194.Hashimoto Thyroiditis（桥本甲状腺炎）

每天朗读一段医学影像学英语文章

Hashimoto thyroiditis, also known as lymphocytic thyroiditis or chronic autoimmune thyroiditis, is a subtype of autoimmune thyroiditis. It is one of the most common thyroid disorders.

Radiographic features

【Hashimoto Thyroiditis 桥本甲状腺炎】

桥本甲状腺炎，又叫淋巴细胞性甲状腺炎或慢性自免性甲状腺炎，是自免性甲状腺炎的一种亚型。是最常见的甲状腺疾病之一。

Ultrasound

It is difficult to reliably sonographically differentiate Hashimoto thyroiditis from other thyroid pathology. Ultrasound features can be variable depending on the severity and phase of disease :

• diffusely enlarged thyroid gland with a heterogeneous echotexture is a common sonographic presentation；

• the presence of hypoechoic micronodules (1-6 mm)with surrounding echogenic septations is also considered to have a relatively high positive predictive values .This appearance may be described as pseudonodular or a giraffe pattern;

• colour Doppler study usually shows normal or decreased flow, but occasionally there might be hypervascularity similar to a thyroid inferno;

• prominent reactive cervical nodes may be present, especially in level VI, but they have normal morphologic features;

• patients are at higher risk for papillary thyroid carcinoma, so a discrete nodule should be considered for biopsy;

In some situations, large nodules may be present, which may be referred to as nodular Hashimoto thyroiditis 10.

影像表现：

超声：很难在声像图上鉴别桥本甲状腺炎与其他甲状腺疾病。超声表现取决于疾病的严重程度与时期。

-甲状腺弥漫性增大、回声不均质是常见的超声表现。

-低回声微结节（1-6mm）伴周围回声分隔，也考虑较高的阳性值。该征象称为“假结节征”或“长颈鹿征”。

-彩色多普勒超声显示血流信号正常或减低，但有时也会有丰富的血流信号，类似“甲状腺火海征”。

-主要的表现可能为颈部结节，特别是在6级病变中，但甲状腺形态正常。

-桥本甲状腺炎的患者有患乳头状甲状腺癌的高风险，因此单发孤立结节应考虑活检。

某些情况下会表现为大结节，可能会是结节性桥本甲状腺炎。

 Nuclear medicine

Radioactive iodine

• early stages: may show increased uptake

• late stages: single or multiple areas of reduced uptake (cold spots)

核医学

放射性碘

-早期：可表现为高度浓聚

-晚期：单发或多发浓聚减低（冷结节）

Pathology

There is autoimmunity to the thyroid gland which bears both humoral-and cell-mediated features. This is followed by lymphocytic

infiltration of the thyroid gland with lymphoid follicles replacing thyroid follicles. This may affect the thyroid gland in either a diffuse or focal manner. Cell populations include:

• lymphocytic aggregates

• transformed follicular cells

(Askanazy/oxyphilic/Hurthle cells)

Later stages show superadded fibrosis.

病理表现：甲状腺是自身调节的腺体，受激素水平和细胞介导通路的调节。由于淋巴细胞的浸润，导致淋巴滤泡取代了正常的甲状腺滤泡。以弥漫或局灶性的方式侵犯甲状腺。细胞群包括：

-淋巴细胞聚集。

-滤泡细胞转运（Askanazy/亲氧/Hurthle细胞）。

晚期表现为极度的纤维化。

Notes：

1. Hashimoto thyroiditis [ˌθaɪəɔɪ'daɪtɪs] n. 桥本甲状腺炎

2. lymphocytic [ˌlɪmfə'saɪtɪk] adj. 淋巴细胞的

3. echotexture [eʃɒ'tekstʃə] 回声特性

4. morphologic [ˌmɔ:fə'lɒdʒɪk] adj. 形态学（上）

来源：每天朗读一段医学影像学英语文章

圈主

深圳市人民医院放射科副主任医师杨敏洁

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