甲状腺肿块评估

甲状腺结节是与周围甲状腺实质结构不同的独立病变。甲状腺周围其他解剖结构的增大，如甲状旁腺、局部淋巴结，还有鳃裂囊肿、甲状舌管囊肿有时会与甲状腺结节相混淆。

甲状腺结节是常见的临床问题，[1]Haugen BR, Alexander EK, Bible KC, et al. 2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer. Thyroid. 2016 Jan;26(1):1-133. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4739132 http://www.ncbi.nlm.nih.gov/pubmed/26462967?tool=bestpractice.com ​ 可见于 50%-60% 的健康人群。[2]Gharib H, Papini E, Garber JR, et al. AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS, AMERICAN COLLEGE OF ENDOCRINOLOGY, AND ASSOCIAZIONE MEDICI ENDOCRINOLOGI medical guidelines for clinical practice for the diagnosis and management of thyroid nodules - 2016 update. Endocr Pract. 2016 May;22(5):622-39. https://endocrinepractice.org/article/S1530-891X(20)42954-4/fulltext http://www.ncbi.nlm.nih.gov/pubmed/27167915?tool=bestpractice.com ​​ 大多数甲状腺结节无症状，可通过触诊发现，或者在影像学检查中意外发现。[3]Alexander EK, Cibas ES. Diagnosis of thyroid nodules. Lancet Diabetes Endocrinol. 2022 Jul;10(7):533-9. http://www.ncbi.nlm.nih.gov/pubmed/35752200?tool=bestpractice.com ​ 一项国际回顾性分析显示，在接受甲状腺针对性手术的患者中，有 20% 病例在针对其他适应证的放射影像学检查中发现了甲状腺结节。[4]Sajisevi M, Caulley L, Eskander A, et al. Evaluating the rising incidence of thyroid cancer and thyroid nodule detection modes: a multinational, multi-institutional analysis. JAMA Otolaryngol Head Neck Surg. 2022 Sep 1;148(9):811-8. https://jamanetwork.com/journals/jamaotolaryngology/fullarticle/2794184 http://www.ncbi.nlm.nih.gov/pubmed/35834240?tool=bestpractice.com 有学者认为，全球甲状腺癌发病报道增多与意外发现甲状腺结节有关。[5]La Vecchia C, Malvezzi M, Bosetti C, et al. Thyroid cancer mortality and incidence: a global overview. Int J Cancer. 2015 May 1;136(9):2187-95. https://onlinelibrary.wiley.com/doi/10.1002/ijc.29251 http://www.ncbi.nlm.nih.gov/pubmed/25284703?tool=bestpractice.com ​

甲状腺结节更常见于女性患者。​[1]Haugen BR, Alexander EK, Bible KC, et al. 2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer. Thyroid. 2016 Jan;26(1):1-133. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4739132 http://www.ncbi.nlm.nih.gov/pubmed/26462967?tool=bestpractice.com ​​[4]Sajisevi M, Caulley L, Eskander A, et al. Evaluating the rising incidence of thyroid cancer and thyroid nodule detection modes: a multinational, multi-institutional analysis. JAMA Otolaryngol Head Neck Surg. 2022 Sep 1;148(9):811-8. https://jamanetwork.com/journals/jamaotolaryngology/fullarticle/2794184 http://www.ncbi.nlm.nih.gov/pubmed/35834240?tool=bestpractice.com ​​ 甲状腺结节性疾病的患病率随年龄增长而增加。[6]Kwong N, Medici M, Angell TE, et al. Thyroid nodule evaluation and management in older adults: a review of practical considerations for clinical endocrinologists. J Clin Endocrinol Metab. 2015 Dec;100(12):4434-40. http://www.ncbi.nlm.nih.gov/pubmed/26465395?tool=bestpractice.com 虽然老年人的结节形成增多，但其甲状腺结节引起恶性肿瘤的风险较低。如果发现甲状腺癌，则其更可能具有高风险组织学特征。[7]Ospina NS, Papaleontiou M. Thyroid Nodule Evaluation and Management in Older Adults: A Review of Practical Considerations for Clinical Endocrinologists. Endocr Pract. 2021 Mar;27(3):261-268. https://www.doi.org/10.1016/j.eprac.2021.02.003 http://www.ncbi.nlm.nih.gov/pubmed/33588062?tool=bestpractice.com [6]Kwong N, Medici M, Angell TE, et al. Thyroid nodule evaluation and management in older adults: a review of practical considerations for clinical endocrinologists. J Clin Endocrinol Metab. 2015 Dec;100(12):4434-40. http://www.ncbi.nlm.nih.gov/pubmed/26465395?tool=bestpractice.com 尸检研究发现半数以上的 40 多岁或 50 多岁的一般人群存在结节。[8]MORTENSEN JD, WOOLNER LB, BENNETT WA. Gross and microscopic findings in clinically normal thyroid glands. J Clin Endocrinol Metab. 1955 Oct;15(10):1270-80. http://www.ncbi.nlm.nih.gov/pubmed/13263417?tool=bestpractice.com ​

大多数结节为良性。[9]Singh Ospina N, Iñiguez-Ariza NM, Castro MR. Thyroid nodules: diagnostic evaluation based on thyroid cancer risk assessment. BMJ. 2020 Jan 7;368:l6670. http://www.ncbi.nlm.nih.gov/pubmed/31911452?tool=bestpractice.com 所有就诊接受结节治疗的患者发生甲状腺癌的风险约为 7%-15%。[3]Alexander EK, Cibas ES. Diagnosis of thyroid nodules. Lancet Diabetes Endocrinol. 2022 Jul;10(7):533-9. http://www.ncbi.nlm.nih.gov/pubmed/35752200?tool=bestpractice.com ​ 评估甲状腺结节的临床目标是区分良性病变和恶性病变。