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目的:探讨桥本甲状腺炎(Hashimoto thyroiditis,HT)合并甲状腺癌患者的临床特征。方法:分析38例HT合并甲状腺癌患者的临床资料,重点分析实验室及辅助检查结果、治疗情况、近期疗效等。结果:38例中男5例,女33例,男:女为1:6.6,颈部有肿块32例,声嘶4例,颈部压痛1例,无症状1例。22例行甲状腺功能和相关抗体检查,血总T3升高1例,降低1例;T4升高1例,降低3例;TSH升高10例,降低3例;甲状腺球蛋白抗体升高9例,甲状腺过氧化物酶抗体升高18例(其他患者未见异常)。影像学检查均未提示HT。15例行甲状腺和淋巴结的细针穿刺检查,提示为甲状腺癌7例,提示为HT合并甲状腺癌3例,提示颈部淋巴结见甲状腺癌转移2例,其余未能作出诊断。38例患者均行手术治疗,所有患者术后服用左甲状腺素,100μg/d。随访时间9～65个月,3例肿瘤复发,2例失访,其余患者情况稳定。结论:女性HT较男性更容易合并甲状腺癌,其临床表现缺乏特异性,甲状腺相关抗体检查、影像学检查结合细针穿刺是诊断HT合并甲状腺癌的有效手段,手术治疗疗效较好。
Objective: To investigate the clinical features of patients with Hashimoto thyroiditis (HT) complicated with thyroid cancer. Methods: The clinical data of 38 patients with HT complicated with thyroid cancer were analyzed. The laboratory and auxiliary examination results, treatment and immediate effect were analyzed emphatically. Results: There were 5 males and 33 females in 38 cases. The male and female were 1: 6.6. There were 32 cases of neoplasms in neck, 4 cases of hoarseness, 1 case of neck tenderness and 1 case of asymptomatic. 22 cases of thyroid function and related antibodies examination, blood total T3 increased in 1 case, decreased in 1 case; T4 increased in 1 case, decreased in 3 cases; TSH increased in 10 cases, decreased in 3 cases; thyroglobulin antibody increased in 9 cases , Thyroid peroxidase antibody increased in 18 cases (no abnormalities in other patients). Imaging examination did not prompt HT. Fine needle aspiration of thyroid and lymph nodes was performed in 15 cases, which suggested thyroid cancer in 7 cases, suggesting that HT combined with thyroid cancer in 3 cases, suggesting that cervical lymph node metastasis in 2 cases of thyroid cancer, the rest failed to make a diagnosis. Thirty-eight patients underwent surgery, and all patients received levothyroxine 100 μg / d after surgery. The follow-up time ranged from 9 to 65 months. Three tumors recurred, two were lost to follow-up, and the rest were stable. CONCLUSION: Female HT is more likely to be associated with thyroid cancer than male, and its clinical manifestations are not specific. Thyroid-related antibody test and imaging combined with fine needle aspiration are effective in diagnosing HT with thyroid cancer. Surgical treatment is effective.