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。
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.
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