Diagnosis And Treatment With Nodular Hashimoto’ Thyroiditis

Objective: Hashimoto’s thyroiditis(HT) were often associated withnodular,Mainly include pseudo nodule, neoplasia nodule，hyperplastic nodules,etc.Nodular Hashimoto’ thyroiditis were included in the difficult identificationas a result of misdiagnosis and mistreatment, even mistakenlythyroidetomy.Comparative analysis sonograpic, color Doppler flow imaging,Computer Tomography and Fine needle aspiraionbiopsy cytology of nodularHashimoto thyroiditis, designed to improve diagnosis of nodular Hashimotothyroiditis, reduced unnessary surgical intervention and prevent delays in thedisease.Methods: With the retrospective series of145patients treated surgicallyfrom January2011to December2013with final pathololgy demonstratoingHashimoto’s thyroiditis associated with nodulars.97cases of Hashimoto’sthyroiditis complicated with benign nodules,meanwhile，48cases withmalignant nodules.145patients who underwented thyroid ultrasoundexamination before surgery.12cases of patients were examined by CT.Allhospitalized patients underwented thyroid function test.Comprehensivecomparison of individual symptoms,thyroid ultrasounography,and CTinspection reports,cytology and histopathology to slselected the typical nodular.Ultrasound diagnosis of hashimoto’s thyroiditis combined nodules basedprimary on Sonographic characteristics,such as nodules composition, internalecho and marginal form, calcification and blood flow. Observe the HTcharacteristics of CT scan and nodular Hashimoto’thyroiditis of CT imagingcharacteristics. Retrospective analysis of Fine needle aspirationbiopsy cytologyin the preoperative identification of hashimoto’s thyroiditis with benign andmalignant nodules of application value.Results: Malignant nodules were more likely to be solid,hypoecho,calcifications, lobulated. Benign nodules were more likely to be hyperechoic,ill-defined margins, have a halo, to lack calcifications, focal thyroidinferno. Malignant nodules’solid and hypoecho detection rate were80%and 60%, lobulated and calcifications detection rate were10%and44%. Benignnodules’ hyperechoic and ill-defined margins detection rate were48%and41%. Have a halo and lack calcificationnes detection rate were90%and36%. Focal thyroid inferno detection rate was9%. Thyroid cancer withHashimoto’s thyroiditis CT scan demonstrated multiple lesions, irregular,hypoattenuation, ect. Nodular Hashimoto thyroiditis CT scan revealedconsistency density decrease, high density or ow density nodular hadowscan not be seen. Thyroid adenoma with HT CT scan showed solitary, regular/irregular, hypoattenuation, ect. Nodular goiter with HT CT scan displayedmultiple, regular/irregular, hypo/isoattenuation, occasional calcification, ect.The sensitivity and specificity of nodule Hashimoto’s thyroiditis FNACfor detecting neoplasia were82.1%and84.2%. The accuracy rate was88.6%.There were three false-negative FNAC results as a result of sampling error.Three false negative FNAC included1cases of follicular adenoma(cytologymisdiagnosed as hyperplasia),2cases with papillary thyroid carcinoma(cytology misdiagnosis of Hashimoto’s thyroiditis). There were six FP cases,which represented in terpretation errors, which consisted of ademnomahyperplasia in one case and Hashimoto’s thyroiditis in five cases. Five casesof Hashimoto’thyroiditis cytology misdiagnosed as Suspicious for neoplasia,one case of of adenomatous hyperplasia cytology misdiagnosed asmalignant.Follicular cells shows some of feature of papillary carcinoma couldbe observed in a cytology slide of HT,leading to diagnostic pitfall.Conclusions:1、Hashimoto’s thyroiditis was often merged with thyroid nodule,differential diagnosis nodular Hashimoto’ thyroiditis for clinical treatment hadimportant guiding significance;2、Diagnosis of nodular Hashimoto’ thyroiditis with thyroid ultrasoundhad a significant effect,by observe the nodules composition,internal echo andmarginal form, calcification and blood flow has important value in differentialdiagnosis;3、Hashimoto’s thyroiditis with pseudotumor confirmed by ultrasound, Further canbe done Computer Tomography, when CT scan shows consistencydensity decrease, high density or low density nodular shadows can not beseen, pseudotumor could be diagnosed;4、Ultrasound and CT examination was suspected malignant nodulesshould underwent fine needle aspirationbiopsy cytology or ultrasound guidedneedle aspiration or puncture biopsy;5、Benign and Malignant Nodules in Patients With HT thyroiditis lackof specific diagnostic criteria, a single application of ultrasound or CT orFNACmay cause misdiagnosis. Diagnosised nodular Hashimoto’thyroiditismust emphasize principles of integrated diagnostics. The thyroid ultrasound,CT, FNAC, ultrasound-guided FNAC should combine to establish trulyfeasible examination method for the patient’s diagnosis and the treatment,reduce misdiagnosis and missed diagnosis.