Daou R
Service de chirurgie générale, hôpital Saint-Georges, Beyrouth, Liban.
Chirurgie. 1998 Dec;123(6):604-8. doi: 10.1016/s0001-4001(99)80011-7.
The idea that thyrotoxicosis is insurance against thyroid cancer has prevailed for a long time. However this association has been reported frequently in the recent literature. The aim of this study is to report our experience concerning this association and to discuss its incidence and its consequences in the light of the present data.
Among the 734 patients who underwent a thyroidectomy between January 1983 and January 1998, there were 125 patients with hyperthyroidism, ten with associated cancer (8%). All patients were female (mean age: 43.8 years) with Graves' disease (n = 2), a toxic adenoma (n = 5), or a multi nodular toxic goiter (n = 3). The cancer was recognized intraoperatively in eight patients. A total thyroidectomy was performed in five cases and a total lobectomy associated with a subtotal contralateral lobectomy in five cases, completed by a treatment with l131 in nine cases.
Concurrent carcinoma was present in 10% of the patients with toxic nodular goiter and in 4.4% in those with Graves' disease. Papillary carcinoma presented in all cases. The size of the cancer was between 0.2 and 1.5 cm. Nodal involvement was present in one patient. With a follow-up of 1 to 15 years, there was no local recurrence and no metastasis.
The diagnosis of hyperthyroidism does not preclude concurrent thyroid carcinoma. The prognostic and therapeutic consequences of this association are still debated.
长期以来，甲状腺毒症可预防甲状腺癌这一观点颇为流行。然而，近期文献中频繁报道了这种关联。本研究的目的是报告我们关于这种关联的经验，并根据现有数据讨论其发生率及后果。
在1983年1月至1998年1月期间接受甲状腺切除术的734例患者中，有125例甲亢患者，其中10例合并癌症（8%）。所有患者均为女性（平均年龄：43.8岁），患有Graves病（n = 2）、毒性腺瘤（n = 5）或多结节毒性甲状腺肿（n = 3）。8例患者术中确诊为癌症。5例行全甲状腺切除术，5例行患侧甲状腺全叶切除加对侧甲状腺次全切除术，9例行¹³¹I治疗。
毒性结节性甲状腺肿患者中并发癌的比例为10%，Graves病患者中为4.4%。所有病例均为乳头状癌。癌灶大小在0.2至1.5厘米之间。1例患者有淋巴结转移。随访1至15年，无局部复发及远处转移。
甲亢的诊断不能排除并发甲状腺癌。这种关联的预后和治疗后果仍存在争议。
