摘要
甲狀腺惡性腫瘤一般是無症狀，尤其是直徑在1公分以下之惡性腫瘤（以下簡稱微小癌）。本科回顧民國85年至94年期間在本院接受手術治療的27位甲狀腺惡性腫瘤的病患中發現有4位是因甲狀腺疾病併發微小癌患者：【病例1】39歲，女性，主訴頸部不舒服；甲狀腺超音波檢查：右葉中部直徑1.5公分及左葉下部直徑0.6公分之邊緣不規則的腫瘤陰影，被診斷為甲狀腺癌併發腺內轉移。【病例2】37歲，女性，主訴頸部腫大，吞嚥困難；甲狀腺超音波檢查：兩側葉內呈瀰漫性均音波質，內有大小不同之囊胞狀腫瘤陰影，被診斷為多結節性甲狀腺腫。【病例3】31歲，女性，主訴心悸及頸部腫大；甲狀腺超音波檢查：兩側葉內呈瀰漫性均音波質，內有大小不同之囊胞狀腫瘤陰影；又於右葉上部發現－直徑0.7公分之邊緣不規則的腫瘤陰影，被診斷為多結節性甲狀腺腫併發甲狀腺癌。【病例4】70歲，女性，主訴咳嗽及呼吸困難；甲狀腺超音波檢查：兩側葉內呈瀰漫性均音波質，內有大小不同之囊胞狀腫瘤陰影，並於左葉中下部發現－直徑0.5公分、半弧形鈣化陰影，被診斷為多結節性甲狀腺腫併發鈣化。這四位中有兩位術前已被診斷出微小癌，有兩位是因為多結節性甲狀腺腫手術後才發現併發微小癌。結論：(1)甲狀腺微小癌通常是在病理解剖或與甲狀腺疾病併發時才易被發現尤其是0.5公分以下之腫瘤都是在手術後病理報告時才知道；為了防止疏漏，門診病患若有主訴頸部症狀者應考慮安排甲狀腺超音波檢查。(2)甲狀腺超音波檢查法有其極限，腫瘤若小於0.5公分時可能無法判斷，但若大於0.5公分時，型狀為第三型時應積極進行手術治療；第一或二型應密切使用超音波檢查法追蹤其變化。
並列摘要
Malignant tumor of thyroid is usually no symptom sign, specialized in diameter under 1 cm malignant tumor(called minute carcinoma). Reviewed operated 27 cases of thyroid cancer in our department since 1996 to 2005, 4 cases was found thyroid disease complicated with minute carcinoma:(case 1) 39 Y/O, female, chief complaint was neck uncomfortable. Ultrasonogram showed one 1.5 cm diameter tumor located at rt. lobe middle portion, margin irregular and other one 0.6 cm diameter tumor located at lt. lobe lower portion, margin irregular too. And was diagnosed thyroid cancer with intraglandular metastasis. (case2)37 Y/O, female, chief complaints were neck swelling and dysphagia. Ultrasonogram showed diffuse and isoechoic of both lobes complicated with various size of cystic degeneration tumor shadows and was diagnosed multiple nodular goiter. (case 3) 31 Y/O, female, chief complaints were palpitation and neck swelling. Ultrasonogram showed diffuse and isoechoic of both lobes complicated with various size of cystic degeneration tumor shadows and one 0.7 cm diameter, margin irregular tumor shadow was detected in rt. lobe upper portion and was diagnosed multiple nodular goiter with thyroid cancer. (case4) 70 Y/O, female, chief complaints were cough and dyspnea. Ultrasonogram showed diffuse and isoechoic of both lobes complicated with various size of cystic degeneration tumor shadows and one 0.5 cm diameter calcification shadow was detected in lt. lobe middle lower portion and was diagnosed multiple nodular goiter with calcification. In these 4 cases, two were diagnosed minute carcinoma preoperation and two were diagnosed minute carcinoma postoperation. Conclusion: (1) diagnosed thyroid minute carcinoma always in autopsy or complicated with thyroid disease. We suggest if patient complained symptom sign of neck in O.P.D., arranged ultrasonography is needed. (2) Thyroid ultrasonography has limitation for diagnosis. If tumor size diameter is under 0.5 cm then couldn't diagnose. But if it is over 0.5cm and was type Ⅲ then operation is suggested. If it is type Ⅰ or Ⅱ then follow up by ultrasonography is suggested.