Clinical Analysis Of Hashimoto’s Thyroiditis And Papillary Thyroid Carcinoma

Objective:To analyzed the clinical characteristics of patients with Hashimoto’s thyroiditis,thyroid papillary carcinoma and Hashimoto’s thyroiditis complicated with thyroid papillary carcinoman,in order to provide clinical theoretical support for the diagnosis of the three dieases and the preoperative evaluation of the latter two.Methods:To choose 400 patients who were diagnosed pathologically after thyroidectomy in the first affiliated Hospital of Nanchang University from October 20,2015 to October 10,2018.These patients were divided into three groups including 61 cases in HT group,117 cases in HT-PTC group and 222 cases in PTC group.Sex,age,course of disease,clinical manifestations,ultrasonographic features,thyroid function with antibody and lymph node metastasis were compared among the three groups.Results:1.The age of patients in HT group was 49.6 ±11.0 years old,that in HT-PTC group was 42.2 ±11.4 years old,and that in PTC group was 45.7 ±12.0 years.There was significant difference in the age among the three groups(P < 0.05).The proportion under 45 years old in HT-PTC group was higher than that in HT group(P’< 0.0125).There was no significant difference in the course of disease among the three groups(P > 0.05).2.The common clinical manifestations of the three groups were cervical mass,compression symptoms were rare,and there was no difference in symptoms(P > 0.05).In goiter grade,the proportion of degree Ⅱ in HT-PTC group and PTC group was lower than that in HT group(P’< 0.0125).3.On ultrasound images,the proportion of nodules whose hypoechoic,unclear boundary,irregular shape,aspect ratio ≥ 1,microcalcification and abundant blood flow signal in HT-PTC group and PTC group was higher than that in HT group(P’< 0.0125),(P’< 0.05),but that were not significant different between the HT-PTC group and the PTC group.The nodule diameter was 2.11 ±1.15 cm in HT group,1.66 ±0.99 cm in HT ≤ PTC group and 1.74 ±1.30 cm in PTC group,which was larger in HT group than in HT-PTC group and PTC group(P < 0.05).Whether or not HT,Compared with the non-PTMC group,the ratio of irregular shape was lower,the proportion of microcalcification is lower,and the blood flow signal was poorer,but the ratio of aspect ratio ≥1 was higher in Papillary thyroid microcarcinoma(P < 0.05).4.In terms of thyroid function and antibody,TSH was 4.165 ±3.391 uIU/mL in HT group,TSH was 2.944 ±2.038 uIU/mL in HT-PTC group,and TSH was 2.649 ±2.981 uIU/mL in PTC group.The level and positive rate of TSH in PTC group and HT-PTC group were lower than those in HT-PTC group(P < 0.05,P’< 0.0125),but there was no significant difference between PTC group and HT-PTC group.The positive rates of TPOAb and TGAb in HT group and HT-PTC group were higher than those in PTC group(P’< 0.0125),but there was no significant difference between HT group and HT-PTC group.There was no significant difference in FT3 and FT4 among the three groups.5.The rate of diagnostic coincidence for the cervical lymph node metastasis by ultrasonography in PTC group and HT-PTC group was 63.4% and 62.5%.The rate of cervical lymph node metastasis was 36.9% in PTC group and 41.0% in HT ≤ PTC group,but there was no significant difference between the two groups(P > 0.05).6.Cervical lymph node metastasis which PTC confirmed cervical lymph node metastasis after ultrasound diagnosis was 1.89 ±1.00 cm,cervical lymph node metastasis which PTC confirmed cervical lymph node metastasis after pathology diagnosis was 1.43 ±0.62 cm.There were significant differences in cervical lymph node size,microcalcification and morphology between the two groups(P < 0.05).Conclusions:1.Patients of with hashimoto’s thyroiditis with papillary thyroid carcinoma are younger than those under 45 years of age,especially hashimoto’s thyroiditis’ patients under 45 years of age,we should be alert to they were suffered papillary thyroid carcinoma at the same time;2.The ultrasound features of patients suffered hashimoto’s thyroiditis with papillary thyroid carcinoma and papillary thyroid carcinoma often have the characteristics of hypoechoic nodules,unclear boundaries,irregular morphology,aspect ratio ≥ 1,microcalcification,abundant blood flow signals.In papillary thyroid microcarcinoma patients,the irregular shape of nodules was less,the proportion of microcalcification was lower,the blood flow signal was poorer,and the ratio of aspect ratio ≥ 1 was higher.3.The ultrasound features of patients suffered papillary thyroid carcinoma with with cervical lymph node metastasis showed larger lymph nodes,more round-like changes and more microcalcification whether they are suffered with hashimoto’s thyroiditis or not.