葛瑞夫茲氏症併有甲狀腺微小乳突狀癌－病例報告

Papillary Thyroid Micro-carcinoma in Grave's Disease-Case Report

吳振宇(Zhen-Yu Wu) ； 莊俊義(Chun-Yi Chuang)

《台灣耳鼻喉頭頸外科雜誌》 54卷4期 (2019/12) Pp. 212-215

https://doi.org/10.6286/jtohns.201912_54(4).212

摘要

葛瑞夫茲氏症（Graves' disease）是導致甲狀腺亢進最常見的原因，根據過去文獻，葛瑞夫茲氏症會增加罹患甲狀腺癌的風險，尤其是伴有結節者機率更高，其中最常見為乳突癌，約佔8成，而甲狀腺微小乳突狀癌更佔其約五分之一，乳突癌若同時合併葛瑞夫茲氏症，惡性度會提高且易骨轉移，臨床上建議積極治療和追蹤。本患者為56歲女性，主訴胸悶及雙手顫抖數週，理學檢查發現雙側甲狀腺腫大，血液檢查T3及T4高、TSH低、TSH受體抗體高，診斷為葛瑞夫茲氏症，頸部超音波發現廣泛性結節樣腫大，甲狀腺鎝掃描顯示多結節性甲狀腺腫，細針抽吸細胞學檢查為非典型細胞（atypical cell），患者接受藥物治療但成效有限，且超音波追蹤發現結節有變大，故接受內視鏡輔助甲狀腺微創切除術，病理報告為甲狀腺微小乳突狀癌，pT1aNxM0，第一期，藉此經驗分享，讓臨床醫師對於葛瑞夫茲氏症伴有結節的患者，勿輕忽癌化之可能性，應與患者充分溝通衛教，積極治療追蹤。

關鍵字

Graves' disease ； papillary thyroid micro-carcinoma ； minimally invasive video-assisted thyroidectomy（葛瑞夫茲氏症 ； 甲狀腺微小乳突狀癌 ； MIVAT內視鏡輔助甲狀腺微創切除術）

並列摘要

Graves' disease is the most common cause of hyperthyroidism. According to past literature, Graves' disease increases the risk of developing thyroid cancer, especially with nodules, the most common of which is papillary carcinoma, which accounts for about 80% of it. Thyroid papillary micro-carcinoma also accounts for about 1/5 of papillary carcinoma. If the papillary carcinoma is combined with Graves' disease, the rate of distant metastasis will increase, especially bone metastasis. It is recommended to follow up patients actively. Our patient was a 56-year-old woman complaining of chest tightness and hand tremor for several weeks. The physical examination revealed bilateral thyroid enlargement. The lab data showed high T3 and T4, low TSH, and high TSH receptor antibody. Diagnosis of Grave's disease was impressed. The findings of neck sonography showed ill-defined thyroid nodules and 99mTc thyroid scan showed multinodular goiter. The cytology of fine needle aspiration showed atypical cell. Our patient received conservative medical treatment, but limited effectiveness was noted. Neck sonography for follow up revealed size of thyroid nodules increased. So patient received minimally invasive video-assisted thyroidectomy, and the pathological report showed thyroid papillary micro-carcinoma, pT1aNxM0, stage I. By sharing this experience, clinicians should not neglect the possibility of cancer in patients with Graves' disease combined with nodules, and should fully communicate with the patients and actively follow up.

並列關鍵字

Graves' disease ； papillary thyroid micro-carcinoma ； minimally invasive video-assisted thyroidectomy