|
|
单中心45例甲状腺毒性结节患者临床特征的分析
|
Abstract:
目的：探讨甲状腺毒性结节患者的临床特征，为临床医生及早识别该病提供依据。方法：回顾性分析2013年7月至2023年7月就诊于青岛大学附属医院经甲状腺静态扫描确诊的甲状腺毒性结节患者的临床资料。结果：10年间，确诊为甲状腺毒性结节的患者共45例，平均年龄57岁，女性患者34例(75.56%)，27例(60.00%)患者在就诊时存在甲状腺毒症的症状。15例(55.55%)患者存在TRAb的升高。TRAb阴性组结节检出率为95.65%，其中17例为囊实性结节；TRAb阳性组6例患者为实性结节。12例患者进行碘131治疗，13例患者接受手术治疗。结论：甲状腺毒性结节多发于老年女性，大部分患者就诊时存在甲状腺毒症症状。TRAb阳性不能排除甲状腺毒性结节，TRAb阳性且结节性质为实性时，可能合并毒性结节。RAI治疗及手术治疗是根治甲状腺毒性结节的有效手段。
Objective: To explore the clinical characteristics of patients with toxic goiter and provide a basis for clinicians to identify the disease early. Methods: The clinical data of patients with toxic goiter diagnosed by static thyroid scan who attended The Affiliated Hospital of Qingdao University from July 2013 to July 2023 were retrospectively analyzed. Results: During the 10 years, a total of 45 patients had confirmed toxic goiter, with a mean age of 57 years, 34 (75.56%) were female patients and 27 (60.00%) patients had symptoms of thyrotoxicosis at presentation. TRAb was elevated in 15 patients (55.55%). The detection rate of nodules in the TRAb negative group was 95.65%, of which 17 patients were cystic solid nodules; 6 patients in the TRAb positive group were solid nodules. 12 patients were treated with iodine-131 and 13 patients underwent surgery. Conclusion: Toxic goiter is more common in elderly women, and most patients have thyrotoxicosis symptoms. Positive TRAb cannot exclude toxic goiter. When TRAb is positive and the nodules are solid, toxic nodules may be combined. RAI treatment and surgical treatment are the effective means for the radical treatment of toxic goiter.
| [1] | Wiersinga, W.M., Poppe, K.G. and Effraimidis, G. (2023) Hyperthyroidism: Aetiology, Pathogenesis, Diagnosis, Management, Complications, and Prognosis. The Lancet Diabetes & Endocrinology, 11, 282-298. https://doi.org/10.1016/s2213-8587(23)00005-0 |
| [2] | Chaker, L., Cooper, D.S., Walsh, J.P. and Peeters, R.P. (2024) Hyperthyroidism. The Lancet, 403, 768-780. https://doi.org/10.1016/s0140-6736(23)02016-0 |
| [3] | Sancak, S., Jaeschke, H., Eren, F., Ozlem, T., Guellueoglu, B., Sen, L.S., et al. (2011) High Prevalence of TSHR/Gsα Mutation-Negative Clonal Hot Thyroid Nodules (HNs) in a Turkish Cohort. Hormone and Metabolic Research, 43, 562-568. https://doi.org/10.1055/s-0031-1280829 |
| [4] | Moroto, D., Torquato-Vieira, I.C.O., Fiorin, L.B., Camacho, C.P., Castiglioni, M.L.V., Maciel, R.M.B., et al. (2024) Long-Term Follow-Up of Patients with Autonomous Thyroid Nodules Treated with Radioiodine. Clinical Nuclear Medicine, 49, 529-535. https://doi.org/10.1097/rlu.0000000000005189 |
| [5] | Vassart, G. and Dumont, J.E. (1992) The Thyrotropin Receptor and the Regulation of Thyrocyte Function and Growth. Endocrine Reviews, 13, 596-611. https://doi.org/10.1210/edrv-13-3-596 |
| [6] | Krohn, K., Führer, D., Bayer, Y., Eszlinger, M., Brauer, V., Neumann, S., et al. (2004) Molecular Pathogenesis of Euthyroid and Toxic Multinodular Goiter. Endocrine Reviews, 26, 504-524. https://doi.org/10.1210/er.2004-0005 |
| [7] | 吕健, 栾梅香. 毒性甲状腺腺瘤21例临床分析[J]. 新疆医科大学学报, 2000(1): 26-28. |
| [8] | Goichot, B., Caron, P., Landron, F. and Bouée, S. (2015) Clinical Presentation of Hyperthyroidism in a Large Representative Sample of Outpatients in France: Relationships with Age, Aetiology and Hormonal Parameters. Clinical Endocrinology, 84, 445-451. https://doi.org/10.1111/cen.12816 |
| [9] | Demir, B.K., Karakilic, E., Saygili, E.S., Araci, N. and Ozdemir, S. (2022) Predictors of Hypothyroidism Following Empirical Dose Radioiodine in Toxic Thyroid Nodules: Real-Life Experience. Endocrine Practice, 28, 749-753. https://doi.org/10.1016/j.eprac.2022.05.001 |
| [10] | Sjölin, G., Watt, T., Byström, K., Calissendorff, J., Cramon, P.K., Nyström, H.F., et al. (2022) Long Term Outcome after Toxic Nodular Goitre. Thyroid Research, 15, Article No. 20. https://doi.org/10.1186/s13044-022-00138-0 |
| [11] | Kahraman, D., Keller, C., Schneider, C., Eschner, W., Sudbrock, F., Schmidt, M., et al. (2012) Development of Hypothyroidism during Long-Term Follow-Up of Patients with Toxic Nodular Goitre after Radioiodine Therapy. Clinical Endocrinology, 76, 297-303. https://doi.org/10.1111/j.1365-2265.2011.04204.x |
| [12] | Robens, E., Spelsberg, F., Kabus, S., et al. (2001) Indications, Risks, and Acceptance of Total Thyroidectomy for Multinodular Benign Goiter. Surgery Today, 31, 958-962. https://doi.org/10.1007/s005950170002 |
| [13] | 张大闯, 李龙, 王凤军, 等. 毒性多结节性甲状腺肿的手术术式探讨[J]. 现代生物医学进展, 2014, 14(31): 6069-6072. |
| [14] | Azizi, F., Takyar, M., Madreseh, E. and Amouzegar, A. (2019) Treatment of Toxic Multinodular Goiter: Comparison of Radioiodine and Long-Term Methimazole Treatment. Thyroid, 29, 625-630. https://doi.org/10.1089/thy.2018.0397 |
| [15] | Azizi, F., Saadat, N., Takyar, M.A., Abdi, H., Mehran, L. and Amouzegar, A. (2022) Efficacy and Safety of Long-Term Methimazole versus Radioactive Iodine in the Treatment of Toxic Multinodular Goiter. Endocrinology and Metabolism, 37, 861-869. https://doi.org/10.3803/enm.2022.1476 |
| [16] | 李洲成, 向元楚, 钟荣国, 石斌. 原发性甲状腺功能亢进症合并甲状腺癌分析[J]. 邵阳学院学报(自然科学版), 2019, 16(1): 71-74. |
| [17] | Negro, R., Valcavi, R. and Toulis, K.A. (2013) Incidental Thyroid Cancer in Toxic and Nontoxic Goiter: Is TSH Associated with Malignany Rate? Results of a Meta-Analysis. Endocrine Practice, 19, 212-218. https://doi.org/10.4158/ep12234.or |
| [18] | Barbaro, D., Orsini, P., Lapi, P., Pasquini, C., Tuco, A., Righini, A., et al. (2007) Percutaneous Laser Ablation in the Treatment of Toxic and Pretoxic Nodular Goiter. Endocrine Practice, 13, 30-36. https://doi.org/10.4158/ep.13.1.30 |
