Nonsurgical management of thyroid abscess with sonographically guided fine needle aspiration

Treatment of thyroid abscess commonly includes the surgical drainage along with systemic antibiotic therapy. Alternatives for open surgical intervention may be the conservative management with use needle aspiration or catheter drainage. We report here two cases of thyroid abscess treatment with 21-gauge needle aspiration under ultrasound guidance. In each case needle drainage was performed twice, at the 1st and 5th day of admission. Antibiotics were administered in pills and injected into the abscess cavity followed the pus aspiration and lavage. Both patients were cured. Follow-up has not revealed recurrence during 6 month and 5 years.     

Acute suppurative thyroiditis following fine‐needle aspiration biopsy in an immunocompetent patient

The thyroid gland is remarkably resistant to infectious agents owing to several protective mechanisms. Acute suppurative thyroiditis after fine‐needle aspiration (FNA) in an immunocompetent patient is very rare. We report the case of a 50‐year‐old immunocompetent male patient who presented with painful cervical swelling, fever, and chills after an FNA of the thyroid. His physical and laboratory examination suggested an acute suppurative thyroiditis. Repeat FNA results were consistent with thyroid abscess. Physicians should be aware of the probability of acute bacterial thyroiditis after FNA. © 2013 Wiley Periodicals, Inc. J Clin Ultrasound 42:215–218, 2014     

Rates of malignancy in incidentally discovered thyroid nodules evaluated with sonography and fine-needle aspiration.

OBJECTIVE: The purpose of this study was to compare the rate of malignancy in thyroid nodules discovered incidentally on magnetic resonance imaging, computed tomography, and sonography with the rate of malignancy in nonincidentally discovered nodules. METHODS: All thyroid sonographic and fine-needle aspiration (FNA) procedures performed during a 6-month period were retrospectively reviewed. Study indications were categorized as incidental (thyroid nodules found on magnetic resonance imaging, computed tomography, or sonography performed for nonthyroid indications) or nonincidental (studies prompted by abnormal physical examination findings or laboratory values or signs or symptoms suggestive of thyroid disease). Rates of malignancy in patients with incidentally discovered nodules were compared with rates in patients with nonincidental thyroid abnormalities by the Fisher exact test. RESULTS: Of 225 thyroid sonographic studies, 35 (16%) were performed for incidentally discovered thyroid nodules, and 190 (84%) were performed for evaluation of nonincidental thyroid abnormalities. A total of 21 patients (60%) in the incidental group and 90 patients (47%) in the nonincidental group underwent FNA. The rate of malignancy in nodules examined by biopsy in the incidental group was 17% compared with 3% in the nonincidental group (P = .020). Patient sex, multiplicity of nodules, nodule size, echo texture, and presence of calcifications did not differ significantly between the groups. The mean age of patients in the incidental group was significantly higher (61 versus 51 years; P = .007); however, advanced age was not associated with a greater rate of malignancy. CONCLUSIONS: This study identified an unexpectedly high rate of malignancy in incidentally discovered thyroid nodules, suggesting that incidentally discovered thyroid nodules should be evaluated with follow-up thyroid sonography and FNA.     

血管回声跟踪技术对甲状腺病变的鉴别诊断价值

目的通过血管回声跟踪技术(E-TRACKING)对颈动脉的研究,以探求对甲状腺病变进行鉴别诊断的价值。方法依据常规超声检查下甲状腺是否病变及血清甲状腺激素是否升高,将116例病例分为对照组、血清甲状腺激素升高组、血清甲状腺激素未升高组,再将经常规超声检查诊断为甲状腺腺瘤的病例分为血清甲状腺激素升高组与血清甲状腺激素未升高组。利用血管回声跟踪技术观察颈总动脉,利用数字化图像管理系统分析软件(e-DMS)计算弹性系数(Ep)、硬度指数(β)、血管顺应性(AC)。结果血清甲状腺激素升高组的Ep、β、AC数值均高于对照组(94.96±38.25 vs 146.2±54.31;7.36±3.25 vs 12.0±4.31;1.06±0.33 vs 2.03±0.55)(q分别=6.75、5.52、5.84,P均<0.05),血清甲状腺激素升高组的Ep、β、AC数值均高于血清甲状腺激素未升高组(146.2±54.31 vs 101.2±35.44;12.0±4.31 vs 8.16±3.17;2.03±0.55 vs 1.22±0.26)(q分别=5.96、4.99、4.27,P均<0.05);对照组与血清甲状腺激素未升高组之间三个参数均差异无统计学意义(q分别=1.28、2.06、2.21,P均>0.05)。甲状腺腺瘤的病例中血清甲状腺激素升高组的Ep、β、AC数值均高于血清甲状腺激素未升高组(133.4±64.35 vs 98.25±47.34;10.6±3.41 vs 8.22±3.76;1.98±0.66 vs 1.17±0.48)(t分别=2.94、2.23、2.85,P均<0.05),且Ep、β、AC与血清甲状腺激素水平具有正相关性(r分别=4.75、3.68、3.57,P均<0.05)。结论血管回声跟踪技术对甲状腺功能性病变的鉴别诊断具有一定参考价值。     

Thyroid abscess due to Acinetobacter calcoaceticus: case report and review of the causes of and current management strategies for thyroid abscesses

Thyroid abscess was a common condition in the era before antibiotics. In the current medical environment, however, it is a clinical entity that is seldom encountered. We report the case of a unique cause of thyroid abscess, the environmental Gram-negative bacterium Acinetobacter calcoaceticus. Review of the published causes of thyroid abscess since 1980 demonstrated that although Gram-positive bacteria (Staphylococcus and Streptococcus species) remain the most common causes, there has been a marked decrease in the number of cases caused by mycobacteria, Salmonella species, and anaerobes when compared with the early part of the 20th century. Patients infected with the human immunodeficiency virus, however, still develop mycobacterial and fungal thyroid infections with some regularity. Reported modes of management of thyroid abscess vary, but drainage remains an integral component of therapy for resolution of the infection.     

甲状腺单发结节367例临床分析

目的总结评价4a来该医院对甲状腺单发结节诊断及治疗体会。方法回顾性分析367例甲状腺单发结节的。临床资料。结果367例中，甲状腺单发结节经病理组织学证实甲状腺癌58例，良性疾患309例。336例获随访，随访率达91.5％。随访时间为6个月～4a。喉返神经损伤2例，未出现术后甲状腺功能低下。结论术前细针穿刺活检结合彩色超声检查对甲状腺单发结节良恶性鉴别有帮助，甲状腺单发结节恶性率较高（15．8％），应积极手术治疗。     

Thyroid cancer review 3: management of medullary and undifferentiated thyroid cancer

This is the last of the three review articles dealing with thyroid cancer. Over 90% of thyroid cancer is of the differentiated type associated with a very good 10-year disease-free survival rate. In contrast, the rare forms of thyroid cancer which comprise medullary thyroid cancer arising from parafollicluar C cells, Hurthle cell carcinoma, anaplastic carcinoma, thyroid lymphoma and squamous cell carcinoma are typically associated with a poorer survival rate. Management is based upon small retrospective cohort studies.     

Thyroid metastasis from rectal carcinoma coexisting with hashimoto's thyroiditis: Gray-scale and power Doppler sonographic findings

We present the gray-scale and power Doppler sonographic findings in a case of rectal carcinoma metastasis to the thyroid that mimicked a primary thyroid neoplasm and coexisted with Hashimoto's thyroiditis in a 67-year-old man. Gray-scale sonography revealed a hypoechoic mass with ill-defined borders in the left lobe of the thyroid; the mass extended through the isthmus to the right lobe. Sonography also showed multiple enlarged cervical lymph nodes. Power Doppler sonography showed increased flow in the nontumorous thyroid gland and decreased flow in the tumor. This contributed to the differentiation between the tumor and the remainder of the thyroid, which was involved with Hashimoto's thyroiditis. © 1998 John Wiley & Sons, Inc. J Clin Ultrasound 26:361–365, 1998.     

核素显像随访诊断甲状腺结节癌变（附19例报告）

目的：探讨核素显像在随访诊断甲状腺结节癌变中的价值。方法：回顾性分析19例经手术病理证实为甲状腺结节癌变患者的临床资料和核素显像表现。结果：19例患者，手术前核素显像表现为单发或多发的“冷”结节或“凉”结节，考虑恶变可能性大，手术病理结果显示：19例甲状腺结节恶变中，13例为甲状腺乳头状癌，4例为滤泡癌及2例未分化癌。结论：核素显像随访诊断甲状腺结节癌变具有重要的意义和价值。     

甲状腺结节影像组学研究进展

影像组学可从医学图像中提取定量特征对肿瘤进行定量评估，从而辅助诊断、治疗及预后评价等，拥有巨大潜力。随着甲状腺结节检出率逐年上升，影像组学逐渐用于研究甲状腺结节。本文对甲状腺结节影像组学研究进展进行综述。     

First report of a thyroid abscess in the pediatric age group caused by Arcanobacterium haemolyticum

Thyroid abscess is a rare event especially in the pediatric age group. We report a 2-year-old girl with thyroid abscess who presented with fever and an anterior painful neck mass. Culture of the aspirated fluid yielded Arcanobacterium haemolyticum, which is one of the etiologies of pharyngitis and rash in children and, especially, young adults. As far as we are aware this is the first report of thyroid abscess in the pediatric or adult age group caused by Arcanobacterium haemolyticum.     

The Thyroid Nodule

The initial portion of this article includes general comments regarding thyroid nodules, reference to 2 recent articles delineating guidelines for management of thyroid nodules, and discussion of several areas of disagreement with these articles and expansion of recommendations in areas not covered by the published guidelines. The main body of the article provides a detailed discussion of our technique for fine‐needle aspiration biopsy of a thyroid nodule.     

甲状腺球蛋白在甲状腺疾病中临床意义的系统评价

目的：采用Meta分析的方法评价甲状腺球蛋白在甲状腺良性疾病和甲状腺癌中的临床意义。方法：通过检索MEDLINE、EMBASE、The Cochrane Library,中国生物医学文献数据库、中国学术期刊全文数据库和其他方式广泛收集文献。根据QUADAS质量评价标准评价纳入文献的质量,用Meta-Disc软件对其敏感度、特异度、阳性似然比、阴性似然比等进行合并分析,并进行异质性检验,绘制综合受试者工作特征曲线（summary receiver operatorcharacteristic curve,SROC）。结果：最终纳入5篇文献。合并敏感度0.60,合并特异度0.83,合并比值比2.68,SROC下面积（AUC）=0.6454。结论：现有研究证实：甲状腺球蛋白在甲状腺癌中的阳性率是甲状腺良性疾病中的2.68倍,有统计学差异,但敏感度不高。尚需更多设计严谨、科学的临床试验进一步证实。     

Tissue harmonic imaging of thyroid nodules: initial experience.

OBJECTIVE: To determine the impact of tissue harmonic imaging on visualization of the thyroid and gray scale contrast between thyroid nodules and adjacent thyroid parenchyma. METHODS: A prospective study was performed on 144 patients (148 lesions) undergoing sonographically guided fine-needle biopsy. The fundamental frequency and tissue harmonic images were obtained on a scanner with a wideband 7.5-MHz linear probe. One hundred forty-two benign nodules, 2 papillary carcinomas, 1 anaplastic carcinoma, and 1 metastatic lesion were found. In 1 case a suggestion of a follicular carcinoma was raised, and in 1 case no diagnostic material was obtained. The gray scale intensity of the lesions and adjacent thyroid tissue was measured with graphics software, and the gray scale contrast between lesions and adjacent thyroid tissue was calculated. Additionally, the overall conspicuity and border definition were evaluated by 2 independent observers. RESULTS: Tissue harmonic imaging improved the gray scale contrast between thyroid nodules and adjacent thyroid parenchyma in 116 lesions (78.4%). The overall conspicuity and border definition were improved or equal in the harmonic mode for most lesions. CONCLUSIONS: The tissue harmonic imaging technique used as an adjunct to conventional thyroid sonography may improve lesion detectability and characterization.     

血清TPO-Ab、TSH、TGA检测在孕妇甲状腺疾病筛查中的意义

目的探讨血清抗甲状腺过氧化物酶抗体(TPO-Ab)、促甲状腺激素(TSH)、抗甲状腺球蛋白抗体(TGA)在孕妇甲状腺疾病筛查中的应用价值。方法选取该院2014年1月至2015年6月125例经颈部超声诊断为甲状腺结节增生的孕妇为甲状腺疾病组,另选取在该院行常规性产前检查且无甲状腺家族史或既往病史的120例孕妇为妊娠对照组,选取100例非妊娠育龄健康妇女为健康对照组,采用化学发光法测定各组血清TPO-Ab、TSH、TGA水平及阳性率。采用受试者工作特征曲线(ROC曲线)分析TPO-Ab、TSH、TGA在孕妇早期甲状腺疾病筛查中的应用价值。结果甲状腺疾病组患者血清中TPO-Ab、TSH、TGA水平及阳性率显著高于妊娠对照组及健康对照组,差异有统计学意义(P0.05)。经ROC曲线分析可知,灵敏性由高到低依次为TPO-Ab、TSH、TGA;特异性由高到低依次为TPO-Ab、TSH、TGA;TPO-Ab、TSH、TGA联合诊断时灵敏性及特异性高于单一指标诊断。结论 TPO-Ab、TSH、TGA可作为孕妇甲状腺疾病的诊断指标,通过联合诊断的方法可提高其在临床上的应用价值。     

广西地区20年甲状腺癌构成比变迁分析与护理对策

[目的]分析我院20年甲状腺癌手术构成比变迁情况,探讨相应的护理对策。[方法]回顾性分析20年我院甲状腺手术后病理报告10 000例,按1991年-1995年、1996年-2000年、2001年-2010年分为3个阶段,分析甲状腺手术中甲状腺癌构成比的变迁过程。[结果]3个阶段中甲状腺癌总病例为101例、213例、628例,构成比分别为6.74%,8.87%,10.30%,构成比呈逐渐上升趋势,其中结节性甲状腺肿合并甲状腺癌、慢性淋巴细胞性甲状腺炎合并甲状腺癌的构成比增高尤为明显,差异有统计学意义(P0.05)。[结论]随着甲状腺疾病谱的变迁,调整护理对策,强化护理干预是提高甲状腺癌临床疗效的重要保证。     

Characteristics of thyroid carcinomas in aging patients

BACKGROUND: To investigate the clinical features of thyroid cancer in aging patients and to present the results of treatment. From this we can provide bases for earlier diagnoses and better treatment of thyroid malignancies in older patients. MATERIALS AND METHODS: In this study a retrospective analysis was performed with 204 thyroid cancer patients aged 60 years or older (132 women, with a mean age of 68.3 +/- 6.6 years; 72 men, with a mean age of 67.0 +/- 5.3 years). RESULTS: Of the 204 patients, 142 had well-differentiated thyroid carcinomas (96 papillary thyroid carcinomas, 43 follicular carcinomas, three Hürthle cell carcinomas) and three medullary carcinomas. Sixty-nine (33.8%) of the 204 patients died after treatment. Of these, three patients died of causes not related to thyroid cancer. For well-differentiated thyroid carcinomas, male gender, follicular carcinoma, and a larger tumour size indicated a poor prognosis. Of the 59 non-well-differentiated thyroid carcinomas, 39 were anaplastic thyroid carcinomas, nine metastatic cancers of the thyroid, seven lymphomas, and four squamous cell carcinomas. After treatment, 40 (67.8%) of the 59 patients died. In multivariant analysis of the differences in clinical parameters between aging and younger thyroid cancer patients, the current status, tumour size, follow-up period, sex, and stage at diagnosis were independent factors. From this data the delayed diagnosis of aging patients with thyroid cancer was of note when compared with younger patients. CONCLUSION: Thyroid cancer in older patients is not a benign clinical disorder. Early diagnosis and urgent aggressive treatment are recommended courses of action for this type of cancer, especially for non-well-differentiated thyroid cancers.     

血清甲状腺球蛋白抗体、甲状腺微粒体抗体、甲状腺过氧化物酶抗体对自身免疫性甲状腺疾病的诊断价值

目的探讨血清甲状腺球蛋白抗体（TGAb）、甲状腺微粒体抗体（TMAb）、甲状腺过氧化物酶抗体（TPOAb）对自身免疫性甲状腺疾病（AITD）的诊断价值。方法100例甲状腺功能异常患者根据血清中三碘甲状腺原氨酸（B）、甲状腺素（Td）、促甲状腺激素（TSH）水平分为甲亢组和甲减组,每组50例;另选择50例甲状腺功能正常人群作为对照组。各组患者均采集静脉血5mL,分离血清,放射免疫法测定患者血清中TGAb、TMAb、TPOAb、L、T4、TSH水平。观察各组患者血清中TGAb、TMAb、TPOAb阳性率;比较各组TGAb、TMAb、TPOAb阳性患者血清水平。结果甲亢组和甲减组血清TPOAb阳性率均明显高于血清TGAb、TMAb阳性率;甲亢组、甲减组患者血清TGAb、TMAb、TPOAb阳性率均明显高于对照组;甲减组患者血清TGAb、TMAb、TPOAb阳性率均明显高于甲亢组。甲亢组和甲减组患者血清TGAb、TMAb、TPOAb水平均明显高于对照组。甲减组患者血清中TGAb、TMAb、TPOAb水平均明显高于甲亢组。结论TPOAb在AITD的诊断中具有重要意义,为AITD的诊断、治疗及预后评估提供了重要依据。     

776例孕早期妇女甲状腺功能筛查结果分析

目的探索甲状腺疾病在妊娠早期的发生率和特点,为优生优育提供科学依据。方法运用化学发光免疫分析法检测776例妊娠早期(12~(+6)周)妇女(试验组)和100例非妊娠育龄妇女(对照组)血清促甲状腺激素(TSH)、游离甲状腺激素(FT4)、游离三碘甲状腺原氨酸(FT3)和甲状腺过氧化物酶抗体(TPO-Ab)的浓度,根据妊娠早期与非妊娠育龄妇女的不同诊断标准分析检测结果。结果试验组的TSH、FT4和TPO-Ab血清浓度与对照组的差异均有统计学意义(P0.05)。妊娠早期妇女的甲状腺疾病总发生率达35.05%,明显高于非妊娠育龄妇女(15.00%),差异有统计学意义(P0.05)。试验组的孕妇所患甲状腺疾病主要为甲状腺功能减退(9.28%)和亚临床甲状腺功能减退(22.94%),与对照组妇女比较差异有统计学意义(P0.05)。结论妊娠早期甲状腺疾病的发生率高,可导致出生缺陷;因此,要重视对妊娠早期甲状腺疾病的筛查,提供优生优育理论依据。     

分化型甲状腺癌患者促甲状腺激素抑制治疗期间骨质疏松风险筛查及影响因素分析

目的了解分化型甲状腺癌患者术后长期行促甲状腺激素(TSH)抑制治疗期间骨质疏松风险,并探索其相关影响因素。方法选取接受分化型甲状腺癌术后行TSH抑制治疗的300例患者为研究对象,利用国际骨质疏松基金会骨质疏松一分钟测试法和亚洲人骨质疏松自我筛查工具(OSTA)进行骨质疏松风险筛查,并根据结果进行影响因素分析。结果300例接受分化型甲状腺癌术后行TSH抑制治疗的患者中,66.00%的患者存在骨质疏松风险;OSTA显示该组患者骨质疏松低度风险为96.00%,中度风险为1.00%,高度风险为3.00%。患者的服药剂量、性别、绝经、婚姻状况、医保支付类型以及是否知晓甲状腺癌术后激素治疗会增加骨质疏松的发病率是骨质疏松的影响因素。结论大部分分化型甲状腺癌TSH抑制治疗患者都存在患有骨质疏松的风险,但多为低度风险。患者对骨质疏松的防范意识普遍不高。