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与甲状腺癌相关的无痛性甲状腺炎:初始超声检查评估的作用

Painless thyroiditis associated to thyroid carcinoma: role of initial ultrasonography evaluation.

作者信息

Valentini Raisa Bressan, Macedo Bruno Mussoi de, Izquierdo Rogério Friedrich, Meyer Erika Laurini Souza

机构信息

Irmandade da Santa Casa de Misericórdia de Porto Alegre, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brasil.

Irmandade da Santa Casa de Misericórdia de Porto Alegre, UFCSPA, Porto Alegre, RS, Brasil.

出版信息

Arch Endocrinol Metab. 2016 Apr;60(2):178-82. doi: 10.1590/2359-3997000000104. Epub 2015 Sep 25.

Abstract

Even though it is a rare event, most associations of thyroid carcinoma with subacute thyroiditis described in the literature are related to its granulomatous form (Quervain's thyroiditis). We present a patient with subacute lymphocytic thyroiditis (painless thyroiditis) and papillary thyroid cancer that was first suspected in an initial ultrasound evaluation. A 30-year old female patient who was referred to the emergency room due to hyperthyroidism symptoms was diagnosed with painless thyroiditis established by physical examination and laboratory findings. With the presence of a palpable painless thyroid nodule an ultrasound was prescribed and the images revealed a suspicious thyroid nodule, microcalcification focus in the heterogeneous thyroid parenquima and cervical lymphadenopathy. Fine needle aspiration biopsy was taken from this nodule; cytology was assessed for compatibility with papillary thyroid carcinoma. Postsurgical pathology evaluation showed a multicentric papillary carcinoma and lymphocytic infiltration. Subacute thyroiditis, regardless of type, may produce transitory ultrasound changes that obscure the coexistence of papillary carcinoma. Due to this, initial thyroid ultrasound evaluation should be delayed until clinical recovery. We recommended a thyroid ultrasound exam for initial evaluation of painless thyroiditis, particularly in patients with palpable thyroid nodule. Further cytological examination is recommended in cases presenting with suspect thyroid nodule and/or non-nodular hypoechoic (> 1 cm) or heterogeneous areas with microcalcification focus.

摘要

尽管这是一个罕见事件,但文献中描述的大多数甲状腺癌与亚急性甲状腺炎的关联都与其肉芽肿性形式(亚急性肉芽肿性甲状腺炎)有关。我们报告一例亚急性淋巴细胞性甲状腺炎(无痛性甲状腺炎)合并甲状腺乳头状癌的患者,最初是在超声初步评估中怀疑有病变。一名30岁女性患者因甲亢症状被转诊至急诊室,经体格检查和实验室检查确诊为无痛性甲状腺炎。由于可触及无痛性甲状腺结节,遂进行超声检查,图像显示一个可疑甲状腺结节、甲状腺实质不均匀内的微钙化灶以及颈部淋巴结病。对该结节进行细针穿刺活检;评估细胞学结果是否与甲状腺乳头状癌相符。术后病理评估显示为多中心乳头状癌和淋巴细胞浸润。无论何种类型,亚急性甲状腺炎都可能产生短暂的超声变化,从而掩盖乳头状癌的并存情况。因此,甲状腺超声初步评估应推迟至临床恢复后进行。我们建议对无痛性甲状腺炎进行甲状腺超声检查以进行初步评估,尤其是对于可触及甲状腺结节的患者。对于出现可疑甲状腺结节和/或非结节性低回声(>1cm)或有微钙化灶的不均匀区域的病例,建议进一步进行细胞学检查。

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