Chou F F, Sheen-Chen S M, Chen Y S, Chen M J
Department of Surgery, Chang Gung Memorial Hospital Kaohsiung Chang Gung Medical College, Niao Sung Hsiang, Taiwan, R.O.C.
Int Surg. 1993 Oct-Dec;78(4):343-6.
A total of 14 patients had hyperthyroidism coexisting with thyroid malignancy. Twelve patients had papillary cancer, 1 follicular cancer and 1 anaplastic cancer. Patients with Graves' disease had a low rate of associated malignancy 1.5% (10/674) and toxic nodular goiter had an incidence of 3.1% (4/27). Subtotal thyroidectomy was performed in 11 patients, total thyroidectomy in 2 and biopsy only in 1. Two of the subtotal thyroidectomy groups had to be operated on again due to their size being over 1 cm. In the follow-up period, only one patient died of anaplastic cancer in the second month. One patient who had multiple foci of the papillary cancer had local recurrence and lymph node metastasis 27 months later, and needed another radical neck dissection. All the other 12 patients were doing well without cancer recurrence. In conclusion, hyperthyroidism may have a malignancy of 1.75% (14/801). Subtotal thyroidectomy is adequate for occult cancer. Those patients with multiple foci, cancer size over 1 cm and capsule invasion should have a second operation with total thyroidectomy.
共有14例患者同时患有甲状腺功能亢进症和甲状腺恶性肿瘤。其中12例为乳头状癌，1例为滤泡状癌，1例为未分化癌。格雷夫斯病患者合并恶性肿瘤的发生率较低，为1.5%（10/674），毒性结节性甲状腺肿的发生率为3.1%（4/27）。11例行甲状腺次全切除术，2例行甲状腺全切除术，1例仅行活检。甲状腺次全切除组中有2例因肿瘤大小超过1 cm而需再次手术。在随访期间，仅1例患者在第二个月死于未分化癌。1例有多发性乳头状癌灶的患者在27个月后出现局部复发和淋巴结转移，需要再次行根治性颈清扫术。其他12例患者均情况良好，无癌症复发。总之，甲状腺功能亢进症患者的恶性肿瘤发生率可能为1.75%（14/801）。甲状腺次全切除术适用于隐匿性癌。对于有多发病灶、肿瘤大小超过1 cm且有包膜侵犯的患者应再次行甲状腺全切除术手术。
