examination not always without hesitations or reexamination (Hashimoto's thyroiditis diagnosed in one case was finally a malignant lymphoma). Large removal decided after intraoperative findings induced for the most of patients a definitive hypothyroidism.
All the diagnosis resources must be exhausted for the diagnosis of the inflammatory lesions of the thyroid to avoid unnecessary surgery. On the other side the chronic overstimulation by the TSH of the glandular tissue affected by the immune process, represent an important factor of producing neoplasia.
甲状腺的炎症性病变占该腺体病理学的主要部分，但其中大多数采用药物治疗，仅在有手术指征时才进行手术。
在464例因不同甲状腺疾病进行的手术中，有14例（3%）出现了真正的炎症性病变，其中9例为桥本甲状腺炎（2例合并甲状腺乳头状癌，1例合并恶性淋巴瘤），2例为Riedel甲状腺炎，分别有1例亚急性甲状腺炎、结核性甲状腺炎和放线菌病。Graves病中常见的淋巴细胞浆细胞浸润同样不被视为该腺体良恶性病变中遇到的非特异性炎症性病变。临床和影像学数据、生物学评估及抗体滴度，尤其是石蜡切片检查以及术中评估对诊断起决定性作用。
术前很少能确诊甲状腺炎，手术指征主要根据以怀疑癌症为主的临床标准制定。这些标准包括弥漫性或（多）结节性甲状腺肿大，有一个近期出现且在切尔诺贝利灾难发生的时间和地域附近快速生长的优势结节，质地坚硬，有玻璃样变或压迫特征以及淋巴结肿大。此外还有影像学征象，尤其是细针穿刺抽吸活检（FNA）（滤泡性或嗜酸性细胞涂片）以及冰冻切片的可疑表现。通过石蜡切片检查最终确诊，并非总是毫无疑虑或无需复查（1例诊断为桥本甲状腺炎最终却是恶性淋巴瘤）。术中发现后决定进行大范围切除，这导致大多数患者最终出现永久性甲状腺功能减退。
必须用尽所有诊断手段来诊断甲状腺的炎症性病变，以避免不必要的手术。另一方面，受免疫过程影响的腺组织受到促甲状腺激素（TSH）的慢性过度刺激，是产生肿瘤的一个重要因素。
