ObjectiveTo investigate the condition of neck lymph node metastasis and related factors in thyroiditis coexisting thyroid cancer, and make clear the indication of neck lymph node dissection. MethodsA retrospective cohort study was conducted with the clinical data of 147 patients with thyroiditis coexisting thyroid cancer who underwent radical resection of thyroid cancer (total thyroidectomy or subtotal thyroidectomy) and neck lymph node dissection, including age, gender, tumor size, number of focuses, and lymph node metastasis. Results Among 147 patients, 65 patients with neck lymph node metastasis (44.22%), central cervical lymph node metastasis rate was 36.05% （53/147）， which was higher than that of lateral lymph node metastasis rate (20.41%, 30/147), Plt;0.05. Neck lymph node metastasis rate was correlated with patient’s gender and tumor size （Plt;0.05）, while it was not correlated with patient’s age and number of focuses (Pgt;0.05). ConclusionCentral neck lymph node metastasis rate is higher in patients with thyroiditis coexisting thyroid cancer, then routine prophylactic central neck lymph node dissection is significant. Patient’s gender and tumor size are correlated with neck lymph node metastasis. When tumor is larger or in male, ipsilateral lymph node dissection should be considered to done.
ObjectiveTo summarize the research progress of related genes in Hashimoto’s thyroiditis with papillary thyroid carcinoma.MethodLiteratures about Hashimoto’s thyroiditis with papillary thyroid carcinoma were reviewed by searching the literatures in domestic and foreign database.ResultsIn recent years, the incidence of Hashimoto’s thyroiditis with thyroid carcinoma (especially papillary thyroid carcinoma) was on the increase, the two might have the same molecular pathology mechanism.ConclusionThere is a close association between Hashimoto’s thyroiditis and papillary thyroid carcinoma, the common molecular genetic changes suggest that Hashimoto’s thyroiditis may have a correlation with papillary thyroid carcinoma.
Objective To analyze clinical and pathological features of patients with papillary thyroid carcinoma (PTC) with coexistent chronic lymphocytic thyroiditis (CLT). Methods The clinicopathologic data of 756 cases of PTC were collected from January 2014 to January 2017 in the First Affiliated Hospital, Xinjiang Medical University were collected. The patients were designed to observational group (PTC with coexistent CLT, n=194) and control group (simple PTC, n=562) according to whether CLT was diagnosed by pathology, then the clinical data, ultrasonic features, thyroid function, and pathological features in these two groups were compared. Results The proportion of the female patients, the proportions of theserum thyroid stimulating hormone and thyroid autoimmune antibodies (thyroglobulin antibody and thyroid peroxidase antibody), and the proportion of multifocal carcinoma in the observational group were significantly higher than those in the control group (P<0.05). There were no significant differences in the preoperative ultrasound, tumor diameter, thyroid capsule invasion, central lymph node metastasis, and TNM stage in these two groups (P>0.05). The results of the multivariate analysis showed that the female, serum thyroid autoimmune antibodies, and the multifocal carcinoma were the independent predictive factors of PTC with CLT (P<0.05). Conclusions There might be a certain correlation between PTC and CLT, PTC with coexistent CLT is more common in female patient and with multifocal carcinoma. With coexistent CLT does not increase invasion of PTC. This may be associated with limit of CLT to development of PTC nodules. It is speculated that CLT may be a protective factor of PTC.
Objective To compare differences of characteristics of ultrasonic elasticity imaging for benign and malignant small thyroid nodules with or without Hashimoto thyroiditis (HT). Methods The thyroid nodules with ≤1 cm size and the category 4A, 4B, 4C, and 5 of Thyroid Imaging Reporting and Data System (TI-RADS) were included into this study, and a further examination of real-time elastography was performed. The final diagnosis was relied on the pathological diagnosis. The elasticity score and strain ratio (SR) were recorded and compared between these two groups, respectively. Results Of the 424 nodules, 103 nodules were accompanied with HT (thyroid nodule with HT group), 321 nodules were not accompanied with HT (thyroid nodule without HT group). In the thyroid nodule with HT group, the area under the receiver operator characteristic (ROC) curve (AUCs) of the elasticity score and the SR was 0.685 and 0.676, respectively; the optimal cut offs of the elasticity score and the SR was 3 points and 2.45 respectively, their corresponding sensitivity, specificity, and accuracy was 75.7%, 57.6%, 68.0% and 75.7%, 60.6%, 67.6%, respectively. In the thyroid nodule without HT group, the AUCs of the elasticity score and the SR was 0.692 and 0.692, respectively; the optimal cut offs of the elasticity score and the SR was 4 points and 2.84, respectively; their corresponding sensitivity, specificity, and accuracy was 57.5%, 74.2%, 69.2% and 76.1%, 59.7%, 67.7%, respectively. Conclusions Elastography is helpful in differential diagnosis of benign and malignant small thyroid nodules. While, standards of elasticity score and SR value in differential diagnosis are different between benign and malignant small thyroid nodules with HT and without HT, elasticity score and SR ratio decrease in benign and malignant small thyroid nodules with HT.
目的 探讨慢性甲状腺炎合并亚急性甲状腺炎患者的临床特征，明确其诊断方法，以减少临床误诊率。方法 回顾性分析2008年6月至2009年12月期间吉林大学中日联谊医院甲状腺外科行手术治疗的5例慢性甲状腺炎合并亚急性甲状腺炎患者的临床资料，包括病史、症状、体征、临床诊治过程、临床辅助检查结果（甲状腺功能检查、彩色多普勒超声检查、核素扫描等）的特点及病理特征。结果 5例患者中仅1例患者术前伴有间断发热和颈部疼痛病史，另外4例患者均无甲状腺炎的典型临床表现。5例患者临床诊治过程较长，病程迁延，平均病程6.8个月，药物对症治疗效果欠佳，症状及彩色多普勒超声检查结果无明显改善，均因术前不能除外恶变情况而行手术治疗。术中及术后病理检查结果均证实为慢性甲状腺炎合并亚急性甲状腺炎。结论 慢性甲状腺炎合并亚急性甲状腺炎临床诊断较困难，病程迁延，易被误诊，必要时可行穿刺病理学检查以明确诊断。
摘要:目的: 探讨儿童慢性淋巴细胞性甲状腺炎的临床特点、诊断方法、治疗及预后。 方法 : 对77例CLT患儿的临床资料进行回顾性分析。 结果 : 77例CLT患儿男女比例1:67,平均年龄1021±233岁(5～15岁)。86％患儿有甲状腺肿大;初诊时表现甲亢患儿51例,甲低20例,甲功正常6例; TGAb阳性率的94％,TPOAb阳性率96％;1例甲状腺细针吸取细胞学检查诊断合并甲状腺乳头状癌。治疗随访1～39月,77例患儿中出现甲低37例。 结论 : 儿童CLT多见于青春期女性,儿童和青春期患者病初表现甲亢较成人多见,TGAb 和TPOAb是CLT诊断的重要指标,随着病程延长,表现甲低患儿比例逐渐增高。Abstract: Objective: To study the clinical feature, diagnosis, treatment and prognosis of Chronic lymphocytic thyroiditis in children. Methods : Analyze the clinical data of 77 children with Chronic lymphocytic thyroiditis. Results : The proportion of men to women was 1:67 in all 77 children, and the mean age at diagnosis was 1021±233(age range 5~15 years). The percentage of positive TGAb and TPOAb were 94% and 96%, respectively in all the 77 children. One children was diagnosed Chronic lymphocytic thyroiditis coexistent with thyroid papillary carcinoma by FNAB. There were 37 children had hypothyrodism in all the 77 after 1～39 months. Conclusion : CLT is more frequent in females, and at the time of diagnosis more children and adolescents had hypethyrodism than adults. TGAb and TPOAb are important markers for the diagnosis of CLT. The percentage of children had hypothyrodism is increasing along with the course of disease.
ObjectiveTo analyze clinical manifestation, diagnosis, therapy, and prognosis of primary thyroid lymphoma. MethodFrom April 2012 to September 2015, the clinical data of 9 patients with primary thyroid lymphoma admitted to The Affiliated Hospital of Xuzhou Medical College, including clinical manifestation, diagnosis procedure, treatment project, and prognosis, were reviewed retrospectively. ResultsThe thyroids or nodules of 4 patients increased rapidly in 1-3 months, with the surrounding tissues and organs oppression symptoms. The preoperative examination revealed that there were 5 patients with swollen lymph nodes. Eight patients were received preoperative thyroid function examination, there were 4 patients with subclinical hypothyroidism, 4 patients with rose TSH, 6 patients with rose thyroglobulin antibody. There were 5 cases of primary thyroid lymphoma associated with Hashimoto thyroiditis. Eight patients were underwent surgical treatment in our hospital, 1 patient was underwent surgery in the other hospital. The results of pathological histology showed that 5 patients with mucosa associated lymphadenoma were stageⅠE, 3 patients with diffuse large B cell lymphoma were stageⅠE, 1 patient with diffuse large B cell lymphoma was stageⅡE. Two patients with diffuse large B cell lymphoma were received chemotherapy, the scheme was CHOP and COP respectively. Seven patients were received follow-up, the follow-up time was 2-42 months, the median follow-up time was 20 months, all of them were survived. ConclusionsPrimary thyroid lymphoma should be considered for patients with rapid growth of thyroid mass in a short term, which relies on the histopathologic and immunohistochemical diagnosis finally. The individualized treatment should be performed for primary thyroid lymphoma according to pathological classification.
Objective To summarize the progress of research about the relationship between papillary thyroid carcinoma (PTC) and Hashimoto’s thyroiditis (HT). Method The relevant literatures at home and abroad in recent years about this topic were collected and analyzed. Results Comprehensive literature reviewed, combined with the author's clinical research results, PTC and HT were indeed closely related, or there was a certain causal link. HT and PTC might both come from the same embryonic stem cells. HT was an autoimmune thyroid disease caused by abnormal immune response, and might be a triggering factor of PTC. Meanwhile, lymphocyte infiltration might play a certain protective role in anti-tumor effect. RET chromosome rearrangement, RAS point mutation and BRAF gene mutation might activate mitogen-activated protein kinase (MAPK) pathway, especially in PTC cases with HT in which RET chromosome rearrangement was more common. In the future, selective targeted therapy aiming at the activation of RET/RAS/BRAF/MAPK pathway was a promising treatment especially in advanced PTC cases. Conclusions The correlation between PTC and HT is not fully clarified. HT is a potential risk factor for PTC but the cases of PTC with HT have a better prognosis. More prospective studies will help to further clarify the correlation between two diseases.