Asociación entre tiroiditis linfocítica crónica y carcinoma papilar de tiroides: Revisión sistemática y metaanálisis de estudios en especímenes quirúrgicos / Association between chronic lymphocityc thyroiditis and papillary thyroid carcinoma: Systematic review and meta-analysis of studieson surgical specimens

Introducción. Existen resultados inconsistentes con relación al planteamiento de la hipótesis que sugiere una mayor probabilidad de documentar un carcinoma papilar de tiroides en especímenes quirúrgicos con cambios compatibles con tiroiditis linfocítica crónica. En los metaanálisis existentes se han incluido estudios no comparables metodológicamente y no se proponen claras fuentes de sesgo, justificación para la realización del presente metaanálisis. Métodos. Se realizó una búsqueda bibliográfica en Pubmed y Embase. Fueron obtenidos estudios retrospectivos donde se comparaba la prevalencia de carcinoma papilar de tiroides en especímenes con y sin cambios por tiroiditis linfocítica crónica. La evidencia recolectada fue sintetizada estadísticamente. Resultados. Un total de 22 artículos fueron incluidos. La población estuvo conformada por 63.548 especímenes. El OR combinado fue 1,81 (IC95%: 1,51-2,21). Hubo heterogeneidad entre la distribución de las razones de oportunidad entre los estudios (I2= 91 %; p>0,00001). La forma del gráfico en embudo de los estudios incluidos en el análisis parece estar simétrica, lo que indica la ausencia del sesgo atribuible a los estudios pequeños. Conclusiones. La literatura actual sugiere que existe un mayor riesgo de documentar un carcinoma papilar de tiroides en especímenes quirúrgicos en los que se observan cambios compatibles con tiroiditis linfocítica crónica; sin embargo, existen fuentes de sesgo que no será posible controlar en estudios retrospectivos, por lo que recomendamos estudiar la hipótesis que sugiere una mayor probabilidad de diagnosticar un carcinoma papilar de tiroides en especímenes con cambios compatibles con tiroiditis linfocítica crónica mediante metodologías prospectivas

Introduction. Inconsistent results exist in the literature regarding the hypothesis statement suggesting an increased likelihood of documenting papillary thyroid carcinoma (PTC) in surgical specimens with changes compatible with chronic lymphocytic thyroiditis. Existing meta-analyses have included studies that are not methodologically comparable and do not propose clear sources of bias, thus, this is justification for the present meta-analysis. Methods. A literature search in Pubmed and Embase was performed from January 1, 1950 to December 31, 2020. Retrospective studies comparing the prevalence of papillary thyroid carcinoma in specimens with and without chronic lymphocytic thyroiditis changes were obtained. The collected evidence was statistically analyzed. Results. A total of 22 articles were included. The study population consisted of 63,548 surgical specimens. The pooled OR, based on the studies, was 1.81 (95% CI: 1.51-2.21). There was heterogeneity between the distribution of prevalence ratios and opportunity ratios across studies (I²= 91%; p>0.00001). The funnel plot shape of the studies included in the analysis appears to be symmetrical, indicating the absence of bias attributable to small studies. Conclusions. The current literature suggests that there is an increased risk of documenting papillary thyroid carcinoma in surgical specimens in which chronic lymphocytic thyroiditis-compatible changes are observed; however, there are sources of bias that will not be possible to control for in retrospective studies, so we recommend studying the hypothesis suggesting an increased likelihood of diagnosing PTC in specimens with chronic lymphocytic thyroiditis-compatible changes using prospective methodologies

Clinicopathologic features and risk factors for lymph node metastasis of papillary thyroid carcinoma with chronic lymphocytic thyroiditis / 中华普通外科杂志

Objective To summarize clinicopathologic features of papillary thyroid carcinoma (PTC) coexistent with chronic lymphocytic thyroiditis (CLT) and investigate risk factors for lymph node metastasis.Methods The medical records of 4 264 consecutive papillary thyroid carcinoma patients who received surgical treatment from Oct 2013 to Oct 2015 in Peking Union Medical College Hospital were reviewed.The diagnoses was confirmed by histopathological tests.Univariate analysis was performed to identify specific clinicopathologic features of PTC with CLT.Univariate and multivariate analysis were performed to determine whether each clinicopathologic feature was an independent risk factor for lymph node metastasis.Results In all 4 265 cases,there were 3 059 papillary thyroid microcarcinoma (PTMC) (71.7％),1 010 PTC patients (23.7％) with CLT.909 female patients (90％),624 cases with multifocal lesions (61.8％),422 cases with extra-thyroid extension (41.8％),429 cases with lymph node metastasis (42.5％),and 133 cases with metastatic lymph nodes(LNs) ≥6 (13.2％).The median age was 43 years old and median tumor size was 0.8 cm.Patients with CLT were more females (90.0％ vs.70.2％;P ＜ 0.001),younger median age (43 vs.44 years;P =0.001),and lower incidence of lymph node metastasis (42.5％ vs.50.9％;P ＜0.001).CLT was not associated with tumor size,multifocal lesions,extra-thyroid extension and metastatic LNs≥6 (0.8 cm vs.0.7 cm,61.8％ vs.62.9％,41.8％ vs.42.1％ and 13.2％ vs.14.8％,respectively,all P ＞ 0.05).In multivariate analysis,CLT was an independent protective factor for lymph node metastasis (OR =0.713,95％ CI 0.609-0.835,P ＜0.001).In PTC patients with lymph node metastasis,CLT was not associated with lymph node metastasis number (3 vs.3,P =0.300).Conclusions Chronic lymphocytic thyroiditis was an independent protective factor for papillary thyroid carcinoma patients with lymph node metastasis.But in patients with lymph node metastasis,the metastatic number didn't decrease.

Influence of chronic lymphocytic thyroiditis on the risk of persistent and recurrent disease in patients with papillary thyroid carcinoma and elevated antithyroglobulin antibodies after initial therapy / Influência da tireoidite linfocítica crônica sobre o risco de doença persistente e recorrente em pacientes com carcinoma papilífero de tireoide e anticorpos antitireoglobulina elevados após a terapia inicial

Abstract Introduction In patients with papillary thyroid carcinoma who have negative serum thyroglobulin after initial therapy, the risk of structural disease is higher among those with elevated antithyroglobulin antibodies compared to patients without antithyroglobulin antibodies. Other studies suggest that the presence of chronic lymphocytic thyroiditis is associated with a lower risk of persistence/recurrence of papillary thyroid carcinoma. Objective This prospective study evaluated the influence of chronic lymphocytic thyroiditis on the risk of persistence and recurrence of papillary thyroid carcinoma in patients with negative thyroglobulin but elevated antithyroglobulin antibodies after initial therapy. Methods This was a prospective study. Patients with clinical examination showing no anomalies, basal Tg < 1 ng/mL, and elevated antithyroglobulin antibodies 8-12 months after ablation were selected. The patients were divided into two groups: Group A, with chronic lymphocytic thyroiditis on histology; Group B, without histological chronic lymphocytic thyroiditis. Results The time of follow-up ranged from 60 to 140 months. Persistent disease was detected in 3 patients of Group A (6.6%) and in 6 of Group B (8.8%) (p = 1.0). During follow-up, recurrences were diagnosed in 2 patients of Group A (4.7%) and in 5 of Group B (8%) (p = 0.7). Considering both persistent and recurrent disease, structural disease was detected in 5 patients of Group A (11.1%) and in 11 of Group B (16.1%) (p = 0.58). There was no case of death related to the disease. Conclusion Our results do not support the hypothesis that chronic lymphocytic thyroiditis is associated with a lower risk of persistent or recurrent disease, at least in patients with persistently elevated antithyroglobulin antibodies after initial therapy for papillary thyroid carcinoma.

Resumo Introdução Em pacientes com carcinoma papilífero de tireoide e com tireoglobulina sérica negativa após a terapia inicial, o risco de doença estrutural é maior entre aqueles com anticorpos antitireoglobulina elevados em comparação com pacientes sem anticorpos antitireoglobulina. Outros estudos sugerem que a presença de tireoidite linfocítica crônica está associada a um menor risco de persistência/recorrência do carcinoma papilífero de teireoide. Objetivo Este estudo prospectivo avaliou a influência da tireoidite linfocítica crônica sobre o risco de persistência e recorrência do carcinoma papilífero de tireoide em pacientes com tireoglobulina negativa, mas com anticorpos antitireoglobulinas elevados após a terapia inicial. Método Esse foi um estudo prospectivo, no qual foram selecionados pacientes com exame clínico sem anomalias; tireoglobulina basal < 1 ng/mL e anticorpos antitireoglobulina elevados 8-12 meses após ablação. Os pacientes foram divididos em dois grupos: Grupo A, com tireoidite linfocítica crônica no exame histológico; Grupo B, histologicamente sem tireoidite linfocítica crônica. Resultados O tempo de seguimento variou de 60 a 140 meses. Doença persistente foi detectada em 3 pacientes do Grupo A (6,6%) e em 6 do Grupo B (8,8%) (p = 1,0). Durante o seguimento, as recidivas foram diagnosticadas em 2 pacientes do Grupo A (4,7%) e em 5 do Grupo B (8%) (p = 0,7). Considerando tanto a doença persistente quanto a recorrente, doença estrutural foi detectada em 5 pacientes do Grupo A (11,1%) e em 11 do Grupo B (16,1%) (p = 0,58). Não houve nenhum caso de óbito relacionado à doença. Conclusão Nossos resultados não apoiam a hipótese de que a tireoidite linfocítica crônica esteja associada a um menor risco de doença persistente ou recorrente, pelo menos em pacientes com anticorpos antitireoglobulina persistentemente elevados após a terapia inicial do carcinoma papilífero de tireoide.

A survey of patients with thyroid diseases who migrated from inland to coastal of Cangzhou City Hebei Province and their urinary iodine levels / 中华地方病学杂志

Objective To investigate the prevalence of common thyroid diseases and urinary iodine levels in the population migrated from inland to coastal areas and to evaluate the epidemiological trend of thyroid disease in Heibei Cangzhou. Methods A retrospective analysis method was adopted. All the persons who were employees of enterprises and institutions,were divided into three groups:the migrated group,who migrated from Cangzhou City and the west counties of Cangzhou City to the Port of Huanghua where they had settled permanently because of the job; the inland group, who lived in Cangzhou City all the time and the seaport group, who lived in the Port of Huanghua for a long-term. Migrated groups were divided into stable occupants and intermittent occupants. During 2010 - 2016, a follow-up survey was conducted in the three groups at Examination Center of Cangzhou Central Hospital Physical. We compared the cumulative incidences of thyroid diseases including: chronic lymphocytic thyroiditis (CLT), nodular thyroid disease and Graves's disease (GD). In migrated group, 28 persons who occasionally lived in the Port of Huanghua were detected urinary iodine levels intermittently.We compared the two parts of urinary iodine level changes for three times by collecting a urine sample,including one part from people who lived in the Port of Huanghua continuously for more than a month,and another part of people who lived in Cangzhou or Hejian County for more than half a month then returned to Port of Huanghua. Results In 2010 - 2016, a total of 7 180 residents were surveyed, of which 2 012 were in the migrated group, 2 858 were in the inland group and 2 310 in the seaport group. The incidences of CLT and nodular thyroid disease were 2.29% (46/2 012)and 8.60% (173/2 012)in the migrated group,which were much higher than that of the inland group and the seaport group [1.05% (30/2 858), 5.42% (155/2 858); 1.47% (34/2 310), 6.88% (159/2 310), P < 0.01 or < 0.05]. At the same time,the incidences of GD was 0.45%(9/2 012) in the migrated group, which was higher than that of the inland group [0.10% (3/2 858), P < 0.05]. In migrated group, there were 1 503 residencies, including 482 stable occupants and 1 021 intermittent residents. The incidences of CLT and nodular thyroid disease in intermittent residents were 3.23% (33/1 021) and 9.89% (101/1 021), which were much higher than that of stable occupants [1.45% (7/482), 6.64% (32/482), P < 0.05]. The urinary iodine levels in the persons who lived in the Port of Huanghua occasionally (464.6 μg/L) were much higher than that of the persons who lived in Cangzhou for a long time(301.4 μg/L, U = 4.648, P < 0.01).There was a marked fluctuation of the median of urinary iodine determined 6 times which were 485.7,285.2,431.7,310.6,470.3 and 304.4 μg/L,respectively.Conclusions The incidence of many thyroid diseases of people migrated from inland to coastal areas has increased, which is not only higher than that of inland people,but also higher than that of coastal people.Large fluctuations in iodine intake due to migration flow and residential instability may be part of the reason for the high incidence of thyroid diseases. In the future, we should pay more attention to thyroid diseases of migratory population.

Relationship between BRAF V600E mutation and clinicopathological features of papillary thyroid carcinoma patients combined with chronic lymphocytic thyroiditis / 肿瘤研究与临床

Objective To investigate the relationship between BRAF V600E mutation and clinicopathological features of papillary thyroid carcinoma (PTC) combined with chronic lymphocytic thyroiditis (CLT). Methods The clinical data of 168 PTC patients combined with Hashimoto thyroiditis who received radical surgery treatment in Beijing Caner Hospital from November 2013 to July 2016 were analyzed retrospectively. Sanger sequence was used to detect the status of BRAF V600E mutation. Then the patients were divided into BRAF V600E mutation positive (the observation group) and the mutation negative group (the control group). The clinicopathological features between the two groups were compared. Results The proportion of gender, age, calcification, lymphatic metastasis and extra gland invasion incidence had no significant difference between the observation group and the control group (χ2= 0.234, 1.139, 0.650, 1.262 and 1.665 respectively, all P＞0.05). Moreover, the differences of tumor size, tumor shape and tumor number in both groups were statistically significant (χ2= 7.071, 3.877 and 6.968 respectively, all P＜ 0.05). Logistic regression analysis showed that there was no statistical difference between the patients with BRAF V600E mutation or without in tumor number and central lymph node metastasis ( OR= 0.263, 95 % CI 0.049-1.402, P=0.118; OR=2.152, 95 % CI 0.666-6.956, P=0.200). Conclusion BRAF V600E mutation has no significant effect on clinicopathological features of PTC patients combined with CLT.

Progress of chronic lymphocytic thyroiditis combined with papillary thyroid carcinoma / 肿瘤研究与临床

Thyroid carcinoma is very common in clinical malignant tumors, while papillary thyroid carcinoma (PTC) is the most common pathological type. The chronic lymphocytic thyroiditis is an autoimmune disease. In recent years, a growing number of cases of chronic lymphocytic thyroiditis combined with PTC are found in clinic, so the relationship between them has become a hot focus. This article will summarize the current research from epidemiology, pathogenesis and pathological morphology.

Analysis of 40 cases of chronic lymphocytic thyroiditis combined with thyroid cancer / 国际外科学杂志

Objective To analyse the treatment,clinical features and prognosis of chronic lymphocytic thyroiditis combined with thyroid cancer.Methods Retrospectively analysed 40 cases with chronic lymphocytic thyroiditis combined with thyroid cancer,admitted to the Department of General Surgery of the First Affiliated Hospital of Dalian Medical University from November 2002 to April 2011.All the 40 patients were female.Results Ultrasound diagnosis or suspected diagnosis of chronic lymphocytic thyroiditis was made in 2 patients.Eleven patients underwent CT examination,and 2 patients were found with thyroid adenoma,1 patient found with thyroid cancer and lymph node metastasis,3 patients with chronic lymphocytic thyroiditis.Forty patients underwent surgical treatment,pathological results of 39 patients showed chronic lymphocytic thyroiditis with thyroid papillary carcinoma,1 patient was medullary thyroid carcinoma combined with chronic lymphocytic thyroiditis.Forty patients were administrated levothyroxine tablets.Thirty-six patients were followed up,4 patients were lost,1 relapsed,the others were in stable condition.Conclusions Preoperative diagnosis is difficult for chronic lymphocytic thyoiditis combined with thyroid cancer,which needs through the thyroid antibody tests,imaging examinations and intraoperative,postoperative pathologic examination and other means of comprehensive application.The method of definitive diagnosis for CLT combined with TC is intraoperative,postoperative pathologic diagnosis.The main pathological type is papillary thyroid carcinoma,which small papillary carcinoma occupies a large proportion.Surgery is the main treatment for CLT combined with TC.

Coexistence of Chronic Lymphocytic Thyroiditis with Papillary Thyroid Carcinoma: Clinical Manifestation and Prognostic Outcome

The study aimed to identify the clinical characteristics of coexisting chronic lymphocytic thyroiditis (CLT) in papillary thyroid carcinoma (PTC) and to evaluate the influence on prognosis. A total of 1,357 patients who underwent thyroid surgery for PTC were included. The clinicopathological characteristics were identified. Patients who underwent total thyroidectomy (n = 597) were studied to evaluate the influence of coexistent CLT on prognosis. Among the total 1,357 patients, 359 (26.5%) had coexistent CLT. In the CLT group, the prevalence of females was higher than in the control group without CLT (P < 0.001). Mean tumor size and mean age in the patients with CLT were smaller than without CLT (P = 0.040, P = 0.047, respectively). Extrathyroidal extension in the patients with CLT was significantly lower than without CLT (P = 0.016). Among the subset of 597 patients, disease-free survival rate in the patients with CLT was significantly higher than without CLT (P = 0.042). However, the multivariate analysis did not reveal a negative association between CLT coexistence and recurrence. Patients with CLT display a greater female preponderance, smaller size, younger and lower extrathyroidal extension. CLT is not a significant independent negative predictive factor for recurrence, although presence of CLT indicates a reduced risk of recurrence.

Interleukin-10 but not interleukin-18 may be associated with the immune response against well-differentiated thyroid cancer

OBJECTIVES: The aim of this study was to investigate the role of the interleukin-18 +105A/C and interleukin-10 -1082A/G germline polymorphisms in the development and outcome of differentiated thyroid carcinoma associated or not with concurrent thyroiditis. METHODS: We studied 346 patients with differentiated thyroid carcinomas, comprising 292 papillary carcinomas and 54 follicular carcinomas, who were followed up for 12-298 months (mean 76.10 ± 68.23 months) according to a standard protocol. We genotyped 200 patients and 144 control individuals for the interleukin-18 +105A/C polymorphism, and we genotyped 183 patients and 137 controls for the interleukin-10 -1082A/G polymorphism. RESULTS: Interleukin-18 polymorphisms were not associated with chronic lymphocytic thyroiditis or any clinical or pathological feature of tumor aggressiveness. However, there was an association between the presence of interleukin-10 variants and chronic lymphocytic thyroiditis. Chronic lymphocytic thyroiditis was present in 21.74 percent of differentiated thyroid carcinoma patients, most frequently affecting women previously diagnosed with Hashimoto's thyroiditis who had received a lower 131I cumulative dose and did not present lymph node metastases. CONCLUSIONS: We conclude that the inheritance of a G allele at the interleukin-10 -1082A/G polymorphism may favor a concurrent thyroid autoimmunity in differentiated thyroid carcinoma patients, and this autoimmunity may favor a better prognosis for these patients.

Surgical treatment for 70 cases chronic lymphocytic thyroiditis / 中华内分泌外科杂志

Objective To discuss diagnosis and surgical treatment for chronic lymphocytic thyroiditis (CLT). Methods Records of 70 patients who were diagnosed as CLT from 2005 to 2009 were retrospectively reviewed. They were divided into two groups according to pathological results. Results There were 6 patients of CLT accompanying with papillary carcinoma. The rest 64 patients were diagnosed as CLT accompanying with benign nodules. All cases were confirmed by pathology and treated with operation. Conclusions Coexistence of nodules which can not be excluded from carcinoma is the main reason for surgical treatment in case of CLT. CLT patients especially for those associated with single nodule and/or microcalcification inside nodules should be given surgical treatment. The operative method depends on pathological results during operation.

Poly (I:C) promotes iodine excess-induced chronic lymphocytic thyroiditis in NOD mouse / 中国病理生理杂志

AIM: To investigate the effects of poly (I:C) as virus mimics on iodine excess-induced chronic lymphocytic thyroiditis in NOD mouse. METHODS: Female, 32 NOD mice were randomly divided into 4 groups: (1) control;(2) high iodine;(3) poly (I:C);(4) high iodine+poly (I:C). Nine weeks after administration, mice were sacrificed. The following parameters were determined: body weight, thyroid weight and anatomic form. Thyroid hormone (T_4) in serum was measured by radioimmunoassay, the thyroid morphology was observed through HE staining, apoptosis was detected by TUNEL, the mRNA expression levels of TRAIL, TRAIL-sR1, ICAM-1 and CXCL10 were determined by the method of real time RT-PCR. RESULTS: Compared to control group and poly (I:C) group, the thyroid absolute weight and relative weight in high iodine group were increased (P<0.01), the level of total T_4 in serum was decreased (P<0.05), inflammation and apoptosis were obviously observed, the mRNA expressions of TRAIL, TRAIL-sR1, CXCL10 and ICAM-1 were upregulated (P<0.05). Compared to high iodine group, thyroid absolute weight and relative weight in high iodine+poly (I:C) group were further increased, the level of total T_4 in serum was further decreased (P<0.05), the ratio of inflammatory degree Ⅳ increased to 50.0%, the numbers of apoptosis cells were further enhanced, the mRNA expressions of TRAIL, TRAIL-sR1, ICAM-1 and CXCL10 were further upregulated (P<0.05). Otherwise, the tendency of all parameters in poly (I:C) group was similar to that in control group (P>0.05). CONCLUSION: Poly (I:C) aggravates chronic lymphocytic thyroiditis induced by excess of iodine associated with increase in infiltration of lymphocytes and induction of apoptosis.

Significance of the alteration of Th17 cells in patients with chronic lymphocytic thyroiditis / 细胞与分子免疫学杂志

AIM: To investigate the alteration and its significance of T help 17 cells(Th17) in patients with chronic lymphocytic thyroiditis(CLT). METHODS: Patients were divided into 3 groups: CLT patients with euthyroidism (n = 15), CLT patients with hypothyroidism (n = 30) and healthy control group(n = 20). The ratio of Th17 lymphocytes subpopulations in the preipheral blood were evaluated by technique of flow cytometry. Production of thyroid autoantibody (TPO-Ab, TG-Ab) were measured by electro-chemiluminescence immunoassay (ECLIA). RESULTS: Compared with the healthy control group, in CLT group: The frequencies of Th17 in peripheral blood were found to be significantly higher in patients with CLT than healthy control group (P < 0.01); Production of TPO-Ab and TG-Ab markedly increased in CLT patients than healthy control group (P < 0.01). There was significant correlation between the positive expression of thyroid autoantibody and the changes of Th17 subpopulations (r=0.50, r=0.43 respectively; P < 0.01). CONCLUSION: The frequencies of Th17 cell increased in patients with CLT which may suggest a potential role for Th17 in the progression and happen of CLT.

Influencia de la tiroiditis linfocitaria crónica en el pronóstico de pacientes con carcinoma papilar de tiroides / Influence of chronic lymphocytic thyroiditis on the prognostic outcome of patients with papillary thyroid carcinoma

Introducción: Algunos estudios atribuyen a la tiroiditis linfocitaria crónica (TLC) asociada al carcinoma papilar de tiroides (CPT) un efecto protector o de buen pronóstico; otros sugieren que sería un factor de riesgo para el desarrollo de recurrencias. Objetivo: Determinar la influencia de la TLC en el pronóstico de pacientes con CPT. Métodos: De un total de 406 CPT operados por un mismo cirujano (JLN), se seleccionaron 140 CPT que cumplieron los siguientes criterios de inclusión: pacientes operados con tiroidectomía total con criterio curativo y diagnóstico histológico de CPT variedad usual, sin tratamientos quirúrgicos previos y con seguimiento mínimo de 5 años. El diagnóstico de CPT y TLC lo realizó un mismo anatomopatólogo. Se definieron como factores de mal pronóstico, la edad ?45 años, el sexo masculino, los tumores grandes (>40 mm), los ganglios metastásicos al momento del diagnóstico de CPT, la multifocalidad tumoral y la invasión extratiroidea. Resultados: Se diagnosticaron histológicamente 51 (36.4%) CPT asociados con TLC y 89 (63.6%) sin TLC. Ninguno de los factores considerados mostró diferencias estadísticamente significativas entre los pacientes con y sin TLC (P=NS). Las tasas de recurrencia (3.6%) y muerte (2.1%) también fueron similares en ambos grupos (P=NS). Conclusión: La coexistencia de CPT y TLC es elevada y concordante con algunas publicaciones, pero la TLC no produjo ningún impacto sobre el pronóstico (recurrencia) de los pacientes. Aquellos que recurrieron y fallecieron presentaron 3 o más factores de mal pronóstico, sin que la TLC fuese un factor determinante del pronóstico.

Introduction: Some articles attribute a protect effect of chronic lymphocytic thyroiditis (CLT) on the prognostic outcome of patients with papillary thyroid carcinoma (PTC); others suggest it as a risk factor of PTC recurrences. Objective: To determine the influence of CLT on the prognostic outcome of patients with PTC. Methods: From 406 PTC patients surgically treated by a same surgeon (JLN), which received radioactive iodine ablative dosis, 140 PTC patients were selected that followed the following criteria: patients who underwent a total thyroidectomy for curative purpose, with histological diagnosis of pure PTC, without previous related surgeries, with a minimal 5-year follow-up. PTC and CLT histological diagnosis were performed by a same pathologist. Bad prognosis factors were defined: ?45 years old, male sex, big tumors (>40 mm), metastatic nodes at PTC diagnosis, multifocality and extrathyroideal extension. Results: 51 (36.4%) were found associated with CLT and 89 (63.6%) showed only pure PTC. No factors showed significantly statistical differences between patients with and without CLT (P=NS). Recurrence (3.6%) and death (2.1%) rates were similar in both groups, too (P=NS). Conclusion: Coexistence of CLT and PTC is high and it coincides with other experiences, but CLT did not cause any impact on the prognostic outcome (recurrence and/or death) of patients with PTC. Patients who had recurrence or died showed at least three risk factors, but CLT did not a bad prognosis factor.

Clinical analysis of Hashimoto's disease complicated with thyroid adenomas in 107 patients / 中国现代普通外科进展

Objective:To summarize diagnosis and treatment of hashimoto's disease(HD) complicated with thyroid adenomas(TA) in 107 patients.Methods:Clinical data of 107 patients of HD complicated with TA were analysed retrospectively.Results:Complete serum immunologic examinations,B ultrasonography and fine needle aspiration biopsy were helpful for the diagnosis of HD with TA.Thirty-eight patients(35.5%) were diagnosed before operation.Misdiagnosis rate was 64.5%(69/107).Intraoperative frozen section diagnosis rate was 81.3%(87/107).Partial,large and total resection of thyroid gland can be selected according to frozen section and local disease focus.Afteroperation,87patients(81.3%)hada goodrecovery.Threepatients with total thyroid gland resection need thyroxin tablet.Thyroid hypofunction did not happented in 104 patients.Conclusions:HD with TA should be treated surgically.Intraoperation frozen section is helpful for selecting operationmethods.

Experience in Diagnosis and Treatment for Chronic Lymphocytic Thyroiditis (Report of 77 Cases) / 中国普外基础与临床杂志

Objective To summarize the experience in diagnosis and treatment for chronic lymphocytic thyroiditis or complicated with other thyroid diseases. Methods Seventy-seven patients were diagnosed as chronic lymphocytic thyroiditis or complicated with other thyroid diseases by operation and histological examination at this department from November 2002 to March 2005. All their clinical records including general information, the results of careful physical examination, thyroid correlated hormone tests, color Doppler, fine needle aspiration cytological examination and some intraoperative examinations have been retrospectively analyzed in this report. Results There were 53 cases of simple chronic lymphocytic thyroiditis, 10 cases complicated by papillary carcinoma, 1 case complicated by follicular carcinoma, 2 cases complicated by non-Hodgkin’s lymphoma, 6 cases complicated by nodular goiter, 4 cases complicated by follicular adenoma, and 1 complicated by parathyroid adenoma. Almost all the operations were successfull and the symptoms of the diseases were alleviated. Seventy-two patients had been followed up ranging from two months to two years differently and none of them relapsed. Sixty-three of these patients have received thyrine inhibition and vicariousness treatment, 2 patients who complicated by non-Hodgkin’s lymphoma had been hospitalized and 7 patients complicated by carcinoma were treated with iodine-131. Conclusion The clinical manifestations of chronic lymphocytic thyroiditis are complex, and it often complicated with other thyroid disease, which make it difficult to diagnose the diseases before operation. However, some ancillary methods such as careful physical examination, thyroid correlated hormone tests, !color Doppler and fine needle aspiration cytological examination may improve the accuracy of preoperative diagnosis. Intraoperative thyroid lamellar section and frozen histological examination are also very important for intraoperative diagnosis and operative modality selection.

Natural Course of Juvenile Chronic Lymphocytic Thyroiditis / 대한소아내분비학회지

PURPOSE:The clinical course in adult autoimmune thyroiditis varies: both transient and intermittent hypothyroidism occur during the course of disease and spontaneous recoveries from the hypothyroid state has been described. To determine whether these kinds of variations occur in the course of juvenile chronic lymphocytic thyroiditis and whether the size of thyroid gland, or immunologic measurement such as thyroid antibodies correlated with the course or outcome of juvenile chronic lymphocytic thyroiditis. METHODS:Fifty six patients (54 girls) who attended the clinic between 1986 and 1996 were followed during 36 months prospectively. The clinical diagnosis of juvenile chronic lymphocytic thyroiditis was confirmed by Fisher et al.(1975) criteria in all patients. Assessment of thyroid function was based on clinical diagnosis and on the levels of thyroid stimulating hormone and free thyroxine. Physical examination, thyroid function test and antithyroid antibody test were evaluated with 6 months intervals. RESULTS:Initially, 27 patients were euthyroid, 19 compensatory hypothyroidism and 10 overt hypothyroidism. At the end of follow up, 31 patients were euthyroid, 11 compensatory hypothyroidism and 14 overt hypothyroidism. On one or more occasions, 92.7% of the patients had positive results for thyroid antibodies. Overt hypothyroidism at the end of follow up correlated with the initial thyroid states and with detection of thyroglobulin antibodies. CONCLUSIONS:The best predictors of the final hypothyroid state were initial hypothyroidism and detection of thyroglobulin antibodies.

Poly(I:C) promotes iodine excess-induced chronic lymphocytic thyroiditis in NOD mouse / 中国病理生理杂志

AIM:To investigate the effects of poly (I:C) as virus mimics on iodine excess-induced chronic lymphocytic thyroiditis in NOD mouse. METHODS:Female,32 NOD mice were randomly divided into 4 groups:(1) control; (2) high iodine; (3) poly (I:C); (4) high iodine+poly (I:C). Nine weeks after administration,mice were sacrificed. The following parameters were determined:body weight,thyroid weight and anatomic form. Thyroid hormone (T4) in serum was measured by radioimmunoassay,the thyroid morphology was observed through HE staining,apoptosis was detected by TUNEL,the mRNA expression levels of TRAIL,TRAIL-sR1,ICAM-1 and CXCL10 were determined by the method of real time RT-PCR. RESULTS:Compared to control group and poly (I:C) group,the thyroid absolute weight and relative weight in high iodine group were increased (P0.05). CONCLUSION:Poly (I:C) aggravates chronic lymphocytic thyroiditis induced by excess of iodine associated with increase in infiltration of lymphocytes and induction of apoptosis.

Positive Criterion And Clinical Significance of Serum TGA TMA Titers in Patients with Chronic Lymphocytic Thyroiditis / 昆明医科大学学报

Serum TGA TMA titers were determined by a radioimmunoassay in 117 patients divided into five groups whose diagnoses of various thyroid diseases were confirmed with thyroid biopsy and 80 normal subjects. The serum TGA, TMA titers of the chronic lymphocytic thyroiditis (CLT) group was Statistically higher than those of other groups (P