甲状腺功能亢进猫的甲状腺病变患病率及程度随疾病持续时间增加：对2096只接受放射性碘治疗的猫的横断面分析
Prevalence and degree of thyroid pathology in hyperthyroid cats increases with disease duration: a cross-sectional analysis of 2096 cats referred for radioiodine therapy.
作者信息
Peterson Mark E, Broome Michael R, Rishniw Mark
机构信息
Animal Endocrine Clinic, New York, NY, USA
Advanced Veterinary Medical Imaging, Tustin, CA, USA.
出版信息
J Feline Med Surg. 2016 Feb;18(2):92-103. doi: 10.1177/1098612X15572416. Epub 2015 Feb 11.
OBJECTIVES
Hyperthyroidism is common in cats, but there are no reports that evaluate its severity or underlying thyroid tumor disease based on disease duration (ie, time from original diagnosis). The objective of this study was to compare serum thyroxine (T4) concentrations and thyroid scintigraphic characteristics of cats referred for radioiodine treatment based on disease duration.
METHODS
This was a cross-sectional study of 2096 cats with hyperthyroidism. Cats were divided into five groups based on time from diagnosis: ⩽1 year (n = 1773); >1-2 years (n = 169); >2-3 years (n = 88); >3-4 years (n = 35); and >4-6.1 years (n = 31). Methimazole, administered to 996 (47.5%) cats, was stopped at least 1 week prior to examination to allow for serum T4 testing. Each thyroid scintiscan was evaluated for pattern (unilateral, bilateral, multifocal), location (cervical, thoracic inlet, chest) and size (small, medium, large, huge) of the thyroid tumor, as well as features suggesting malignancy.
RESULTS
Median serum T4 concentration increased with increasing disease duration from 100 nmol/l (⩽1 year) to 315 nmol/l (>4-6.1 years) (P <0.001). Prevalence of unilateral thyroid disease decreased, whereas multifocal disease (three or more tumor nodules) increased (P <0.001) with increasing disease duration. Median tumor volume in the five groups increased from 1.6 cm(3) (⩽1 year) to 6.4 cm(3) (>4-6.1 years). Prevalence of large (4-8 cm(3)) and huge (>8 cm(3)) thyroid tumors increased from 5.1% (⩽1 year) to 88.6% (>4-6.1 years), while the prevalence of intrathoracic tumor tissue increased from 3.4% (⩽1 year) to 32.3% (>4-6.1 years). Prevalence of suspected thyroid carcinoma (characterized by severe hyperthyroidism; huge, intrathoracic, multifocal tumors; refractory to methimazole treatment) increased with increasing disease duration from 0.4% (⩽1 year) to 19.3% (>4-6.1 years).
CONCLUSIONS AND RELEVANCE
Our results indicate that the prevalence of severe hyperthyroidism, large thyroid tumors, multifocal disease, intrathoracic thyroid masses and suspected malignant disease all increase with disease duration in cats referred for radioiodine therapy.
目的
甲状腺功能亢进在猫中很常见，但尚无基于疾病持续时间（即从最初诊断起的时间）评估其严重程度或潜在甲状腺肿瘤疾病的报告。本研究的目的是比较根据疾病持续时间转诊接受放射性碘治疗的猫的血清甲状腺素（T4）浓度和甲状腺闪烁扫描特征。
方法
这是一项对2096只甲状腺功能亢进猫的横断面研究。根据诊断后的时间将猫分为五组：≤1年（n = 1773）；>1 - 2年（n = 169）；>2 - 3年（n = 88）；>3 - 4年（n = 35）；>4 - 6.1年（n = 31）。对996只（47.5%）猫使用的甲巯咪唑在检查前至少停用1周，以便进行血清T4检测。对每次甲状腺闪烁扫描评估甲状腺肿瘤的形态（单侧、双侧、多灶性）、位置（颈部、胸廓入口、胸部）和大小（小、中、大、巨大），以及提示恶性的特征。
结果
血清T4中位数浓度随疾病持续时间增加而升高，从100 nmol/l（≤1年）升至315 nmol/l（>4 - 6.1年）（P <0.001）。随着疾病持续时间增加，单侧甲状腺疾病的患病率下降，而多灶性疾病（三个或更多肿瘤结节）增加（P <0.001）。五组中的肿瘤中位数体积从1.6 cm³（≤1年）增加到6.4 cm³（>4 - 6.1年）。大（4 - 8 cm³）和巨大（>8 cm³）甲状腺肿瘤的患病率从5.1%（≤1年）增加到88.6%（>4 - 6.1年），而胸内肿瘤组织的患病率从3.4%（≤1年）增加到32.3%（>4 - 6.1年）。疑似甲状腺癌（特征为严重甲状腺功能亢进；巨大、胸内、多灶性肿瘤；对甲巯咪唑治疗耐药）的患病率随疾病持续时间增加从0.4%（≤1年）升至19.3%（>4 - 6.1年）。
结论及意义
我们的结果表明，在转诊接受放射性碘治疗的猫中，严重甲状腺功能亢进、大甲状腺肿瘤、多灶性疾病、胸内甲状腺肿块和疑似恶性疾病的患病率均随疾病持续时间增加。
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