甲状腺结节的诊治进展-wxh.pptVIP

江苏省人民医院内分泌科 武晓泓 drxhwu@163.com;尸体解剖：50.5% 人群普查可触及：3-6% 超声发现非触及：20-60% 甲状腺结节的恶性率：6%左右 ; 年龄：小儿患病率在0.05~1.8%，随年龄增大而增加 性别：男女比可达到1:2-4 既往史：头颈部有照射史者新结节以2%/年 递增，10-15年达高峰 检查方法：超声触诊；尸检：50%（60岁） 饮食中碘含量：低碘区发病率高;江苏地区甲状腺结节的患病率;The prevalence of thyroid incidentalomas in different age groups;甲状腺结节的性质 ;Characteristics of thyroid incidentalomas in different age groups;Characteristics of thyroid incidentalomas;占全部癌的1% 乳头状癌(65%)，高峰20-30岁，女性几倍于男性 滤泡细胞癌(15%)，高峰30-40岁，女性几倍于男性 未分化癌(5-10%)，多见于老年或老年前期，男女发病相等 髓样癌(＜10%)，男女发病相等 淋巴瘤(＜4%), 癌转移 老年男性单结节要多考虑甲状腺癌 儿童甲状腺癌几乎都是乳头状癌;甲状腺癌的病理特点——胞膜浸润;;甲状腺结节诊断思路;确定颈部包块是否源于甲状腺 ;确定甲状腺结节的功能状态 ;实验室检查;了解结节是否恶性病变 ;甲状腺结节诊断的关键-区分良恶性;年轻（20岁）或老年（70岁） 男性 儿童或青春期颈部外照射史 有甲状腺癌既往史 近期有发声、呼吸或吞咽改变 有甲状腺癌或2型多发性内分泌肿瘤的家族史 甲状腺查体时触及坚硬、形状不规则、活动度差的结节;甲状腺结节与MEN;血清学指标-甲状腺激素谱 ;血清学指标-甲状腺特异性抗体 ;血清学指标-甲状腺球蛋白(TG) ;血清学指标-降钙素;甲状腺髓样癌的诊疗程序;甲状腺超声检查; 筛查及随诊 区分囊性和实性病变 限定甲状腺穿刺的范围和辅助穿刺定位;甲状腺囊肿（无血流）;分化癌（PTC）;缺乏晕环征 实体或低回声 回声异质性 边缘不规则 微钙化 腺体外延伸;Transverse sonogram of a 35-year-old man with a hypoechoic solid papillary thyroid carcinoma (arrowheads) with numerous punctate echogenic foci with no acoustic shadow representing microcalcifications. This nodule also has a partial hypoechoic halo. ;Papillary carcinoma in a 27-year-old woman with a palpable mass. Sagittal view of the left lobe of the thyroid gland shows a large, solid mass containing psammomatous calcifications, suspicious for papillary carcinoma. Cytology of a fine-needle aspirate confirmed the diagnosis. ;Papillary carcinoma. US of the thyroid gland shows an irregular, solid, hypoechoic nodule (arrows) containing some coarse calcifications (curved arrow).;Longitudinal sonogram of a 39-year-old woman with a papillary thyroid carcinoma with peripheral, “egg-shell calcifications” casting an acoustic shadow which obscures other sonographic features of this nodule.;Longitudinal sonogram of a 47-year-old man with a papillary thyroid carcinoma metastasis to a cervical lymph node (arrowheads). Numerous punctate microcalcificati