Outcome of patients surgically treated for various forms of hyperthyroidism with differentiated thyroid cancer: Experience at an endocrine center in Italy
Outcome of patients surgically treated for various forms of hyperthyroidism with differentiated thyroid cancer: Experience at an endocrine center in Italy
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DOI：
10.1007/s00595-005-3115-3
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发表时间：
2006-02-01
期刊：
影响因子：
2.5
通讯作者：
Rosei, EA
中科院分区：
文献类型：
--
作者：
Cappelli, C;Braga, M;Rosei, EA
目的。与甲状腺功能亢进相关的甲状腺癌的发病率和侵袭性仍然是一个备受争议的话题。本研究的目的是分析甲状腺功能亢进症和甲状腺癌共存的频率，并确定癌症是否会因不同形式的甲状腺功能亢进症而变得更具侵袭性。方法。我们回顾性研究了 1985 年至 2001 年间接受评估的 2449 名甲状腺功能亢进患者。所有闪烁扫描显示“冷”结节的患者，例如患有格雷夫斯病并伴有实性结节的患者，均接受了细针抽吸活检 (FNAB)。手术的标准是细胞学检查结果表明恶性肿瘤、甲状腺肿伴气管或食管受压症状、抗甲状腺药物治疗的副作用或格雷夫斯病在治疗停药后多次复发或对抗甲状腺药物有反应。结果。格雷夫斯病患者 (6.5%) 的甲状腺癌诊断率高于单结节性毒性甲状腺肿 (UTG) (4.4%) 或多结节性毒性甲状腺肿 (MTG) (3.9%) 患者。 56% 的格雷夫斯病患者发现淋巴结受累，23% 的 MTG 患者发现淋巴结受累，而 UTG 患者则没有发现淋巴结受累。 1例Graves病患者发现远处转移。结论。与格雷夫斯病相关的癌症似乎比与 MTG 或 UTG 相关的癌症更具侵袭性。因此，我们建议对格雷夫斯病患者进行仔细监测，以检测甲状腺结节。超声检查似乎是检测此类结节的最佳方式。
Purpose. The incidence and aggressiveness of thyroid cancer associated with hyperthyroidism remains a subject of much controversy. The aim of this study was to analyze the frequency of coexisting hyperthyroidism and thyroid cancer, and to determine whether cancer becomes more aggressive with different forms of hyperthyroidism.Methods. We retrospectively studied 2449 patients assessed for hyperthyroidism between 1985 and 2001. All patients with a "cold" nodule on scintigraphy, such as those with Graves' disease and a concomitant solid nodule, underwent fine-needle aspiration biopsy (FNAB). Criteria for surgery were cytological findings indicative of malignancy, goiter with signs of tracheal or esophageal compression, side effects of antithyroid drug therapy, or Graves' disease with multiple relapses after therapy withdrawal or responsiveness to antithyroid drugs.Results. Thyroid cancer was diagnosed more frequently in patients with Graves' disease (6.5%) than in those with uninodular toxic goiter (UTG) (4.4%) or multinodular toxic goiter (MTG) (3.9%). Lymph node involvement was found in 56% of the patients with Graves' disease, in 23% of those with MTG, and in none of those with UTG. Distant metastases were found in one patient with Graves' disease.Conclusions. Cancers associated with Graves' disease seems to be more aggressive than those associated with MTG or UTG. Thus, we suggest that patients with Graves' disease be carefully monitored for the detection of thyroid nodules. Ultrasonography seems to be the best modality to detect such nodules.