桥本甲状腺炎的病理学及甲状腺癌风险
Hashimoto's thyroiditis pathology and risk for thyroid cancer.
作者信息
Paparodis Rodis, Imam Shahnawaz, Todorova-Koteva Kristina, Staii Anca, Jaume Juan Carlos
机构信息
1 Endocrine Autoimmunity Unit, Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison , Madison, Wisconsin.
出版信息
Thyroid. 2014 Jul;24(7):1107-14. doi: 10.1089/thy.2013.0588. Epub 2014 Jun 5.
BACKGROUND
Hashimoto's thyroiditis (HT) has been found to coexist with differentiated thyroid cancer (DTC) in surgical specimens, but an association between the two conditions has been discounted by the medical literature. Therefore, we performed this study to determine any potential relationship between HT and the risk of developing DTC.
METHODS
We collected data for thyrotropin (TSH), thyroxine (T4), thyroid peroxidase antibody (TPO-Ab) titers, surgical pathology, and weight-based levothyroxine (LT4) replacement dose for patients who were referred for thyroid surgery. Patients with HT at final pathology were studied further. To estimate thyroid function, patients with preoperative hypothyroid HT (Hypo-HT) were divided into three equal groups based on their LT4 replacement: LT4-Low (<0.90 μg/kg), LT4-Mid (0.90-1.43 μg/kg), and LT4-High (>1.43 μg/kg). A group of preoperatively euthyroid (Euth-HT) patients but with HT by pathology was also studied. All subjects were also grouped based on their TPO-Ab titer in TPO-high (titer >1:1000) or TPO-low/negative (titer <1:1000 or undetectable) groups. The relationship of HT and DTC was studied extensively.
RESULTS
Of 2811 subjects, 582 had HT on surgical pathology, 365 of whom were Euth-HT preoperatively. DTC was present in 47.9% of the Euth-HT, in 59.7% of LT4-Low, 29.8% of LT4-Mid, and 27.9% of LT4-High groups. The relative risk (RR) for DTC was significantly elevated for the Euth-HT and LT4-Low groups (p<0.001), but not for the LT4-Mid or LT4-High replacement dose groups. TPO-low/negative status conferred an increased RR in the Euth-HT and LT4-Low replacement dose groups (p<0.001 both), while TPO-high status decreased it in Euth-HT group (p<0.05) and made it nonsignificant in the LT4-Low group.
CONCLUSIONS
HT pathology increases the risk for DTC only in euthyroid subjects and those with partially functional thyroid glands (LT4-Low) but not in fully hypothyroid HT (LT4-Mid and LT4-High). High TPO-Ab titers appear to protect against DTC in patients with HT.
背景
在手术标本中发现桥本甲状腺炎（HT）与分化型甲状腺癌（DTC）共存，但医学文献对这两种疾病之间的关联并不认可。因此，我们开展本研究以确定HT与发生DTC风险之间的潜在关系。
方法
我们收集了因甲状腺手术前来就诊患者的促甲状腺激素（TSH）、甲状腺素（T4）、甲状腺过氧化物酶抗体（TPO-Ab）滴度、手术病理以及基于体重的左甲状腺素（LT4）替代剂量的数据。对最终病理诊断为HT的患者进行进一步研究。为评估甲状腺功能，术前甲状腺功能减退的HT患者（Hypo-HT）根据其LT4替代剂量分为三个相等的组：LT4-低剂量组（<0.90μg/kg）、LT4-中等剂量组（0.90-1.43μg/kg）和LT4-高剂量组（>1.43μg/kg）。还研究了一组术前甲状腺功能正常（Euth-HT）但病理诊断为HT的患者。所有受试者也根据其TPO-Ab滴度分为TPO高滴度组（滴度>1:1000）或TPO低滴度/阴性组（滴度<1:1000或检测不到）。广泛研究了HT与DTC的关系。
结果
在2811名受试者中，582人手术病理诊断为HT，其中365人术前甲状腺功能正常。甲状腺功能正常的HT组中DTC的发生率为47.9%，LT4-低剂量组为59.7%，LT4-中等剂量组为29.8%，LT4-高剂量组为27.9%。甲状腺功能正常的HT组和LT4-低剂量组发生DTC的相对风险（RR）显著升高（p<0.001），但LT4-中等剂量组或LT4-高剂量替代剂量组则不然。TPO低滴度/阴性状态使甲状腺功能正常的HT组和LT4-低剂量替代剂量组的RR增加（两者p<0.001），而TPO高滴度状态使甲状腺功能正常的HT组RR降低（p<0.05），并使LT4-低剂量组RR无显著变化。
结论
HT病理改变仅在甲状腺功能正常的受试者以及甲状腺部分功能减退（LT4-低剂量）的患者中增加DTC风险，而在完全甲状腺功能减退的HT患者（LT4-中等剂量和LT4-高剂量）中则不然。高TPO-Ab滴度似乎对HT患者的DTC有保护作用。
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