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患者女,43岁。颈部肿大伴心悸、食亢、消瘦14年,按甲亢服用他巴唑等治疗无效。经查体、化验与甲状腺扫描诊断为甲状腺机能亢进症,给予~(131)Ⅰ 370 MBq/(125克甲状腺)治疗。 3个月后随访,症状和体征无变化,加服他巴唑治疗2年,症状仍无缓解,甲状腺肿大,且呈多个结节、质硬,血清T_3 7.0ng/ml,T_4220ng/ml。甲状腺扫描:甲状腺右叶中下部及左叶中部查见多个冷结节。行手术切除,术中见甲状腺表面有多个结节,大如乒乓球,小如花生米。病理诊断:甲状腺乳头状癌。术后3个月,患者仍有甲亢症状,颈部左侧触及2cm ×2cm结节,甲状腺扫描:残留甲状腺及结节处有摄取~(131)Ⅰ功能。全身骨扫描末见转移性病灶。血清T_3 5.2ng/ml、T_4189ng/ml、TSH1.3μIU/ml。又给服~(131)Ⅰ11850MBq,2个月后症状缓解,左颈部结节消失,病人情况良好。
Female patient, 43 years old. Neck enlargement with palpitations, hyperactivity, weight loss 14 years, according to hyperthyroidism methimazole treatment fails. After physical examination, thyroid scan and thyroid examination were diagnosed as hyperthyroidism, given ~ (131) Ⅰ 370 MBq / (125 g thyroid) treatment. After 3 months of follow-up, the symptoms and signs did not change. After 2 years of treatment with methimazole, the symptoms remained unchanged and the goiter developed multiple nodules. Hard, serum T_3 7.0ng / ml and T_4220ng / ml . Thyroid scan: middle and lower right lobe of the thyroid and left middle lobe check multiple cold nodules. Surgical resection, intraoperative thyroid surface see multiple nodules, such as table tennis, small, such as peanuts. Pathological diagnosis: thyroid papillary carcinoma. 3 months after surgery, the patient still had symptoms of hyperthyroidism, touching the left side of the neck 2cm × 2cm nodules, thyroid scan: the residual thyroid and nodules up 131I function. Whole body bone scan end metastatic lesions. Serum T_3 5.2ng / ml, T_4189ng / ml, TSH1.3μIU / ml. Give ~ (131) I11850MBq, 2 months after the symptoms were relieved, left neck nodules disappeared, the patient was in good condition.