Method Choices in Diagnosis and Treatment of Thyroid Tuberculosis: Report of Five Cases and Review of Literatures_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

KUAI Yong ¹ , GUO Dong ¹ , ZHANG Yongzhen ¹ , ZHANG Xuegong ¹ , MU Qingling ²

1.The Second Department of General Surgery, Rizhao People’s Hospital, Rizhao 276826， Shandong Province, China;;
2.Department of General Surgery, Shandong Provincial Hospital, Jinan 250012, Shandong Province, China;

Corresponding author：

Keywords：

Thyroid disease; Tuberculosis; Surgery; Diagnosis; Treatment

Video：

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ObjectiveTo investigate the diagnosis, treatment, classification, and epidemiology of thyroid tuberculosis. MethodsA retrospective study of 5 cases of thyroid tuberculosis and a review of the literatures were analyzed, which related to the clinical characteristics, the gist of the diagnosis and treatment, the causes of misdiagnosis and the methods of operation. ResultsAll of the cases were misdiagnosed before operation. Two cases were diagnosed by the frozen sections during the operations and three cases were diagnosed by postoperative pathology. Subtotal resection or lobectomy and local excision (3 cases) were performed respectively. Debidement and anti-tuberculosis medicine were given locally in 2 unresectable cases. All patients underwent standard chemotherapy for 6－8 months after operations and recovered finally. Four cases were caseous necrosis, 1 case was hyperplasia, all of which were chronic infections thyroid tuberculosis, and no acute thyroid tuberculosis be found. No recurrence was found in the 2－15 years of follow-up. ConclusionsUsually, it is difficult to establish a definite preoperative diagnosis for thyroid tuberculosis. Treatment, such as resection, debridement with local medication or systemic chemotherapy, shall be taken individually according to pathology types, focal features, and comorbidities. For hyperplasia cases, surgical resection shall be the best choice, while, for caseous necrosis cases, sometime difficult to remove, debridement with local medication may be suitable.

Citation： KUAI Yong ,GUO Dong,ZHANG Yongzhen,ZHANG Xuegong,MU Qingling. Method Choices in Diagnosis and Treatment of Thyroid Tuberculosis: Report of Five Cases and Review of Literatures. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2011, 18(7): 755-758. doi: Copy

1.	Takami H, Kozakai M. Tuberculous thyroiditis: report of a case with a review of the literature [J]. Endocr J, 1994, 41(6): 743747.
2.	李泮泉, 程少彦. 甲状腺结核９例报告 [J]. 中华结核和呼吸杂志, 1994, 17(4): 256.
3.	全国结核病流行病学抽样调查技术指导小组. 第四次全国结核病流行病学抽样调查报告 [J]. 中华结核和呼吸杂志, 2002, 25(1): 37.
4.	Klassen KP, Curtis GM. Tuberculous abscess of the thyroid gland [J]. Surgery, 1945, 17(4): 552559.
5.	Das DK, Pant CS, Chachra KL, et al. Fine needle aspiration cytology diagnosis of tuberculous thyroiditis: a report of eight cases [J]. Acta Cytol, 1992, 36(4): 517522.
6.	Mondal A, Patra DK. Efficacy of fine needle aspiration cytology in the diagnosis of the thyroid gland: a study of 18 cases [J]. J Laryng Otol, 1995, 109(1): 3638.
7.	李永年, 莫永灼. 甲状腺结核四例报告 [J]. 中华外科杂志, 1983, 21(7): 388390.
8.	邓晓刚, 郭梗. 甲状腺结核18例报告 [J]. 中华结核和呼吸杂志, 1994, 17(1): 35.
9.	应静芳, 徐音. 甲状腺结核的诊断和治疗 [J]. 中国防痨杂志, 2001, 23(2): 117119.
10.	Tas A, Yagiz R, Karasalihoglu AR. Thyroid gland tuberculosis with endolaryngeal extension: a case with laryngotracheal dyspnoea [J]. J Laryngol Otol, 2005, 119(1): 5456.
11.	Barnes P, Weatherstone R. Tuberculosis of the thyroid: two cases reports [J]. Br J Dis Chest, 1979, 73(2): 187191.
12.	李允山, 文明星. 甲状腺结核诊断与治疗探讨 [J]. 中国现代医学杂志, 1997, 7(3): 39， 41.
13.	田延锋, 刘学刚. 甲状腺结核1例报告 [J]. 中国普外基础与临床杂志, 2000, 7(3): 179.
14.	Akbulut S, Gomceli I, Cakabay B, et al. Clinical presentation of primary thyroid tuberculosis [J]. Thyroid, 2010, 20(2): 231232.
15.	Kang BC, Lee SW, Shim SS, et al. US and CT findings of tuberculosis of the thyroid: three case reports [J]. Clin Imaging, 2000, 24(5): 283286.
16.	彭禹, 徐光, 郭发金. 甲状腺结核的声像图表现 [J]. 中国医学影像技术, 2005, 21(9): 14251426.
17.	Sanehi S, Dravid C, Chaudhary N, et al. Primary thyroid tuberculosis [J]. Indian J Otolaryngol Head Neck Surg, 2007, 59(2): 154156.
18.	方国恩, 李莉. 甲状腺结节的诊断和处理 [J]. 中国实用外科杂志, 2003, 23(3): 135137.
19.	Pazaitou K, Crisoulidou A, Ginikopoulou E, et al. Primary tuberculosis of the thyroid gland: report of three cases [J]. Thyroid, 2002, 12(12): 11371140.
20.	Liote HA, Spaulidng C, Bazalyy B, et al. Thyroid tuberculosis associated with mediastinal lymphadenitis [J]. Tubercle, 1987, 68(3): 229231.
21.	Sachs MK, Dickinson G, Amazon K. Tuberculous adenitis of the thyroid mimicking subacute thyroiditis [J]. Am J Med, 1988, 85(4): 573575.
22.	Aerts S, Gypen BJ, Van Hee R, et al. Tuberculosis of the thyroid gland: A case report [J]. Acta Chir Belg, 2009, 109(6): 805807.
23.	Al Mulhim AA, Zakaria HM, Abdel Hadi MS, et al. Thyroid tuberculosis mimicking carcinoma: report of two cases [J]. Surg Today, 2002, 32(12): 10641067.
24.	Intarasupht N, Hunsapinyo K, Rajatanavin R. Treatment of tuberculous thyroiditis with repeated puncture drainage and antituberculous medications [J]. Intern Med J Thai, 2003, 19(1): 4851.
25.	谢荣景, 李秀清, 於太斌, 等. 甲状腺结核一例 [J]. 中华结核和呼吸杂志, 2004, 27(8): 556.
26.	Hizawa K, Okamura K, Sato K, et al. Tuberculous thyroiditis and miliary tuberculosis manifested postpartum in a patient with thyroid carcinoma [J]. Endocrinol Jpn, 1990, 37(4): 571576.

1. Takami H, Kozakai M. Tuberculous thyroiditis: report of a case with a review of the literature [J]. Endocr J, 1994, 41(6): 743747.
2. 李泮泉, 程少彦. 甲状腺结核９例报告 [J]. 中华结核和呼吸杂志, 1994, 17(4): 256.
3. 全国结核病流行病学抽样调查技术指导小组. 第四次全国结核病流行病学抽样调查报告 [J]. 中华结核和呼吸杂志, 2002, 25(1): 37.
4. Klassen KP, Curtis GM. Tuberculous abscess of the thyroid gland [J]. Surgery, 1945, 17(4): 552559.
5. Das DK, Pant CS, Chachra KL, et al. Fine needle aspiration cytology diagnosis of tuberculous thyroiditis: a report of eight cases [J]. Acta Cytol, 1992, 36(4): 517522.
6. Mondal A, Patra DK. Efficacy of fine needle aspiration cytology in the diagnosis of the thyroid gland: a study of 18 cases [J]. J Laryng Otol, 1995, 109(1): 3638.
7. 李永年, 莫永灼. 甲状腺结核四例报告 [J]. 中华外科杂志, 1983, 21(7): 388390.
8. 邓晓刚, 郭梗. 甲状腺结核18例报告 [J]. 中华结核和呼吸杂志, 1994, 17(1): 35.
9. 应静芳, 徐音. 甲状腺结核的诊断和治疗 [J]. 中国防痨杂志, 2001, 23(2): 117119.
10. Tas A, Yagiz R, Karasalihoglu AR. Thyroid gland tuberculosis with endolaryngeal extension: a case with laryngotracheal dyspnoea [J]. J Laryngol Otol, 2005, 119(1): 5456.
11. Barnes P, Weatherstone R. Tuberculosis of the thyroid: two cases reports [J]. Br J Dis Chest, 1979, 73(2): 187191.
12. 李允山, 文明星. 甲状腺结核诊断与治疗探讨 [J]. 中国现代医学杂志, 1997, 7(3): 39， 41.
13. 田延锋, 刘学刚. 甲状腺结核1例报告 [J]. 中国普外基础与临床杂志, 2000, 7(3): 179.
14. Akbulut S, Gomceli I, Cakabay B, et al. Clinical presentation of primary thyroid tuberculosis [J]. Thyroid, 2010, 20(2): 231232.
15. Kang BC, Lee SW, Shim SS, et al. US and CT findings of tuberculosis of the thyroid: three case reports [J]. Clin Imaging, 2000, 24(5): 283286.
16. 彭禹, 徐光, 郭发金. 甲状腺结核的声像图表现 [J]. 中国医学影像技术, 2005, 21(9): 14251426.
17. Sanehi S, Dravid C, Chaudhary N, et al. Primary thyroid tuberculosis [J]. Indian J Otolaryngol Head Neck Surg, 2007, 59(2): 154156.
18. 方国恩, 李莉. 甲状腺结节的诊断和处理 [J]. 中国实用外科杂志, 2003, 23(3): 135137.
19. Pazaitou K, Crisoulidou A, Ginikopoulou E, et al. Primary tuberculosis of the thyroid gland: report of three cases [J]. Thyroid, 2002, 12(12): 11371140.
20. Liote HA, Spaulidng C, Bazalyy B, et al. Thyroid tuberculosis associated with mediastinal lymphadenitis [J]. Tubercle, 1987, 68(3): 229231.
21. Sachs MK, Dickinson G, Amazon K. Tuberculous adenitis of the thyroid mimicking subacute thyroiditis [J]. Am J Med, 1988, 85(4): 573575.
22. Aerts S, Gypen BJ, Van Hee R, et al. Tuberculosis of the thyroid gland: A case report [J]. Acta Chir Belg, 2009, 109(6): 805807.
23. Al Mulhim AA, Zakaria HM, Abdel Hadi MS, et al. Thyroid tuberculosis mimicking carcinoma: report of two cases [J]. Surg Today, 2002, 32(12): 10641067.
24. Intarasupht N, Hunsapinyo K, Rajatanavin R. Treatment of tuberculous thyroiditis with repeated puncture drainage and antituberculous medications [J]. Intern Med J Thai, 2003, 19(1): 4851.
25. 谢荣景, 李秀清, 於太斌, 等. 甲状腺结核一例 [J]. 中华结核和呼吸杂志, 2004, 27(8): 556.
26. Hizawa K, Okamura K, Sato K, et al. Tuberculous thyroiditis and miliary tuberculosis manifested postpartum in a patient with thyroid carcinoma [J]. Endocrinol Jpn, 1990, 37(4): 571576.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Method Choices in Diagnosis and Treatment of Thyroid Tuberculosis: Report of Five Cases and Review of Literatures

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