| Objective Hashimoto's disease(Hashimoto's disease HD),also known as chronic lymphocytic thyroiditis is an autoimmune disease. HD is generally believed that the chance of occurs early hypothyroidism is rarely, but can easily occur after thyroidectomy hypothyroidism, it was advocated at medical treatment. However, the clinical HD is often co-exist with other thyroid diseases, such as nodular goiter, thyroid carcinoma, malignant lymphoma and thyroid adenoma and so on, often misdiagnosed, mis-governance and is treated in surgery. This paper aims to analyze the clinical case study, to summarize the experience in the diagnosis and surgical treatment of HD.Methods:Retrospective analysis the surgical treatment of 63 cases of clinical data of HD in our hospital from February 2008 to October 2009. All were met by their neck mass, physical examination found their thyroid enlargement in I ~â…¢degree, diffuse goiter in 27 cases, palpable nodule in 48 cases, 3 cases have heat intolerance, palpitation, irritability, sweating, eat , weight loss and other symptoms of hyperthyroidism, a hoarse voice in 1 case, there is difficulty in breathing in 1 case, accompanie by pain in 3 cases, hypothyroidism symptoms (low mood, afraid of the cold, easy to colds, etc.) in 1 case. All patients received preoperative thyroid B-type ultrasonography, some patients also received puncture cytology and thyroid immune function plus a full set of thyroglobulin antibody (TGAB) and thyroid microsomal antibodies (TMAB) and thyroid peroxidase antibodies (TPO-AB) examination, thyroid radionuclide scan, neck CT. Preoperative B-examination revealed diffuse thyroid disease, there were 43 cases of nodules, including nodules with dense calcification in 8 cases. Preoperative aspiration cytology proved to be one cases of HD. Intraoperative rapid frozen section confirmed four cases of thyroid cancer. By preoperative B-type ultrasonography, nodules were ?detected in 43 cases; among 8 of the cases calcification was found in the nodules. The result of 1 case preoperative fine needle biopsy was Hashimoto's disease. 1 case quick frozen pathologic section during the operation were thyroid cancer.Results:Conventional surgery for thyroid cancer and the pathology report 4 cases of HD, in which B-discovered thyroid nodules associated with dense calcification in 3 cases (75%, 3 / 4), 1 case of respiratory difficulty and 1 case of hoarseness were both proved to be thyroid cancer. There are 3 cases of HD with thyroid tumors, 56 cases of HD.Conclusions:HD is not an uncommon disease. It is closed to thyroid cancer, so doctors should pay attention to diagnosis and treatment of HD, should pay attention to diagnosis and differential diagnosis and the analysis of the causes of misdiagnosis in order to reduce the rate of misdiagnosis and mistreating. The key to diagnosis and rational treatment includes detailed understanding of clinical feature, routine examination of serum antibodies and scintigraphic thyroid scan or FNAC and quick frozen pathologic section during the operation. Patients with nodules should be treated by surgery. Intraoperative detection of thyroid should be careful, such as the thyroid tissue was found in white or baby pink, quality and tough, cut with little bleeding, rubber-like, you should consider this disease. Surgical treatment of HD is desirable, but we should strictly control their indications, surgical treatment should be individualized, surgery is to retain a sufficient number of thyroid tissue as much as possible, thyroxine with long-term use is to achieve a good therapeutic effect. Pairs of HD patients regardless of the surgical method should be followed up with regular determination of T3, T4, TSH; observed treatment effect, after taking thyroid hormone for the prevention and treatment of possible recurrence of hypothyroidism and concurrent benefit both thyroid cancer. |
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