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发生于甲状腺腺体的自主功能性甲状腺结节(autonomously functioning thyroid nodule,AFTN)是一种能引起甲状腺毒症的少见疾病,其发病率为0.9%~9%,且女性多于男性,99%的AFTN为良性,可单发也可多发,单发的AFTN也被称为Plummer病[1-2]。手术治疗、131I治疗和射频消融治疗均可作为AFTN的临床治疗方法且各有优劣[3]。约1%的AFTN可表现为恶性,尤其发生在碘缺乏地区[4]。在罕见的情况下,患者可能同时患有AFTN和Graves病,被称为Marine-Lenhart综合征[5]。在131I治疗AFTN后2~14个月,少部分患者体内会检测到TSH受体抗体(thyrotropin receptor antibody,TRAb),TRAb表达水平的升高可诱发自身免疫性甲状腺功能亢进(简称甲亢),其发病率为0.05%~5%[6]。我们对AFTN的临床诊疗进展和上述特殊的临床情况综述如下。
自主功能性甲状腺结节的临床诊疗进展
Progress in the clinical diagnosis and treatment of autonomously functioning thyroid nodule
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摘要: 自主功能性甲状腺结节(AFTN)是发生于甲状腺腺体的以良性结节为主的疾病,可表现为甲状腺功能正常、亚临床甲状腺功能亢进(毒性结节前期)和临床甲状腺功能亢进(毒性结节期)。AFTN的治疗方法包括手术治疗、131I治疗和射频消融治疗等。笔者对AFTN的诊断和治疗及其特殊的临床情况(如恶性结节、Marine-Lenhart综合征和131I治疗后诱发的Graves甲状腺功能亢进等)进行综述,为临床工作进一步的开展提供依据。
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关键词:
- 甲状腺结节 /
- 碘放射性同位素 /
- 射频消融术 /
- 甲状腺肿瘤 /
- Marine-Lenhart综合征
Abstract: Autonomously functioning thyroid nodule (AFTN) is a predominantly benign neoplasm presenting in thyroid gland. AFTN can cause a range of functional abnormalities, from euthyroidism to subclinical hyperthyroidism (pre-toxic nodule stage) and overt hyperthyroidism (toxic nodule stage). The treatment methods include surgery treatment, 131I therapy, radiofrequency ablation treatment, etc. This paper reviews the progress in diagnosis and treatment of AFTN and the special clinical conditions (such as malignant nodules, Marine-Lenhart syndrome, Graves hyperthyroidism induced by 131I therapy, etc.) to provide a basis for further clinical application. -
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