Blondeau P H, Legros A, René L
J Chir (Paris). 1976 Mar;111(3):271-88.
The main object of this report was to attract again attention to the fact that obvious hyperthyroidism does not exclude the possibility of associated thyroid carcinoma, although this is an exceptional association. The 12 cases presented here may be added to about 30 cases found in the world literature. They were observed over a period of 13 years by the same surgical team and correspond to 0,3 p. 100 of all thyroid operations, 1 p. 100 of operated cases of hyperthyroidism and 3,6 p. 100 of cases of thyroid carcinoma. Contrary to most published cases, 11 or these cases out of 12, presented, clinically, mainly as hyperthyroidism the carcinotous lesion was either palpabale clinically in the form of a very small nodule (6 cases) or totally latent and discovered operation or even on histology as in 5 cases. Hyperthyroidism produced in 3 cases the classical picture of Graves' disease, in 6 cases that of toxic nodular goiter and, in 2 cases, that of a solitary toxic adenoma. The hyperplasia and the carcinoma were always in anatomically different areas. There is no apparent physiopahtological link and the classical notion of para-neoplastic hyperthyroidism seems debatable in most cases presented here, even in the cases of diffuse hyperfunctional hyperplasia. In any case, whatever the pathogenesis of this association, its possibility should be brought to mind in a case of hyperthyroidism. Surgery should always be advised in cases of toxic adenoma and in Graves' disease when the goiter is irregular and, especially, when a nodule is found. The course and prognosis seem to be mainly dictated by the histological type and the local spread or distant spread of the carcinoma, hyperthyroidism does not aggravate seriously the prognosis.
本报告的主要目的是再次提请注意这样一个事实，即明显的甲状腺功能亢进并不排除合并甲状腺癌的可能性，尽管这种关联较为罕见。此处呈现的12例病例可补充到世界文献中发现的约30例病例中。它们由同一手术团队在13年的时间里进行观察，占所有甲状腺手术的0.3%，甲亢手术病例的1%，甲状腺癌病例的3.6%。与大多数已发表的病例相反，这12例病例中的11例在临床上主要表现为甲亢，癌性病变在临床上要么以非常小的结节形式可触及（6例），要么完全隐匿，在手术时甚至在组织学检查时才发现，如5例。3例甲亢表现为典型的格雷夫斯病，6例表现为毒性结节性甲状腺肿，2例表现为孤立性毒性腺瘤。增生和癌总是位于解剖学上不同的区域。不存在明显的生理病理联系，并且在此处呈现的大多数病例中，即使在弥漫性功能亢进增生的病例中，副肿瘤性甲亢的经典概念似乎也值得商榷。无论如何，无论这种关联的发病机制如何，在甲亢病例中都应想到其可能性。对于毒性腺瘤和格雷夫斯病，当甲状腺肿大不规则，特别是发现有结节时，应始终建议进行手术。病程和预后似乎主要取决于癌的组织学类型以及局部扩散或远处扩散情况，甲亢并不会严重恶化预后。
