Radetti Giorgio, Loche Sandro, D'Antonio Valeria, Salerno Mariacarolina, Guzzetti Chiara, Aversa Tommaso, Cassio Alessandra, Cappa Marco, Gastaldi Roberto, Deluca Filippo, Vigone Maria Cristina, Tronconi Giulia Maria, Corrias Andrea
Marienklinik, Bolzano, Italy.
Ospedale Pediatrico Microcitemico, A. Cao, Cagliari, Italy.
J Endocr Soc. 2019 Jan 4;3(3):607-616. doi: 10.1210/js.2018-00287. eCollection 2019 Mar 1.
It is unclear whether patients with Hashimoto thyroiditis (HT) are predisposed to develop thyroid nodules and/or thyroid cancer. The objective of our study was therefore to assess the prevalence of thyroid nodules and/or cancer in patients with HT and to look for possible prognostic factors. A retrospective survey of 904 children/adolescents with HT (709 females, 195 males) regularly followed in nine Italian centers of pediatric endocrinology was performed. Median period of follow-up was 4.5 years (1.2 to 12.8 years). We evaluated free T4, TSH, thyroid peroxidase antibody (TPOAb), thyroglobulin antibodies, and thyroid ultrasound yearly. One hundred seventy-four nodules were detected, with an annual incidence rate of 3.5%. Ten nodules were malignant (8 papillary and 2 papillary follicular variant), giving a 5.7% prevalence of cancer among patients with nodules. The severity of hypoechogenity at ultrasound, TPOAb, and free T4 serum concentrations were predictive for the appearance of new nodules. Furthermore, a positive correlation was observed between TPOAb titer and the development of thyroid cancer. In conclusion, HT seems to influence the development of thyroid nodules, but not cancer in children and adolescents.
目前尚不清楚桥本甲状腺炎（HT）患者是否更容易发生甲状腺结节和/或甲状腺癌。因此，我们研究的目的是评估HT患者甲状腺结节和/或癌症的患病率，并寻找可能的预后因素。我们对意大利9个儿科内分泌中心定期随访的904例儿童/青少年HT患者（709例女性，195例男性）进行了一项回顾性调查。中位随访时间为4.5年（1.2至12.8年）。我们每年评估游离T4、促甲状腺激素（TSH）、甲状腺过氧化物酶抗体（TPOAb）、甲状腺球蛋白抗体和甲状腺超声。共检测到174个结节，年发病率为3.5%。10个结节为恶性（8个乳头状和2个乳头状滤泡变体），在有结节的患者中癌症患病率为5.7%。超声检查时低回声的严重程度、TPOAb和游离T4血清浓度可预测新结节的出现。此外，还观察到TPOAb滴度与甲状腺癌的发生之间存在正相关。总之，HT似乎会影响儿童和青少年甲状腺结节的发生，但不会影响甲状腺癌的发生。
