- 期刊
Prevalence of Thyroid Cancer in Hyperthyroidism Treated by Surgery
甲狀腺機能亢進經手術後發現併有甲狀腺癌症之盛行率
摘要
根據文獻研究,甲狀腺機能亢進患者併發甲狀腺癌之盛行率,結果有很大的差異性（0.21-9.0%）。此差異性可能與眾多因子有關（如手術患者之選擇、組織病理學之準確度等），不過一般認為此兩種疾病同時併存之情形並不算罕見，而且盛行率於近年之研究更有升高的趨勢，此可能與更詳盡的檢查有關。本研究即針對甲狀腺機能亢進患者，其經手術後發現併有甲狀腺癌之盛行率作一探討。本文採回溯性研究，收集自民國78年4月至89年7月間，因甲狀腺機能亢進而於本科接受手術治療之45位患者（女性34位、男性11位），14-67歲。其中Graves’ disease有42例，功能性多發性結節之甲狀腺腫有1 例，單一功能性結節有2例。施行甲狀腺全切除術43例，單側全葉切除術2例。其中6例併有甲狀腺癌（發生率13.3%）：男性2位，女性4位（19-48歲），其中Graves’ disease 4例，功能性多發性結節之甲狀腺腫1例，單一功能性結節1例。術後之組織病理學顯示，3例乳頭狀腺癌、1例濾泡腺癌、1 例濾泡腺癌併亮細胞癌、1 例亮細胞癌。本研究顯示甲狀腺機能亢進之患者術後證實併有甲狀腺癌症之發生率為13.3%，單一功能性結節亦有潛藏惡性腫瘤之情形。故對此類患者，必須小心的評估以排除存在惡性腫瘤的可能性，以便做最適當的治療計劃。
並列摘要
The reported prevalence of thyroid cancer with concurrent hyperthyroidism varies from 0.21% to 9.0%. This variability may be due to multiple factors, such as indications for surgery and histopathologic accuracy. However, this condition is not rare and its prevalence has increased in recent surveys, perhaps as a result of more detailed examinations. The aim of this retrospective study was to determine the prevalence of thyroid cancer in hyperthyroid patients at surgery. Forty-five patients, 34 women and 11 men, underwent surgery for hyperthyroidism in our department between 1989 and 2000. Ages ranged from 14 to 67 years. There were 42 cases of Graves’ disease, one of functional multinodular goiter, and two of single toxic nodules. Forty-three patients underwent total thyroidectomy and two underwent total lobectomy. Six case (13.3%) of thyroid cancer were found, two men and four women with ages ranging from 19 to 48 years. Final hisologic examination revealed three papillary carcinomas, one follicular carcinoma, one follicular carcinoma combined with clear-cell carcinoma, and one clear-cell carcinoma. Thus, in our department, the prevalence of thyroid cancer in hyperthyroidism treated using surgery was 13.3%. Our study showed that even a single toxic nodule may occur with concurrent thyroid cancer. Careful evaluation of such patients is needed to exclude the presence of associated malignancy and to determine the most appropriate therapeutic plan.