Diagnosis and Treatment of Hashimoto Thyroiditis Coexistence with Thyroid Cancer_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

ONG Weidong , HUANG Kun , WANG Nanpeng , YE Hui , GAO Qingjun , ZHOU Yan , GAO Rongjun , DUAN Haisong ,  ZHAO Daiwei

Department of Thyroid Surgery， The Affiliated Hospital of Guiyang Medical College， Guiyang 550004， Guizhou Province， China;

Corresponding author：

ZHAO Daiwei, Email: zhaodw@hotmail.com

Keywords：

Hashimoto thyroiditis; Thyroid cancer; Diagnosis; Treatment; Auxiliary examination

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Objective 　To summarize the diagnosis and treatment of Hashimoto thyroiditis （HT） coexistence with
thyroid cancer （TC）.
Methods 　One hundred and eighty-four patients with HT treated in The Affiliated Hospital of Guiyang Medical College from Jan. 2008 to Dec. 2011 were collected， and clinical data of 32 patients with TC of them were analyzed retrospectively.
Results 　Thirty two patients combined with TC of the 184 patients with HT， and the incidence rate was 17.4%. All of the 32 patients were treated surgically according to the principle of surgery treatment for TC. Of the 32 cases of HT coexistence with TC， 15 patients were diagnosed by preoperative fine needle aspiration cytology （FNAC）， and the sensitivity of FNAC was 46.9% （15/32）. Twenty seven patients were diagnosed by intraop-erative frozen section pathological examination， and the sensitivity of it was 84.4% （27/32）， which was significantly higher than those of FNAC （χ2=7.563，P=0.004）. Thirty patients were diagnosed as papillary thyroid carcinoma （PTC）， and 2 patients were diagnosed as follicular thyroid carcinoma （FTC） by postoperative paraffin section pathological exam-ination and （or） immunohistochemistry， respectively. All patients were treated with levothyroxine （L-T4） after operation，and 5 patients were treatment with 131I therapy in addition. One patient suffered convulsion， and 2 patients suffered mild hoarsenessthere after operation. Only 29 patients were followed up for 3-49 months （average 35 months）， and during the followed up， there were no tumor recurrence， metastasis， and death.
Conclusions 　The rate of preoperative diagnosis of HT coexistence with TC is low， and auxiliary examinations play an important role in diagnosis and guiding treatment. Surgery is the preferred treatment， but auxiliary therapies after surgery are indispensable too.

Citation： ONG Weidong,HUANG Kun,WANG Nanpeng,YE Hui,GAO Qingjun,ZHOU Yan,GAO Rongjun,DUAN Haisong,ZHAO Daiwei,.. Diagnosis and Treatment of Hashimoto Thyroiditis Coexistence with Thyroid Cancer. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2013, 20(6): 643-647. doi: Copy

1.	王家耀，廖松林，程秀英，等. 桥本甲状腺炎合并甲状腺乳头状癌[J]. 中华病理学杂志， 1997， 26(3)：171.
2.	陈佳瑞，王家东. 桥本甲状腺炎与甲状腺乳头状癌相关性的研究进展[J]. 现代肿瘤医学， 2009， 17(12)：2449-2451.
3.	Lindsay S， Dailey ME， Friedlander J， et al. Chronic thyroiditis：a clinical and pathologic study of 354 patients[J]. J Clin Endocrinol Metab， 1952， 12(12)：1578-1600.
4.	李里，黄新余，郑起. 桥本病合并甲状腺肿瘤的外科治疗和临床特征分析[J]. 中国癌症杂志， 2009， 19(7)：544-547.
5.	Loh KC， Greenspan FS， Dong F， et al. Influence of lymphocytic thyroiditis on the prognostic outcome of patients with papillary thyroid carcinoma[J]. Clin Endocrinol Metab， 1999， 84(2)：458-463.
6.	葛国祥，崔崇仁，侯军，等. 桥本病合并甲状腺癌的临床分析[J]. 中国普通外科杂志， 2004， 13(5)：385-386.
7.	唐波，姜军. RET原癌基因与分化性甲状腺癌关系的研究进展[J]. 中国普外基础与临床杂志， 2004， 11(1)：89-91.
8.	Pino Rivero V， Guerra Camacho M， Marcos García M， et al. The incidence of thyroid carcinoma in Hashimoto’s thyroiditis. Our experience and literature review[J]. An Otorrinolaringol Ibero Am， 2004， 31(3)：223-230.
9.	朱月秀. 桥本甲状腺炎甲状腺功能测定的临床分析[J]. 检验医学与临床， 2010， 7(23)：2650-2651.
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12.	Iannuccilli JD， Cronan JJ， Monchik JM. Risk for malignancy of thyroid nodules as assessed by sonographic criteria：the need for biopsy[J]. J Ultrasound Med， 2004， 23(11)：1455-1464.
13.	潘福顺，谢晓燕，李晓曦，等. 甲状腺微小癌超声特征探讨[J]. 中国实用外科杂志， 2010， 30(10)：874-875.
14.	平波. 细针穿刺细胞学诊断甲状腺癌价值及评价[J]. 中国实用外科杂志， 2011， 31(5)：386-388.
15.	马寄晓，刘秀杰. 实用临床核医学[M]. 第2版. 北京：原子能出版社， 2002：359-367.
16.	赵代伟，叶晖，王南鹏，等. 桥本甲状腺炎合并甲状腺腺癌9例诊治体会[J]. 山东医药， 2008， 48(29)：82-83.
17.	Hay ID， McConahey WM， Goellner JR. Managing patients with papillary thyroid carcinoma：insights gained from the Mayo Clinic’s experience of treating 2 512 consecutive patients during 1940 through 2000[J]. Trans Am Clin Climatol Assoc， 2002， 113：241-260.
18.	苏清华，潘小明，吴宣林. 甲状腺全切除术治疗甲状腺良性疾病[J]. 中国普外基础与临床杂志， 2004， 11(6)：493-495.
19.	吴骥，管小青，吴建强，等. 甲状腺全切除术治疗分化型甲状腺癌的安全性探讨(附72例报道)[J]. 中国普外基础与临床杂志， 2011， 18(5)：541-544.
20.	Vaiman M， Nagibin A， Hagag P， et al. Subtotal and near total versus total thyroidectomy for the management of multinodular goiter[J]. World J Surg， 2008， 32(7)：1546-1551.
21.	杜伟，刘善廷，黑虎，等. 分化型甲状腺癌手术中暴露并保护甲状旁腺的必要性分析[J]. 中国耳鼻咽喉头颈外科， 2010， 17(9)：449-451.
22.	Haigh PI， Urbach DR， Rotstein LE. Extent of thyroidectomy is not a major determinant of survival in low- or high-risk papillary thyroid cancer[J]. Ann Surg Oncol， 2005， 12(1)：81-89.
23.	中国抗癌协会头颈肿瘤专业委员会. 分化型甲状腺癌诊治指南[J]. 中国实用外科杂志， 2011， 31(10)：908-914.
24.	Wartofsky L. Highlights of the American thyroid association guidelines for patients with thyroid nodules or differentiated thyroid carcinoma：the 2009 revision[J]. Thyroid， 2009， 19(11)：1139-1143.
25.	American Thyroid Association Surgery Working Group， American Association of Endocrine Surgeons， American Academy of Otolaryngology-Head and Neck Surgery， et al. Consensus statement on the terminology and classification of central neck dissection for thyroid cancer[J]. Thyroid， 2009， 19(11)：1153-1158.
26.	康增寿. 131I治疗甲状腺癌[J]. 中国普外基础与临床杂志， 2006， 13(3)：252-253.
27.	， 41(4)：357-362.

1. 王家耀，廖松林，程秀英，等. 桥本甲状腺炎合并甲状腺乳头状癌[J]. 中华病理学杂志， 1997， 26(3)：171.
2. 陈佳瑞，王家东. 桥本甲状腺炎与甲状腺乳头状癌相关性的研究进展[J]. 现代肿瘤医学， 2009， 17(12)：2449-2451.
3. Lindsay S， Dailey ME， Friedlander J， et al. Chronic thyroiditis：a clinical and pathologic study of 354 patients[J]. J Clin Endocrinol Metab， 1952， 12(12)：1578-1600.
4. 李里，黄新余，郑起. 桥本病合并甲状腺肿瘤的外科治疗和临床特征分析[J]. 中国癌症杂志， 2009， 19(7)：544-547.
5. Loh KC， Greenspan FS， Dong F， et al. Influence of lymphocytic thyroiditis on the prognostic outcome of patients with papillary thyroid carcinoma[J]. Clin Endocrinol Metab， 1999， 84(2)：458-463.
6. 葛国祥，崔崇仁，侯军，等. 桥本病合并甲状腺癌的临床分析[J]. 中国普通外科杂志， 2004， 13(5)：385-386.
7. 唐波，姜军. RET原癌基因与分化性甲状腺癌关系的研究进展[J]. 中国普外基础与临床杂志， 2004， 11(1)：89-91.
8. Pino Rivero V， Guerra Camacho M， Marcos García M， et al. The incidence of thyroid carcinoma in Hashimoto’s thyroiditis. Our experience and literature review[J]. An Otorrinolaringol Ibero Am， 2004， 31(3)：223-230.
9. 朱月秀. 桥本甲状腺炎甲状腺功能测定的临床分析[J]. 检验医学与临床， 2010， 7(23)：2650-2651.
10. Arif S， Blanes A， Diaz-Cano SJ. Hashimoto’s thyroiditis shares features with early papillary thyroid carcinoma[J]. Histopathology，.
11. 高明. 甲状腺癌诊治进展[J]. 肿瘤学杂志， 2003， 9(1)：40-44.
12. Iannuccilli JD， Cronan JJ， Monchik JM. Risk for malignancy of thyroid nodules as assessed by sonographic criteria：the need for biopsy[J]. J Ultrasound Med， 2004， 23(11)：1455-1464.
13. 潘福顺，谢晓燕，李晓曦，等. 甲状腺微小癌超声特征探讨[J]. 中国实用外科杂志， 2010， 30(10)：874-875.
14. 平波. 细针穿刺细胞学诊断甲状腺癌价值及评价[J]. 中国实用外科杂志， 2011， 31(5)：386-388.
15. 马寄晓，刘秀杰. 实用临床核医学[M]. 第2版. 北京：原子能出版社， 2002：359-367.
16. 赵代伟，叶晖，王南鹏，等. 桥本甲状腺炎合并甲状腺腺癌9例诊治体会[J]. 山东医药， 2008， 48(29)：82-83.
17. Hay ID， McConahey WM， Goellner JR. Managing patients with papillary thyroid carcinoma：insights gained from the Mayo Clinic’s experience of treating 2 512 consecutive patients during 1940 through 2000[J]. Trans Am Clin Climatol Assoc， 2002， 113：241-260.
18. 苏清华，潘小明，吴宣林. 甲状腺全切除术治疗甲状腺良性疾病[J]. 中国普外基础与临床杂志， 2004， 11(6)：493-495.
19. 吴骥，管小青，吴建强，等. 甲状腺全切除术治疗分化型甲状腺癌的安全性探讨(附72例报道)[J]. 中国普外基础与临床杂志， 2011， 18(5)：541-544.
20. Vaiman M， Nagibin A， Hagag P， et al. Subtotal and near total versus total thyroidectomy for the management of multinodular goiter[J]. World J Surg， 2008， 32(7)：1546-1551.
21. 杜伟，刘善廷，黑虎，等. 分化型甲状腺癌手术中暴露并保护甲状旁腺的必要性分析[J]. 中国耳鼻咽喉头颈外科， 2010， 17(9)：449-451.
22. Haigh PI， Urbach DR， Rotstein LE. Extent of thyroidectomy is not a major determinant of survival in low- or high-risk papillary thyroid cancer[J]. Ann Surg Oncol， 2005， 12(1)：81-89.
23. 中国抗癌协会头颈肿瘤专业委员会. 分化型甲状腺癌诊治指南[J]. 中国实用外科杂志， 2011， 31(10)：908-914.
24. Wartofsky L. Highlights of the American thyroid association guidelines for patients with thyroid nodules or differentiated thyroid carcinoma：the 2009 revision[J]. Thyroid， 2009， 19(11)：1139-1143.
25. American Thyroid Association Surgery Working Group， American Association of Endocrine Surgeons， American Academy of Otolaryngology-Head and Neck Surgery， et al. Consensus statement on the terminology and classification of central neck dissection for thyroid cancer[J]. Thyroid， 2009， 19(11)：1153-1158.
26. 康增寿. 131I治疗甲状腺癌[J]. 中国普外基础与临床杂志， 2006， 13(3)：252-253.
27. ， 41(4)：357-362.

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Diagnosis and Treatment of Hashimoto Thyroiditis Coexistence with Thyroid Cancer

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