甲状腺结节的评估与管理-English.ppt

Evaluation and Management of Thyroid Nodules Wu Xiaohong Endocrinology Department, First Affiliated of Nanjing Medical University Prevalence The Framingham study in US: 6.4% of females and 1.6% of males had one or more thyroid nodules, an annual incidence of 1.4% over the following 15 years. The Whickham survey in England: palpable goitres --- 8.6%; palpable and visible goitres --- 6.9%; females : males=4:1; Follow-up for 20 years, amongst women, 70% had no goitre, 20% had a goitre at first survey but not at follow-up, 6% had goitres at both surveys and 4% developed goitres; Postmortem studies have shown that up to 50% of the population have either single or multiple nodules in the thyroid, many of which are very small; High resolution ultrasound scans revealed discrete nodules in up to 50% of those beyond the fifth decade of life; Nodular thyroid disease is found in 5% of the population at palpation screening and is ten-fold more frequent at echographic screening. Thyroid nodules are rare in children and adolescents and increase linearly with age; females/males are 2~4; Nodular thyroid disease is a heterogeneous disorder : nodules may be single or multiple, hyper- or hypo-functioning, benign or malignant. Thyroid cancer is rare: less than 0.5% of all new malignancies ; less than 0.5% of all cancer deaths ; Thyroid cancer is 6~14% of single thyroid nodules selected for surgery. Postmortem studies: Occult cancer in up to 5% of thyroid glands normal to palpation; Most are small, only several millimetres in diameter, without clinical significance. Thyroid cancer can be a mortal disease: well differentiated tumors--- mortality 10 %; poorly differentiated and medullary--- 50 %; anaplastic tumors---100%. Malignant nodules account for 5% of all nodules. well-differentiated carcinomas in 75 %; poorly differentiated or anaplastic in 15 % ; medullary cancer in 10% cases. Aeti