甲状腺癌在透析患者的甲状腺癌在甲状腺切除术后被确诊为无法控制的二次甲状腺功能障碍症
Ryoko Tatsumi1, Yusuke Tomita2, Shinya Takiguchi2
1Department of Nephrology, Osaka Police Hospital, Osaka, Japan.
CEN case reports
|August 19, 2024
概括
透析患者的二次性副甲状腺功能障碍症 (SHPT) 可以掩盖副甲状腺癌. 这一案例凸显了当SHPT在医学上耐药时考虑甲状腺癌,即使有正常的水平,也会导致通过甲状腺切除术进行最终诊断.
科学领域:
- 内分泌学 在内分泌学.
- 腎臟病學 (nephrology) 是一種醫學專業.
- 在瘤学瘤学.
背景情况:
- 二次性偏甲状腺症 (SHPT) 是慢性病 (CKD) 患者接受维持透析的常见并发症.
- 在2006年推后,SHPT的副甲状腺切除术 (PTx) 率增加了,但随着2008年引入模药而下降.
- 副甲状腺癌是一种罕见的内分泌恶性瘤,通常伴有高血症和升高的副甲状腺激素 (PTH).
研究的目的:
- 报告一例初步用模剂治疗的SHPT透析患者的病例.
- 为了突出甲状腺癌的诊断挑战在一个常态血症患者持续高PTH.
- 强调在SHPT耐药性治疗中考虑副甲状腺癌的重要性.
主要方法:
- 一个透析患者患有SHPT的病例报告.
- 用仿药进行医疗管理.
- 手术干预 (副甲状腺切除术) 用于诊断和治疗.
- 超声波成像用于诊断参考.
主要成果:
- 患者呈现了正常血症,但持续高的PTH水平,引起了对甲状腺癌的怀疑.
- 副甲状腺切除术证实了副甲状腺癌的诊断.
- 到目前为止,该患者在及时进行手术后没有出现复发或转移.
结论:
- 在透析患者中,SHPT对药物治疗不耐药,甲状腺癌应被视为差异诊断,即使没有高血症.
- 及时和适当的甲状腺切除术对于确定甲状腺癌的诊断和管理至关重要.
- 这一案例强调了在常见疾病的标准治疗证明无效时考虑罕见恶性瘤的价值.
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