| Thyroid carcinoma(TC) is a common malignant tumor in endocrine system, whose pathological types are thyroid papillary carcinoma(PTC),thyroid medullary carcinoma, thyroid follicular carcinoma and thyroid anaplastic carcinoma. The thyroid papillary carcinoma is the most common.Hashimoto’s thyroiditis(HT) is the subtype of autoimmune thyroiditis. It is a major cause of hypothyroidism. Recent years, the prevalence rate of Hashimoto’s thyroiditis and thyroid cancer showed an upward trend.Hashimoto’s thyroiditis complicated with thyroid carcinoma has also increased year by year. Whether there is a relationship between Hashimoto’s thyroiditis and thyroid carcinoma is debatable. Most scholars believes that Hashimoto’s thyroiditis is a risk factor to thyroid cancer. The mechanism of the relationship between thyroid carcinoma and Hashimoto’s thyroiditis is not clear, which is a hot spot. With the in-depth study of tumor molecure, it has been found that many gene mutation is associated with the occurrence, development, prognosis of papillary thyroid. BRAF is also known as murine sarcoma viral oncogene homolog(V-Raf) B1. It is a proto oncogene. It promotes growth, invasion and metastasis of tumor.BRAF V600 E is realated with the invasion, metastasis and recurrence of papillary thyroid cancer. Whether it is the mechanism of relationship between papillary thyroid carcinoma and Hashimoto’s thyroiditis is unkwown. This study is desiged to explore the relationship between thyroid carcinoma and Hashimoto’s thyroiditis and the mechanism of the relationship.A retrospective analysis method was used to analyse1141 postoperative patients with thyroid nodules in Air Force General hospital duing2001.1-2013.9. According to pathological diagnosis, there were 270 cases of thyroid cacinoma and 871 cases of thyroid benign nodules including 194 cases of thyroid adenoma, 341 cases of nodular goiter, 336 cases of adenomatous nodular goiter. They were grouped into two groups including thyriod carcinoma group and thyriod benign group. Compared the differences of the gender, age, course of disease, size of nodules, thyroid function between different groups. Logistic regression analysis was used to explore the risk factors to thyroid carcinoma. The paraffin specimens of pathologically confirmed thyroid disease during 2012.1-2014.6 in the General Hospital of the Air Force PLA were collected in the experiment part, including papillary thyroid carcinoma(40 cases), Hashimoto’s thyroiditis(20 cases), papillary thyroid carcinoma with Hashimoto’s thyroiditis(20 cases), thyroid adenoma(20 cases). Immunohistochemistry(Envision method) was used to detect the difference of different thyroid diseases.The clinical result is that the prevalence of Hashimoto’s thyroiditis was higher in thyroid carcinoma [30.2%(62 / 205) vs. 15.7%(93/592), P< 0.01]than benign thyroid nodules. Patiens with thyroid carcinoma were younger[(45.29±11.90)ages vs.(49.02±11.89)ages, P<0.01]. The diameter of the nodules in thyroid carcinoma was smaller[(1.90±1.41) cm vs.(2.64±1.27)cm, P<0.01]. Thyroid stimulating hormone(TSH) in patiens with thyroid cancinoma was higher[(2.84±2.96)m IU/L vs.(2.43±3.37)m IU/L, P<0.05].The abnormal rate of thyroid globulinanti-body in thyroid carcinoma was higher [24.0%(44/183) vs.11.4%(51/446), P<0.01 ]. The abnormal rate of thyroid peroxidase anti-body in thyroid carcinoma was higher[21.4%(39/182)vs. 13.0%(58/446), P<0.01]. The prevalence of solid nodules,hypoechoic nodules, irregular shape nodules, less clear boundary nodules in thyroid carcinoma is higher than benign thyroid nodules. Logistic regression analysis indicated that Hashimoto’s thyroiditis [OR=1.829,95%CI: 1.163-2.877, P<0.01], ≦45 years(OR=1.716, 95%CI: 1.166-2.528,P<0.01). The diameter of the nodules ≦1 cm(OR=4.261, 95%CI: 2.467-7.360, P<0.01) is risk factors to thyroid carcinoma. The results of experiment is that the positive rate of BRAFV600 E in papillary thyroid carcinoma was 77.5%(31/40). The positive rate of BRAF V600 E in Hashimoto’s thyroiditis was 45%(9/20), P<0.01. In papillary thyroid carcinoma with Hashimoto’s thyroiditis, the positive rate of BRAFV600 E in thyroid papillary carcinoma tissue was 70.0%(14/20). It was not significant different from thyroid papillary carcinoma P>0.05. The positive rate of BRAF V600 E in Hashimoto’s thyroiditis tissue was 55.0%(11/20).It was not different from Hashimoto’s thyroiditis, P>0.05. The positive rate of BRAFVE600 in metastatic papillary thyroid carcinoma was 88.2%(15/17), which was higher than that in papillary thyroid carcinoma without metastasis 69.5%(16/23), P<0.05. There was no positive expression of BRAFV600 E in thyroid adenoma.Hashimoto’s thyroiditis may be a risk factor to thyroid cancinoma. The thyroid nodules patients whose TSH, thyroid globulin anti-body, thyroid peroxidase antibody levels are higher,the nodules with less clear boundary,and with irregular shape, solid nodules, nodules with low echo according to ultrasound findings should be highly concerned about.Hashimoto’s thyroiditis patiens with BRAF V600 E mutation should be followed up regularly. |
