Sharma Sunil Dutt, Kumar Gaurav, Guner Karen, Kaddour Hesham
Department of Otorhinolaryngology, Queens Hospital, Rom Valley Way, Romford, Essex RM7 0AG, UK.
Ear Nose Throat J. 2016 Jun;95(6):236-9.
We present a retrospective case series of patients with hyperthyroidism and thyroid cancer. Our goal was to look at their clinical characteristics and outcomes to determine which patients would require further investigation. We reviewed the case notes of all patients with a histopathologic diagnosis of thyroid cancer and biochemical evidence of hyperthyroidism who had been treated at a thyroid cancer center from January 2006 through October 2013. During that time, 66 patients had been diagnosed with thyroid cancer. Of these, 8 patients (12%)-all women, aged 29 to 87 years (mean: 55.6; median: 50.5)-had biochemical evidence of hyperthyroidism. Among these 8 patients, 4 had an autonomously functioning toxic nodule (AFTN), 3 were diagnosed with Graves disease, and 1 had a toxic multinodular goiter. Five patients had suspicious features on preoperative ultrasonography. All 8 patients were diagnosed with the papillary type of thyroid carcinoma. The mean size of the tumor in the 4 patients with AFTN was significantly larger than it was in those with Graves disease (42.3 ± 23.8 mm vs. 3.8 ± 1.6; p = 0.04). The 3 patients with Graves disease all had incidentally found papillary microcarcinoma. Between these two groups, the patients with AFTN had a poorer prognosis; 2 of them had extracapsular invasion and lymph node metastasis, and another died of her disease. We found that the incidence of hyperthyroidism in thyroid cancer patients was relatively high (12%). In contrast to what has previously been reported in the literature, patients with AFTN seem to have more aggressive disease and poorer outcomes than do patients with Graves disease. Any suspicious nodule associated with hyperthyroidism should be evaluated carefully.
我们呈现了一组甲状腺功能亢进症合并甲状腺癌患者的回顾性病例系列。我们的目标是观察他们的临床特征和预后情况，以确定哪些患者需要进一步检查。我们回顾了2006年1月至2013年10月期间在一家甲状腺癌中心接受治疗的所有经组织病理学诊断为甲状腺癌且有甲状腺功能亢进症生化证据的患者的病历。在此期间，66例患者被诊断为甲状腺癌。其中，8例患者（12%）——均为女性，年龄在29至87岁之间（平均：55.6岁；中位数：50.5岁）——有甲状腺功能亢进症的生化证据。在这8例患者中，4例有自主功能性毒性结节（AFTN），3例被诊断为格雷夫斯病，1例有多结节性毒性甲状腺肿。5例患者术前超声检查有可疑特征。所有8例患者均被诊断为乳头状甲状腺癌。4例AFTN患者的肿瘤平均大小明显大于格雷夫斯病患者（42.3±23.8毫米对3.8±1.6毫米；p = 0.04）。3例格雷夫斯病患者均偶然发现乳头状微小癌。在这两组之间，AFTN患者的预后较差；其中2例有包膜外侵犯和淋巴结转移，另1例死于该病。我们发现甲状腺癌患者中甲状腺功能亢进症的发生率相对较高（12%）。与之前文献报道的情况相反，AFTN患者似乎比格雷夫斯病患者的病情更具侵袭性，预后更差。任何与甲状腺功能亢进症相关的可疑结节都应仔细评估。
