Mount Sinai Medical Center, Miami Beach, FL, USA.
J Investig Med High Impact Case Rep. 2020 Jan-Dec;8:2324709620942672. doi: 10.1177/2324709620942672.
Thyroid nodules are palpable on up to 7% of asymptomatic patients. Cancer is present in 8% to 16% of those patients with previously identified thyroid nodules. Papillary thyroid carcinoma (PTC) is the most common type of thyroid cancer, accounting for approximately 85% of thyroid cancers. Although most appear as solid nodules on ultrasound imaging, a subset of 2.5% to 6% has cystic components. The presence of cystic changes within thyroid nodules decreases the accuracy of fine needle aspiration (FNA) in the diagnosis of thyroid cancer, given the difficulty of obtaining appropriate cellular content. This becomes a diagnostic and therapeutic challenge. We present a case of a 31-year-old female with a 1-month history of palpitations, fatigue, and night sweats, who underwent evaluation, and was diagnosed with subclinical hyperthyroidism. She presented 4 years later with compressive symptoms leading to repeat FNA, showing Bethesda III-atypia of undetermined significance and negative molecular testing. Thyroid lobectomy revealed PTC with cystic changes. This case is a reminder that patients with hyperfunctioning thyroid nodule should have closer follow-up. It poses the diagnostic dilemma of how much is good enough in the evaluation and management of a thyroid nodule. Early detection and action should be the standard of care.
甲状腺结节在无症状患者中可触及的比例高达 7%。在那些先前已确定存在甲状腺结节的患者中，有 8%至 16%患有癌症。甲状腺乳头状癌（PTC）是最常见的甲状腺癌类型，约占甲状腺癌的 85%。尽管大多数在超声成像上表现为实性结节，但有 2.5%至 6%的亚组具有囊性成分。由于难以获得适当的细胞含量，甲状腺结节内囊性改变的存在降低了细针抽吸（FNA）诊断甲状腺癌的准确性。这成为了一个诊断和治疗上的挑战。我们报告了一例 31 岁女性患者，其病史为心悸、疲劳和盗汗 1 个月，经评估诊断为亚临床甲状腺功能亢进症。4 年后，她因压迫症状再次进行 FNA，结果显示为 Bethesda III 级-意义不明的不典型性，且分子检测为阴性。甲状腺叶切除术显示为伴有囊性改变的 PTC。该病例提醒我们，患有功能性甲状腺结节的患者应进行更密切的随访。这提出了一个诊断难题，即在评估和管理甲状腺结节时，要达到何种程度的充分性。早期发现和行动应成为护理标准。
