Graves病合并甲状腺癌（附47例报告）

doi:10.16139/j.1007-9610.2018.06.011

摘要/Abstract

摘要： 目的: 回顾性分析Graves病合并甲状腺癌病人,为规范化治疗提供参考。方法: 2013年1月至2017年10月收治Graves病合并甲状腺癌病人47例。分析临床资料、治疗方法及短期随访情况,与同期单纯甲状腺乳头状癌病人进行肿瘤特性的比较。结果: 本研究Graves病合并甲状腺癌病人占同期Graves病手术治疗的54.7%（47/86）。Graves病病程≤12个月25例（53.2%）,13~48个月和>48个月均为11例（23.4%）。47例均完成甲状腺癌手术。其中5例术前行碘剂准备。均无永久性甲状旁腺功能减退及神经损伤并发症发生。术后未出现甲状腺危象。中位随访时间14个月,仅2例发现颈部淋巴结转移,余均无复发及转移。在微小癌、多灶癌的发生率和中央组、颈侧区淋巴结的转移率4个方面,该47例病人与同期单纯甲状腺癌病人均无统计学差异。结论: Graves病合并甲状腺癌并不少见,Graves病易早期发生甲状腺癌。Graves病合并甲状腺癌的侵袭性与单纯甲状腺癌相似,总体预后良好。

关键词: Graves病, 甲状腺癌, 临床特点, 预后

Abstract: Objective To analyze the patients of Graves′ disease with thyroid cancer retrospectively for reference of standardized treatment. Methods Forty-seven patients diagnosed Graves′ disease with thyroid cancer were treated between January 2013 and October 2017. Clinical data, treatments and short outcomes by follow-up were analyzed. Comparison was conducted between 47 cases and thyroid cancer cases without Graves′ disease during same period in our hospital. Results There were 86 cases with Graves′ disease among whom 47(54.7%) were combined with thyroid cancer. It was found that 25 (53.2%) cases with thyroid cancer had Graves′ disease less than 12 months and 11 (23.4%) cases had both 13-48 months and more than 48 months respectively. All 47 cases were performed operations uneventfully. Preoperative potassium iodide was given only 5 cases. No thyroid crisis occurred, and there was no permanent hypoparathyroidism or permanent nerve injury. Only two cases were found cervical lymph node metastasis during the follow-up period of median 14 months. There was no significant difference between the cases with and without Graves′ disease in terms of thyroid microcarcinoma, multifocal tumors and central, lateral lymph node metastasis. Conclusions Graves′ disease with thyroid cancer might not be rare. Increased risk of thyroid cancer was present in patients with shorter course of Graves′ disease. Graves′ disease might not have a significant influence on the aggressiveness of thyroid cancer. The prognosis of thyroid cancer with Graves′ disease is generally favorable.

Key words: Graves'disease, Thyroid cancer, Clinical feature, Prognosis

中图分类号:

R736.1

黄海燕, 匡洁, 应夏洋, 陈曦, 严佶祺. Graves病合并甲状腺癌（附47例报告）[J]. 外科理论与实践, 2018, 23(06): 519-522.

HUANG Haiyan, KUANG Jie, YING Xiayang, CHEN Xi, YAN Jiqi. Graves′ disease with thyroid cancer: a report of 47 cases[J]. Journal of Surgery Concepts & Practice, 2018, 23(06): 519-522.

参考文献

[1] 黄海燕, 翁原驰, 严佶祺, 等. Graves病合并甲状腺癌的研究进展[J]. 外科理论与实践,2016,21(5):446-450.
[2] Gabriella P, Francesco F, Concetto R, et al.Worldwide increasing incidence of thyroid cancer: update on epidemiology and risk factors[J]. J Cancer Epidemiol,2013, 2013:965212.
[3] Staniforth JU, Erdirimanne S, Eslick GD.Thyroid carcinoma in Graves′ disease: A meta-analysis[J]. Int J Surg,2016,27:118-125.
[4] Hancock BW, Bing RF, Dirmikis SM, et al.Thyroid carcinoma and concurrent hyperthyroidism: a study of ten patients[J]. Cancer,1977,39(1):298-302.
[5] Belfiore A, Garofalo MR, Giuffrida D, et al.Increased aggressiveness of thyroid cancer in patients with Graves′ disease[J]. J Clin Endocrinol Metabol,1990,70(4):830-835.
[6] Kraimps JL, Bouin-Pineau MH, Mathonnet M, et al.Multicentre study of thyroid nodules in patients with Graves′ disease[J]. Br J Surg,2000,87(8):1111-1113.
[7] Weber KJ, Solorzano CC, Lee JK, et al.Thyroidectomy remains an effective treatment option for Graves′ disease[J]. Am J Surg,2006,191(3):400-405.
[8] Erbil Y, Barbaros U, Özbey N, et al.Graves′ disease, with and without nodules, and the risk of thyroid carcinoma[J]. J Laryngol Otol,2008,122(3):291-295.
[9] Boutzios G, Vasileiadis I, Zapanti E, et al.Higher incidence of tall cell variant of papillary thyroid carcinoma in Graves′ disease[J]. Thyroid,2014,24(2):347-354.
[10] Tam AA, Kaya C, Kılıç FB, et al.Thyroid nodules and thyroid cancer in Graves′ disease[J]. Arq Bras Endocr Metabol,2014,58(9):933-938.
[11] Kunjumohamed FP, Al-Busaidi NB, Al-Musalhi HN, et al.The prevalence of thyroid cancer in patients with hyperthyroidism[J]. Saudi Med J,2015,36(7):874-877.
[12] Wei S, Baloch ZW, LiVolsi VA. Thyroid carcinoma in patients with Graves′ disease: an institutional experience[J]. Endocr Pathol,2015,26(1):48-53.
[13] Shu X, Ji J, Li X, et al.Cancer risk in patients hospitalised for Graves′ disease: a population-based cohort study in Sweden[J]. Br J Cancer,2010,102(9):1397-1399.
[14] Chen YK, Lin CL, Chang YJ, et al.Cancer risk in patients with Graves′ disease: a nationwide cohort study[J]. Thyroid,2013,23(7):879-884.
[15] Ross DS, Burch HB, Cooper DS, et al.2016 American Thyroid Association guidelines for diagnosis and management of hyperthyroidism and other causes of thyrotoxicosis[J]. Thyroid,2016,26(10):1343-1421.
[16] Shinall MC Jr, Broome JT, Baker A, et al.Is potassium iodide solution necessary before total thyroidectomy for Graves′ disease?[J]. Ann Surg Oncol,2013,20(9):2964-2967.
[17] Yano Y, Shibuya H, Kitagawa W, et al.Recent outcome of Graves′ disease patients with papillary thyroid cancer[J]. Eur J Endocrinol,2007,157(3):325-329.
[18] Pellegriti G, Belfiore A, Giuffrida D, et al.Outcome of differentiated thyroid cancer in Graves′ patients[J]. J Clin Endocrinol Metab,1998,83(8):2805-2809.
[19] Belfiore A, Russo D, Vigneri R, et al.Graves′ disease, thyroid nodules and thyroid cancer[J]. Clin Endocrinol (Oxf),2001,55(6):711-718.
[20] Boi F, Minerba L, Lai ML, et al.Both thyroid autoimmunity and increased serum TSH are independent risk factors for malignancy in patients with thyroid nodules[J]. J Endocrinol Invest,2013,36(5):313-320.
[21] Chao TC, Lin JD, Chen MF.Surgical treatment of thyroid cancers with concurrent Graves′ disease[J]. Ann Surg Oncol,2004,11(4):407-412.
[22] Haugen BR, Alexander EK, Bible KC, et al.2015 Ame-rican Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American Thyroid Association Guidelines Task Force on thyroid nodules and differentiated thyroid cancer[J]. Thyroid,2016,26(1):1-133.