甲状腺结节的评估

甲状腺结节(TN)是很常见的疾患,在成人中触诊可查出5%,但超声检查则可高达50%,TN的评估重要性在于对恶性结节需及时外科手术治疗,对大多数的良性结节则采取更为保守的治疗方法。近年对TN的诊断方法有许多进展,其中超声检查是第一线方法,超声检查TN如有以下特征时要考虑恶性的可能:(1)边缘不整;(2)形状不规则;(3)实体回声结构;(4)低回声;(5)晕轮消失;(6)微钙化;(7)结节内血流。而细针穿刺抽吸细胞学活检在诊断TN时是最准确和直接的方法。其他有实验室检查(TSH、Tg测定),CT、MRI和PET-CT等。在TN的原发疾病中,良性多结节腺肿最为多见,占60%左右;甲状腺癌的发生率为5%～15%,这需看其年龄、性别、放射线病史、家族史等因素而定。慢性淋巴细胞性甲状腺炎、甲状腺囊肿、Graves病和高功能结节等则比较少见。

Evaluation of Thyroid Nodule

Thyroid nodules（TN） are very common lesions. Approximately 5 % of adults have a palpable TN, while ultra- sound studies have suggested that up to 50% of the general population may have TN. Malignant TN should be managed ag- gressively and will regularize surgical management, while the much more common benign TN may be managed more conser- vatively. In current advances in the diagnositic methods,ultrasounography was first line diagnostic method, the US features significantly with malignancy are ： blurred margin, irregular shape, echogenecity structure, hypoechoic, Halo absent, micro calcifications,intranodular vascular pattern. Fine --neadle aspiration biopsy is the most accurate and cost-effective method for evatluating TN. Other methods include laboratory test （TSH and Tg） , CT, MRI and PET-CT. Benign multi-nodules goiter is the most common TN disorder,occur 60% of TN. Thyroid cancer which occur in 5%-15% depending on age, sex, radiation exposure history, family history and the other factors. Chronic lymphocytic thyroiditis, thyroid cyst, Graves disease,hyper function nodule also the less common kind of TN.