甲状腺结节的评估与管理
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Nodular thyroid disease is a heterogeneous disorder : nodules may be single or multiple, hyper- or hypofunctioning, benign or malignant.
Thyroid cancer is rare: less than 0.5% of all new malignancies ; less than 0.5% of all cancer deaths ;
had one or more thyroid nodules, an annual incidence of 1.4% over the
following 15 years.
The Whickham survey in England: palpable goitres --- 8.6%; palpable and visible goitres --- 6.9%; females : males=4:1; Follow-up for 20 years, amongst women, 70% had no goitre, 20% had a goitre at first survey but not at follow-up, 6% had goitres at both surveys and 4% developed goitres;
Colloid(adenomatoid) nodule Thyroid adenoma
Follicular adenoma Hurthle cell Thyroid cancer Primary--Papillary,Follicular,Medullary,Anaplastic
Meetastatic/direct invasion Renal cell,Breast,Lung,Melanoma, Colon cancer,Gastric carcinoma,Pancreatic carcinoma,Head and neck tumors, Hodgkin’s disease; Thyroid lymphoma Thyroid cyst---pure, complex Thyroiditis---Acute, Subacute, Hashimoto’s; Riedel’s disease Graves’disease Infectious---Abscess, Tuberculosis;
Aetiological factors
TSH Growth stimulating immunoglobulins Iodine deficiency Exposure to ionizing radiation
Differential diagnosis of the thyroid nodule
Evaluation and Management of Thyroid Nodules
Wu Xiaohong Endocrinology Department, First Affiliated of Nanjing Medical
University
Prevalence
The Framingham stud百度文库 in US: 6.4% of females and 1.6% of males
Malignant nodules account for 5% of all nodules. well-differentiated carcinomas in 75 %; poorly differentiated or anaplastic in 15 % ;
medullary cancer in 10% cases.
Thyroid cancer can be a mortal disease: well differentiated tumors--- mortality 10 %; poorly differentiated and medullary--- 50 %; anaplastic tumors---100%.
Postmortem studies have shown that up to 50% of the population have either single or multiple nodules in the thyroid, many of which are very small;
High resolution ultrasound scans revealed discrete nodules in up to 50% of those beyond the fifth decade of life;
Thyroid cancer is 6~14% of single thyroid nodules selected for surgery.
Postmortem studies: Occult cancer in up to 5% of thyroid glands normal to palpation; Most are small, only several millimetres in diameter, without clinical significance.
Nodular thyroid disease is found in 5% of the population at palpation screening and is ten-fold more frequent at echographic screening.
Thyroid nodules are rare in children and adolescents and increase linearly with age; females/males are 2~4;
Thyroid cancer is rare: less than 0.5% of all new malignancies ; less than 0.5% of all cancer deaths ;
had one or more thyroid nodules, an annual incidence of 1.4% over the
following 15 years.
The Whickham survey in England: palpable goitres --- 8.6%; palpable and visible goitres --- 6.9%; females : males=4:1; Follow-up for 20 years, amongst women, 70% had no goitre, 20% had a goitre at first survey but not at follow-up, 6% had goitres at both surveys and 4% developed goitres;
Colloid(adenomatoid) nodule Thyroid adenoma
Follicular adenoma Hurthle cell Thyroid cancer Primary--Papillary,Follicular,Medullary,Anaplastic
Meetastatic/direct invasion Renal cell,Breast,Lung,Melanoma, Colon cancer,Gastric carcinoma,Pancreatic carcinoma,Head and neck tumors, Hodgkin’s disease; Thyroid lymphoma Thyroid cyst---pure, complex Thyroiditis---Acute, Subacute, Hashimoto’s; Riedel’s disease Graves’disease Infectious---Abscess, Tuberculosis;
Aetiological factors
TSH Growth stimulating immunoglobulins Iodine deficiency Exposure to ionizing radiation
Differential diagnosis of the thyroid nodule
Evaluation and Management of Thyroid Nodules
Wu Xiaohong Endocrinology Department, First Affiliated of Nanjing Medical
University
Prevalence
The Framingham stud百度文库 in US: 6.4% of females and 1.6% of males
Malignant nodules account for 5% of all nodules. well-differentiated carcinomas in 75 %; poorly differentiated or anaplastic in 15 % ;
medullary cancer in 10% cases.
Thyroid cancer can be a mortal disease: well differentiated tumors--- mortality 10 %; poorly differentiated and medullary--- 50 %; anaplastic tumors---100%.
Postmortem studies have shown that up to 50% of the population have either single or multiple nodules in the thyroid, many of which are very small;
High resolution ultrasound scans revealed discrete nodules in up to 50% of those beyond the fifth decade of life;
Thyroid cancer is 6~14% of single thyroid nodules selected for surgery.
Postmortem studies: Occult cancer in up to 5% of thyroid glands normal to palpation; Most are small, only several millimetres in diameter, without clinical significance.
Nodular thyroid disease is found in 5% of the population at palpation screening and is ten-fold more frequent at echographic screening.
Thyroid nodules are rare in children and adolescents and increase linearly with age; females/males are 2~4;