de Luca F, Chaussain J L, Job J C
Acta Paediatr Scand. 1986 Jan;75(1):118-23. doi: 10.1111/j.1651-2227.1986.tb10167.x.
Eight children and adolescents, seven female and one male, aged 7.1 to 15.0 years, referred over a 12-year period for a solitary mass in an otherwise normal thyroid gland, exhibited a hyperfunctioning nodule on thyroid scintiscan. Tracer uptake in the surrounding thyroid tissue was reduced or completely suppressed, but could be restored after TSH stimulation. Only one patient had mild clinical hyperthyroidism with normal T4 but increased T3 serum levels and blunted TSH responsiveness to TRH. A similar hormonal pattern suggestive of subclinical hyperthyroidism was found in three other subjects who were clinically euthyroid. One patient initially euthyroid progressed to subclinical hyperthyroidism two years later. In the whole group a significant negative relationship was found between serum T3 level and TRH-stimulated TSH peak (r = -0.829, p less than 0.02). All the patients underwent selective surgery after a 3-month to 2-year period of follow-up. Microscopic examination was consistent with adenoma in seven patients, while in one case a well-encapsulated papillary adenocarcinoma was found. Though hyperfunctioning nodules are seldom malignant, their surgical removal must be recommended when they become thyrotoxic, exceed 3 cm or show progressive enlargement.
在12年期间转诊来的8名儿童和青少年（7名女性，1名男性，年龄7.1至15.0岁），因甲状腺其他部位正常但存在孤立性肿块，甲状腺闪烁扫描显示为功能亢进结节。周围甲状腺组织的示踪剂摄取减少或完全受抑制，但促甲状腺激素（TSH）刺激后可恢复。只有1例患者有轻度临床甲亢，T4正常但血清T3水平升高，TSH对促甲状腺激素释放激素（TRH）的反应迟钝。在另外3名临床甲状腺功能正常的受试者中发现了类似的提示亚临床甲亢的激素模式。1例最初甲状腺功能正常的患者两年后进展为亚临床甲亢。在整个组中，血清T3水平与TRH刺激后的TSH峰值之间存在显著负相关（r = -0.829，p < 0.02）。所有患者在随访3个月至2年后均接受了选择性手术。显微镜检查显示7例患者为腺瘤，1例发现为包膜完整的乳头状腺癌。尽管功能亢进结节很少恶变，但当它们出现甲状腺毒症、超过3 cm或显示进行性增大时，仍建议手术切除。
