Thyroid gland

甲状腺
  • 文章类型: Journal Article
    背景:改善原发性甲状腺神经鞘瘤(PTS)的特点,为临床诊治提供参考依据。
    方法:使用搜索词“甲状腺神经鞘瘤”或“甲状腺神经鞘瘤”或“甲状腺神经鞘瘤”搜索截至2022年12月的PTS病例报告,分别。筛查34例。
    结果:PTS可以发生在任何年龄,结节平均3.9厘米。最常见的症状是声音改变和吞咽困难。神经鞘瘤应考虑细针穿刺细胞学检查显示纺锤形细胞。大多数病例均行甲状腺叶切除术或结节切除术,预后良好。具有安东尼A和安东尼B特征的组织类型是常见的。S-100蛋白免疫组织化学染色阳性,CD34和波形蛋白有助于确认诊断。
    结论:S-100和波形蛋白的阳性免疫组化有助于确诊。术前诊断具有挑战性,但是病理和免疫组织化学染色是诊断的金标准。首选的治疗方法是手术切除结节,预后良好。
    BACKGROUND: To improve the characteristics of primary thyroid schwannomas (PTS) and to provide reference basis for clinical diagnosis and treatment.
    METHODS: PubMed was searched for case reports of PTS up to December 2022 using the search terms \"Thyroid nerve sheath tumor\" or \"Thyroid schwannoma\" or \"Thyroid Neurilemmoma\", respectively. 34 cases were screened.
    RESULTS: PTS can occur at any age, nodules averaged 3.9 cm. The most common symptoms were voice change and dysphagia. Fine needle aspiration cytology showing spindle-shaped cells should be considered for schwannoma. Most cases underwent thyroid lobectomy or nodule removal with a good prognosis. Tissue types with both Antoni A and Antoni B features are common. Positive immunohistochemical staining for S-100 protein, CD34 and waveform proteins helped confirm the diagnosis.
    CONCLUSIONS: Positive immunohistochemistry for S-100 and wave proteins helps confirm the diagnosis. Preoperative diagnosis is challenging, but pathology and immunohistochemical staining are the gold standard for diagnosis. The first choice of treatment is surgical resection of the nodules, the prognosis is good.
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    文章类型: Journal Article
    孤立性纤维瘤是一种相对罕见的软组织成纤维细胞瘤,约占软组织肿瘤的2%。它主要被描述为胸膜腔的肿瘤;然而,高达70%的病例发生在其他地方,在任何解剖位置,这会使诊断变得困难。如果这是正在考虑的诊断,STAT6抗体目前具有高灵敏度和特异性.在本文中,我们描述了一名72岁的女性患者的情况,随访并由门诊内分泌学家治疗甲状腺多结节性甲状腺肿。由于甲状腺左叶完全结节状重塑和甲状腺右叶几个小结节的超声检查结果,建议患者行甲状腺全切除术.该手术是在Jind之所以伊希夫Hradec医院的耳鼻喉科进行的。随后将手术材料送去进行组织病理学检查。显微镜下在甲状腺右叶发现了几个增生性胶体结节和一个小的嗜酸细胞腺瘤。在左叶,一个不精确的划定,在切片上观察到2x1.8x1.5cm的灰白色病变。微观上,肿瘤由局灶性透明基质中的纺锤形细胞组成。在免疫组织化学检查中,肿瘤细胞与CD34抗体呈阳性反应,对甲状腺球蛋白抗体呈阴性,细胞角蛋白(CKAE1/AE3)和S100蛋白。在较高机构咨询后,补充了具有阳性结果的进一步免疫组织化学检查(Bcl2,CD99,STAT6)。根据形态学和免疫组织化学检查结果,该肿瘤被诊断为甲状腺的孤立性纤维瘤。这在这个地方是一个相对不寻常的发现;根据文献,只描述了几十个案例。
    Solitary fibrous tumour is a relatively rare soft tissue fibroblastic tumour, accounting for approximately 2% of soft tissue tumours. It has been described primarily as a tumour of the pleural cavity; however, up to 70% of cases occur elsewhere, in any anatomical location, which can make diagnosis difficult. If this is the diagnosis being considered, the STAT6 antibody is currently available with high sensitivity and specificity. In this paper we describe the case of a 72-year-old female patient, followed up and treated by an outpatient endocrinologist for a multinodular euthyroid goitre for several years. Due to complete nodular remodelling of the left lobe of the thyroid gland and sonographic findings of several small nodules in the right lobe of the thyroid gland, total thyroidectomy was recommended to the patient. The operation was performed at the ENT department in Jindřichův Hradec Hospital. Material from the operation was subsequently sent for histopathological examination. Several hyperplastic colloid nodules and a small oncocytic adenoma were detected microscopically in the right lobe of the thyroid gland. In the left lobe, an imprecisely delineated, greyish-white lesion measuring 2 x 1.8 x 1.5 cm was observed on the section. Microscopically, the tumour consisted of spindle-shaped cells in a focally hyalinised stroma. In the immunohistochemical examination, tumour cells reacted positively with the CD34 antibody, and negatively with antibodies against thyroglobulin, cytokeratins (CK AE1/AE3) and S100 protein. Further immunohistochemical examinations (Bcl2, CD99, STAT6) with positive results were supplemented upon consultation at a higher facility. Based on morphology and the results of the immunohistochemical examinations, the tumour was diagnosed as a solitary fibrous tumour of the thyroid gland. This is a relatively unusual finding in this location; according to literature, only a few dozen cases have been described.
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  • 文章类型: Journal Article
    目的:本研究的目的是总结一名接受多器官群(“喉-气管-甲状腺-下咽-食管”)联合移植的患者的重症监护经验。
    方法:该病例的重症监护管理计划是由多学科小组制定的,重点研究6个方面:(1)通过体位管理稳定循环,降低吻合口张力,提高移植器官的存活机会,(2)采用目标导向镇痛和镇静方案,以及预防吻合口瘘,(3)实施床旁超声引导营养计划,(4)采用“身心”同步康复促进功能恢复,(5)采取抗排斥治疗和保护性隔离措施,(6)甲状腺功能的监测与护理。
    结果:在重症监护期间,患者的生命体征稳定。患者成功脱离呼吸机,于术后9天转至普通病房接受进一步治疗,并在术后58天恢复后出院。随访期间患者情况良好。
    结论:本研究为今后类似移植患者的护理提供参考。
    OBJECTIVE: The aim of this study was to summarize the intensive care experience of a patient undergoing combined multi-organ cluster (\"larynx-trachea-thyroid-hypopharynx-esophagus\") transplantation.
    METHODS: The intensive care management plan for this case was developed by a multidisciplinary team, with focus on 6 aspects: (1) stabilizing the circulation and reducing anastomotic tension by position management to improve the survival chances of transplanted organs, (2) adopting goal-directed analgesia and sedation protocols, as well as preventing anastomotic fistula, (3) implementing a bedside ultrasound-guided nutrition plan, (4) employing \"body-mind\" synchronous rehabilitation to facilitate functional recovery, (5) taking antirejection treatment and protective isolation measures, (6) monitoring and nursing thyroid function.
    RESULTS: During the intensive care, the patient\'s vital signs were stable. The patient was successfully weaned from the ventilator and transferred to the general ward for further treatment at 9 days postoperatively, and discharged upon recovery at 58 days postoperatively. The patient was in good condition during follow-up.
    CONCLUSIONS: This study provides reference for the care of patients who undergo similar transplantation in the future.
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  • 文章类型: Case Reports
    朗格汉斯细胞组织细胞增生症(LCH)是一种罕见的克隆肿瘤,源自表达CD1a的朗格汉斯型细胞,langerin,和S100的免疫组织化学。LCH通常涉及多个站点和多个系统或单个系统中的多个站点。孤立性LCH通常涉及骨骼(尤其是头骨),淋巴结,皮肤,还有肺.甲状腺孤立性LCH是一种极为罕见的疾病,在索引文献中报道了一些病例,对临床医生和病理学家都构成了诊断困境。组织病理学与辅助测试一起形成了诊断的黄金标准。一旦排除了多系统受累,仅手术切除即可提供良好的预后。本文报道了一名年轻男性患者的单发LCH病例,该患者在随访2年后仍无病。
    UNASSIGNED: Langerhans cell histiocytosis (LCH) is a rare clonal neoplasm derived from Langerhans-type cells that express CD 1a, langerin, and S 100 on immunohistochemistry. LCH usually involves multiple sites and multiple systems or multiple sites in a single system. Solitary LCH commonly involves the bones (especially the skull), lymph nodes, skin, and lungs. Solitary LCH of the thyroid is an extremely rare disease with a few reported cases in the indexed literature and poses a diagnostic dilemma for both the clinician and pathologist. Histopathology along with ancillary tests forms the gold standard for diagnosis. Surgical resection alone offers a good prognosis once multisystemic involvement has been ruled out. Herein is reported one such case of solitary LCH in a young male patient who remains disease-free after 2 years of follow-up.
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  • 文章类型: Case Reports
    睾丸(NUT)癌(NC)中的核蛋白是一种罕见的,高度侵袭性肿瘤,通常伴有NUTM1(NUT中线癌家族成员1)基因融合。原发性甲状腺NC在临床上是罕见的,并且迄今为止还没有可用于NC的既定治疗指南。我们报告1例经组织病理学证实的甲状腺NC,为诊断和治疗提供参考。
    我们介绍了一名32岁的女性,她因“颈部疼痛肿胀和进行性吞咽困难”入院。术前超声引导芯针穿刺活检提示肿瘤分化差。考虑到计算机断层扫描(CT)扫描时肿瘤完全未切除,我们进行了甲状腺部分切除术,以获得足够的组织以明确诊断.组织病理学标本显示突发性角化病的特征。通过免疫组织化学(IHC)检测到与NUT的强免疫反应性,从而证实了NC的诊断。CK5/6、P40和P63仅在角化病区部分呈阳性。下一代测序(NGS)和RNA测序结果揭示了NSD3-NUTM1融合。患者接受了70Gy的联合放疗方案治疗,紫杉醇化疗(白蛋白结合),nivolumab免疫疗法,使用安洛替尼和BET抑制剂NHWD-870进行靶向治疗,但患者在诊断后7个月死亡。
    甲状腺NC是NUT癌的一种罕见且独特的病理子集,具有较高的NSD3-NUTM1融合率。在临床诊断过程中,我们建议对低分化甲状腺肿瘤进行NUTIHC.基因重排检测也有助于诊断和治疗。目前,手术和放疗仍然是NC的首选,和靶向免疫治疗的进展,如布罗莫结构域和末端基序抑制剂(BETi)可能会给患者带来更好的治疗选择。
    UNASSIGNED: Nuclear protein in testis (NUT) carcinoma (NC) is a rare, highly aggressive neoplasm, usually accompanying with NUTM1 (NUT midline carcinoma family member 1) gene fusions. Primary thyroid NC is clinically rare and to date there is no established treatment guideline available for NC. We report a case of histopathologically confirmed thyroid NC and provide reference for diagnosis and treatment.
    UNASSIGNED: We presented a 32-year-old female admitted to hospital with \"painful neck swelling and progressive dysphagia\". Preoperative ultrasound-guided core needle aspiration biopsy suggested a poorly differentiated tumor. Considering the tumor was totally unresected on computed tomography (CT) scan, a partial thyroidectomy was performed to obtain sufficient tissue for a clear diagnosis. Histopathological specimens showed features of sudden keratosis. Strong immunoreactivity with NUT was detected by immunohistochemistry (IHC) and thus confirmed the diagnosis of NC. CK5/6, P40 and P63 were partially positive exclusively in keratosis area. Next-generation sequencing (NGS) and RNA sequencing results revealed a NSD3-NUTM1 fusion. The patient was treated with a combined regimen of radiotherapy of 70 Gy, chemotherapy with paclitaxel (albumin-bound), immunotherapy with nivolumab, targeted therapy with anlotinib and BET inhibitor NHWD-870, but the patient died 7 months after diagnosis.
    UNASSIGNED: Thyroid NC is a rare and distinct pathological subset of NUT carcinoma with a higher rate of NSD3-NUTM1 fusion. In the clinical diagnosis process, we recommended performing NUT IHC for poorly differentiated thyroid tumors. Gene rearrangement detection is also helpful for diagnosis and treatment. At present, surgery and radiation are still first choices for NC, and advances in targeted immunotherapy such as bromodomain and end motif inhibitors (BETi) may bring better treatment options to patients.
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  • 文章类型: Journal Article
    目的:胰高血糖素样肽-1受体激动剂(GLP-1RA)治疗表明啮齿动物甲状腺C细胞增生和C细胞肿瘤的风险增加。由于这种风险,对于有甲状腺髓样癌或多发性内分泌瘤变综合征2型的个人或家族史的患者,存在该类药物的黑框警告.缺乏关于GLP-1RA治疗对血清甲状腺水平的任何可能影响的数据。本病例报告的目的是描述一例在接受左旋甲状腺素治疗的甲状腺全切除术后患者开始皮下苏美鲁肽后,甲状腺刺激激素水平受到抑制的病例,以强调需要对这些患者进行更密切的监测和进一步的研究。
    方法:该病例中描述的患者于2015年接受了甲状腺全切除术,需要使用左旋甲状腺素进行稳定的甲状腺激素替代治疗5年,直到开始并滴定皮下苏美鲁肽。开始GLP-1RA治疗后,促甲状腺激素(TSH)的减少需要将左甲状腺素的剂量从原始剂量减少25%。
    结论:该患者在开始和滴定皮下司马鲁肽后,TSH水平受到抑制。这些变化的病因可能与GLP-1治疗对TSH水平的直接影响有关。与胃排空率延迟相关的吸收变化,继发于GLP-1RA相关的体重减轻,或这些提出的机制的组合。在开始和滴定基于GLP-1RA的治疗时,对需要基于体重的给药和治疗指数狭窄的药物进行更频繁的监测可能是谨慎的,并且是潜在研究领域。
    OBJECTIVE: Glucagon-like peptide-1 receptor agonist (GLP-1 RA) therapy has demonstrated an increased risk of thyroid C-cell hyperplasia and C-cell tumors in rodents. Due to this risk, a boxed warning for this drug class exists for people with a personal or family history of medullary thyroid carcinoma or multiple endocrine neoplasia syndrome type 2. There is a lack of data regarding any possible effect of GLP-1 RA therapy on serum thyroid levels. The objective of this case report is to describe a case of suppressed thyroid stimulating hormone levels after initiation of a subcutaneous semaglutide in a post-total thyroidectomy patient managed with levothyroxine in order to highlight the need for closer monitoring of these patients and further research in this area.
    METHODS: The patient described in the case underwent a total thyroidectomy in 2015 with stable thyroid hormone replacement requirements with levothyroxine for 5 years until the initiation and titration of subcutaneous semaglutide. The reduction in thyroid stimulating hormone (TSH) after starting GLP-1 RA therapy necessitated a 25 percent dose reduction of levothyroxine from her original dose.
    CONCLUSIONS: This patient experienced suppressed TSH levels following initiation and titration of subcutaneous semaglutide. The etiology of these changes may be related to the direct effects of GLP-1 RA therapy on TSH levels, changes in absorption related to delayed gastric emptying rates, secondary to GLP-1 RA-associated weight loss, or a combination of these proposed mechanisms. It may be prudent to exercise more frequent monitoring of medications that require weight-based dosing and those with a narrow therapeutic index when initiating and titrating GLP-1 RA-based therapies and is an area of potential study.
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    文章类型: Journal Article
    甲状腺炎可能是由戈舍瑞林(促性腺激素释放激素的长效类似物)引起的,用于治疗子宫内膜异位症的疼痛和出血。戈舍瑞林诱发的甲状腺炎有可能影响甲状腺功能,因此可能导致高tech酸钠Tc-99m甲状腺扫描的摄取不良。
    本病例报告重点介绍了一例罕见的中年妇女,有症状的毒性甲状腺肿,其高科技酸钠Tc-99m甲状腺扫描摄取被戈舍瑞林治疗抑制。
    照顾戈舍瑞林患者的医务人员需要意识到其影响甲状腺功能的可能性。
    UNASSIGNED: Thyroiditis may be induced by goserelin (a long acting analogue of gonadotropin - releasing hormone) prescribed for the treatment of pain and bleeding of endometriosis. Goserelin induced thyroiditis has a possibility of affecting thyroid function and hence may cause poor uptake on sodium pertechnetate Tc-99m thyroid scan.
    UNASSIGNED: This case report highlights a rare instance of a middle-aged woman with symptomatic toxic goitre whose sodium pertechnetate Tc-99m thyroid scan uptake was inhibited by goserelin therapy.
    UNASSIGNED: Medical personnel caring for patients on goserelin need to be aware of the possibility of it affecting thyroid function.
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  • 文章类型: Case Reports
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  • 文章类型: Journal Article
    IgG4相关疾病是一种罕见的慢性病理学表现为一个或多个器官的淋巴浆细胞浸润,storiform纤维化的形成,组织水肿,和血液中IgG4的增加。这种疾病仅在2001年被列为独立的疾病单位。发病率每年不到100,000人中的1人。几乎任何器官都可以在IgG4相关疾病中受到影响。Riedel甲状腺炎与IgG4的关系于2010年建立。里德尔甲状腺炎是一种极为罕见的甲状腺炎症性疾病,该诊断因非典型病程和缺乏特征性症状而复杂化。世界上已有不到300例临床病例的描述,他们中只有两个是孩子。本文介绍了一个6岁男孩患有Riedel甲状腺炎的临床病例。
    IgG4-related disease is a rare chronic pathology manifested by lymphoplasmacytic infiltration of one or more organs, the formation of storiform fibrosis, tissue edema, and an increase of IgG4 in the blood. This disease was singled out as an independent nosological unit only in 2001. The incidence is less than 1 in 100,000 people per year. Almost any organ can be affected in IgG4-related disease. The association of Riedel\'s thyroiditis with IgG4 was established in 2010. Riedel\'s thyroiditis is an extremely rare inflammatory disease of the thyroid gland, which diagnosis is complicated by an atypical course and the absence of characteristic symptoms. Less than 300 clinical cases of the disease have been described in the world, only two from them were in children. This article presents a clinical case of a 6-year-old boy with Riedel\'s thyroiditis.
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  • 文章类型: Case Reports
    甲状腺发育不全被定义为一个甲状腺叶发育失败。这种情况主要表现为放射学检查期间的偶然发现。本文报道了一名53岁女性的案例,一个已知的高血压病例,他参观了AKU的耳鼻喉科诊所,在卡拉奇的第三纪中心,巴基斯坦斯坦,于9月12日至9月5日r2021进行了住院治疗。患者出现甲状腺右叶偏瘫,对侧叶增大,导致气道受压。她接受了甲状腺切除术,没有任何术中或术后并发症。有关于呼吸困难的投诉,住院期间喘鸣或声音嘶哑。患者已出院,在随后的随访中发现情况良好。
    Thyroid hemiagenesis is defined as a failure of one thyroid lobe development. This condition predominantly manifests as an incidental finding during radiological investigation. This paper repor ts the case o f a 53-year-ol d female, a known case of hypertension, who visited the ENT clinic at AKU, a ter tiary ca re centre in Karachi, Pak istan and was hospi talized from 12 th to 1 5th Septembe r 202 1. The patient presented with hemiagenesis of the right thyroid lobe with enlargement of the contralateral lobe resulting in airway compression. She was subjected to excision of the thyroid gland without any intra-operative or postoperative com plicati ons. There were n o complaints o f dyspnoea, stridor or hoarseness during the hospital stay. The patient was discharged and was found to be well on subsequent follow-ups.
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