摘要:目的: 探討兒童慢性淋巴細胞性甲狀腺炎的臨床特點、診斷方法、治療及預后。 方法 : 對77例CLT患兒的臨床資料進行回顧性分析。 結果 : 77例CLT患兒男女比例1:67,平均年齡1021±233歲(5～15歲)。86％患兒有甲狀腺腫大;初診時表現甲亢患兒51例,甲低20例,甲功正常6例; TGAb陽性率的94％,TPOAb陽性率96％;1例甲狀腺細針吸取細胞學檢查診斷合并甲狀腺乳頭狀癌。治療隨訪1～39月,77例患兒中出現甲低37例。 結論 : 兒童CLT多見于青春期女性,兒童和青春期患者病初表現甲亢較成人多見,TGAb 和TPOAb是CLT診斷的重要指標,隨著病程延長,表現甲低患兒比例逐漸增高。Abstract: Objective: To study the clinical feature, diagnosis, treatment and prognosis of Chronic lymphocytic thyroiditis in children. Methods : Analyze the clinical data of 77 children with Chronic lymphocytic thyroiditis. Results : The proportion of men to women was 1:67 in all 77 children, and the mean age at diagnosis was 1021±233(age range 5~15 years). The percentage of positive TGAb and TPOAb were 94% and 96%, respectively in all the 77 children. One children was diagnosed Chronic lymphocytic thyroiditis coexistent with thyroid papillary carcinoma by FNAB. There were 37 children had hypothyrodism in all the 77 after 1～39 months. Conclusion : CLT is more frequent in females, and at the time of diagnosis more children and adolescents had hypethyrodism than adults. TGAb and TPOAb are important markers for the diagnosis of CLT. The percentage of children had hypothyrodism is increasing along with the course of disease.
Objective To analyze clinical and pathological features of patients with papillary thyroid carcinoma (PTC) with coexistent chronic lymphocytic thyroiditis (CLT). Methods The clinicopathologic data of 756 cases of PTC were collected from January 2014 to January 2017 in the First Affiliated Hospital, Xinjiang Medical University were collected. The patients were designed to observational group (PTC with coexistent CLT, n=194) and control group (simple PTC, n=562) according to whether CLT was diagnosed by pathology, then the clinical data, ultrasonic features, thyroid function, and pathological features in these two groups were compared. Results The proportion of the female patients, the proportions of theserum thyroid stimulating hormone and thyroid autoimmune antibodies (thyroglobulin antibody and thyroid peroxidase antibody), and the proportion of multifocal carcinoma in the observational group were significantly higher than those in the control group (P<0.05). There were no significant differences in the preoperative ultrasound, tumor diameter, thyroid capsule invasion, central lymph node metastasis, and TNM stage in these two groups (P>0.05). The results of the multivariate analysis showed that the female, serum thyroid autoimmune antibodies, and the multifocal carcinoma were the independent predictive factors of PTC with CLT (P<0.05). Conclusions There might be a certain correlation between PTC and CLT, PTC with coexistent CLT is more common in female patient and with multifocal carcinoma. With coexistent CLT does not increase invasion of PTC. This may be associated with limit of CLT to development of PTC nodules. It is speculated that CLT may be a protective factor of PTC.
ObjectiveTo detect the expression of programmed cell death ligand 1 (PD-L1) in papillary thyroid carcinoma (PTC) and PTC with coexistent Hashimoto’s thyroiditis (HT) tissues, and to explore its clinical significance of its expression.MethodsThe PTC patients who underwent thyroidectomy at the Thyroid Surgery Department of the Affiliated Hospital of Guizhou Medical University from March 2017 to May 2019 were retrospectively collected. Immunohistochemical staining was used to detect the expression of PD-L1 in the PTC tissues, PD-L1 staining positive cells ≥20% was judged as positive expression, <20% was judged as negative expression. The relationship between PD-L1 positive expression rate and clinicopathologic characteristics of patients with PTC were analyzed, and the correlation between the presence of HT in PTC tissues and PD-L1 positive expression was studied.ResultsA total of 138 patients with PTC were included in this study, including 104 patients with PTC alone and 34 PTC patients with coexistent HT. The positive rate of PD-L1 expression in the 138 cases of PTC tissues was 35.5% (49/138), among which was 43.3% (45/104) in the pure PTC tissues, and 11.8% (4/34) in the PTC tissues with HT, the latter was significantly lower than the former (P=0.001). The results of univariate analysis showed that the positive rate of PD-L1 expression was related to the tumor size, the presence or absence of extraglandular invasion and HT in PTC patients (P<0.05), and the results of Spearman correlation analysis showed that the positive rate of PD-L1 expression was positively correlated with tumor size (rs=0.173, P=0.041) and extraglandular invasion (rs=0.197, P=0.021), and negatively correlated with whether TH was merged (rs=–0.284, P=0.001). The multivariate analysis results showed that the positive rate of PD-L1 expression was closely related to whether PTC with coexistent HT [OR=5.720, 95%CI (1.879, 17.411), P=0.002], and it was not found to be related to tumor size and presence of extraglandular invasion (P>0.05).ConclusionsPositive rate of PD-L1 expression has a certain relationship with tumor size and presence or absence of extraglandular invasion, and which in PTC patients with or without HT is significantly different, that is, positive rate of PD-L1 expression in PTC with HT is lower suggests that coexistent HT might be an inhibitory factor in occurrence of PTC, and immune microenvironment-related factors of PTC might be involved in occurrence and development of thyroid cancer.
ObjectiveTo analyze clinical manifestation, diagnosis, therapy, and prognosis of primary thyroid lymphoma. MethodFrom April 2012 to September 2015, the clinical data of 9 patients with primary thyroid lymphoma admitted to The Affiliated Hospital of Xuzhou Medical College, including clinical manifestation, diagnosis procedure, treatment project, and prognosis, were reviewed retrospectively. ResultsThe thyroids or nodules of 4 patients increased rapidly in 1-3 months, with the surrounding tissues and organs oppression symptoms. The preoperative examination revealed that there were 5 patients with swollen lymph nodes. Eight patients were received preoperative thyroid function examination, there were 4 patients with subclinical hypothyroidism, 4 patients with rose TSH, 6 patients with rose thyroglobulin antibody. There were 5 cases of primary thyroid lymphoma associated with Hashimoto thyroiditis. Eight patients were underwent surgical treatment in our hospital, 1 patient was underwent surgery in the other hospital. The results of pathological histology showed that 5 patients with mucosa associated lymphadenoma were stageⅠE, 3 patients with diffuse large B cell lymphoma were stageⅠE, 1 patient with diffuse large B cell lymphoma was stageⅡE. Two patients with diffuse large B cell lymphoma were received chemotherapy, the scheme was CHOP and COP respectively. Seven patients were received follow-up, the follow-up time was 2-42 months, the median follow-up time was 20 months, all of them were survived. ConclusionsPrimary thyroid lymphoma should be considered for patients with rapid growth of thyroid mass in a short term, which relies on the histopathologic and immunohistochemical diagnosis finally. The individualized treatment should be performed for primary thyroid lymphoma according to pathological classification.
From May 1982 to September 1994, 13 cases patients with acute suppurative thyroiditis were treated. Their ages ranged from 6 to 39 years with a mean of 13. 9 years (nine of them were children). In this group, 8 cases had a pre-existing thyroid mass. Correct diagnosis were made preoperatively in 11 cases and the other two were misdiagnosed before operation. Eleven patients underwent incision and drainge, amony them 6 cases had been followed up with no recurrence. Based on this result and re-viewing literatures, the author draw the conclusion that acute suppurative thyoiditis is related with fistula of pyriform fossa, incision and drainage must be carried out and if there is fistula present, fistulectomy should be performed.
ObjectivesTo systematically review the efficacy of Bailing capsule for autoimmune antibodies in Hashimoto thyroiditis (HT).MethodsPubMed, EMbase, The Cochrane Library, CBM, WanFang Data and CNKI databases were electronically searched to collect the randomized controlled trials (RCTs) on Bailing capsule in treatment of HT from inception to January 2019. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then, meta-analysis was performed by using RevMan 5.3 software.ResultsA total of 7 RCTs involving 428 patients were included. The results of meta-analysis showed that the changes of TGAb and TPOAb in Bailing capsule combined with Euthyrox group were higher than that in control group (MD=?228.91, 95%CI ?398.61 to ?59.20, P=0.008; MD=?158.19, 95%CI ?222.44 to ?93.94, P<0.000 01); the changes of TGAb and TPOAb in Bailing capsule combined with Iodine modification diet group were higher than that in control group(MD=?499.27, 95%CI ?540.39 to ?458.15, P<0.000 01; MD=?407.37, 95%CI ?448.60 to ?366.14, P<0.000 01).ConclusionsCurrent evidence shows that Bailing capsule combined with other therapies can decrease the levels of TGAb and TPOAb in HT patients. Due to limited quality and quantity of the included studies, more high-quality studies are required to verify the above conclusion.
【Abstract】ObjectiveTo summarize the experience in diagnosis and treatment for chronic lymphocytic thyroiditis or complicated with other thyroid diseases． MethodsSeventyseven patients were diagnosed as chronic lymphocytic thyroiditis or complicated with other thyroid diseases by operation and histological examination at this department from November 2002 to March 2005. All their clinical records including general information, the results of careful physical examination， thyroid correlated hormone tests， color Doppler, fine needle aspiration cytological examination and some intraoperative examinations have been retrospectively analyzed in this report. ResultsThere were 53 cases of simple chronic lymphocytic thyroiditis, 10 cases complicated by papillary carcinoma， 1 case complicated by follicular carcinoma， 2 cases complicated by nonHodgkin’s lymphoma, 6 cases complicated by nodular goiter, 4 cases complicated by follicular adenoma, and 1 complicated by parathyroid adenoma. Almost all the operations were successfull and the symptoms of the diseases were alleviated. Seventytwo patients had been followed up ranging from two months to two years differently and none of them relapsed. Sixtythree of these patients have received thyrine inhibition and vicariousness treatment, 2 patients who complicated by nonHodgkin’s lymphoma had been hospitalized and 7 patients complicated by carcinoma were treated with iodine131. ConclusionThe clinical manifestations of chronic lymphocytic thyroiditis are complex, and it often complicated with other thyroid disease, which make it difficult to diagnose the diseases before operation. However, some ancillary methods such as careful physical examination， thyroid correlated hormone tests， color Doppler and fine needle aspiration cytological examination may improve the accuracy of preoperative diagnosis. Intraoperative thyroid lamellar section and frozen histological examination are also very important for intraoperative diagnosis and operative modality selection．
ObjectiveTo investigate the diagnosis and treatment of primary thyroid lymphoma.MethodThrough reading of relevant literatures at home and abroad in recent years, the diagnosis and treatment progress of primary thyroid lymphoma were summarized.ResultsThe pathogenesis of primary thyroid lymphoma was associated with chronic inflammatory stimuli such as Hashimoto’s thyroiditis. Its preoperative diagnosis mainly relied on ultrasound-guided biopsy. The treatment depended mainly on its pathological type and tumor stage. Surgical resection was mainly used for pathological biopsy and relieving compression symptoms, and radiotherapy and chemotherapy were the main treatments.ConclusionsPrimary thyroid lymphoma is a rare thyroid malignancy. Being familiar with and understands its clinicopathological features have important guiding significance for preoperative diagnosis, clearing pathological type and staging, and selection of reasonable treatment measures.
ObjectiveTo clarify the application value of thyroid organoids in basic research and clinical translation of thyroid diseases, analyze the key challenges currently faced, and prospect future development directions. MethodsRelevant domestic and international literatures in recent years were systematically searched. This review summarized the construction strategies of thyroid organoids, and their application progress in disease model establishment (e.g., thyroid cancer, Hashimoto thyroiditis), drug screening, and personalized treatment. ResultsThyroid organoids can highly simulate the morphological structure and gene expression profile of native thyroid tissue. In terms of disease modeling, they can accurately reproduce the pathological characteristics and immune microenvironment of thyroid diseases. In drug screening, organoids can predict the response to radioactive iodine therapy and the sensitivity to targeted drugs, with high consistency between their drug sensitivity results and clinical efficacy. In mechanism research, organoids have been successfully used to reveal the roles of abnormal mitogen-activated protein kinase/phosphatidylinositol 3 kinase-protein kinase B signaling pathways, epithelial-mesenchymal transition, ferroptosis, and immunoregulatory mechanisms in thyroid carcinogenesis and disease progression, providing experimental evidence for target identification. ConclusionsAs an in vitro model that highly simulates the in vivo environment, thyroid organoids have become an important platform for thyroid disease research. Although challenges remain in standardized construction and clinical translation, with technical optimization and research evidence accumulation, they hold broad prospects in the field of precision medicine.
ObjectiveTo summarize the research progress of related genes in Hashimoto’s thyroiditis with papillary thyroid carcinoma.MethodLiteratures about Hashimoto’s thyroiditis with papillary thyroid carcinoma were reviewed by searching the literatures in domestic and foreign database.ResultsIn recent years, the incidence of Hashimoto’s thyroiditis with thyroid carcinoma (especially papillary thyroid carcinoma) was on the increase, the two might have the same molecular pathology mechanism.ConclusionThere is a close association between Hashimoto’s thyroiditis and papillary thyroid carcinoma, the common molecular genetic changes suggest that Hashimoto’s thyroiditis may have a correlation with papillary thyroid carcinoma.