甲状腺压迫症状：术前检查与治疗结果的评估

文献信息

中文摘要

目的： 甲状腺压迫症状包括一系列呼吸消化道症状，如咽部异物感、吞咽困难、呼吸困难和颈部压迫感。然而，这些症状也可能由其他疾病引起。本研究评估了因甲状腺病变导致"压迫症状"而就诊患者的检查、治疗及结果。
方法： 纳入2015年至2025年间在单一学术中心耳鼻喉科门诊转诊的、因甲状腺结节、甲状腺肿或囊肿导致压迫症状的患者。将人口统计学资料、症状、影像学表现、治疗及病理结果与症状缓解情况进行相关性分析。采用Wilcoxon秩和检验比较结节大小，卡方独立性检验分析相关性，简单逻辑回归评估因果关系。
结果： 共纳入214例患者（87%为女性，平均年龄=50岁）。82例（38%）患者接受了甲状腺手术；其中83%（n=69）报告术后症状改善。在未建议手术的患者中（n=110），咽部异物感（n=18）和吞咽困难（n=21）是最常见的症状。胃食管反流病（GERD）（n=39，36%）和喉部肌肉紧张（n=39，23%）是最常见的替代诊断。接受手术的患者甲状腺结节中位体积高于未接受手术者（36.41 vs. 6.38 cm3，p < 0.05）。有呼吸困难（n=35，p < 0.01）和端坐呼吸（n=29，p < 0.01）的患者更可能被建议手术。有端坐呼吸的患者术后症状缓解率最高（91%）。
结论： 包括GERD和肌肉紧张性疾病在内的其他疾病可引起归因于甲状腺压迫的症状。被选择进行手术的患者，尤其是结节较大、有呼吸困难和端坐呼吸者，术后症状改善率较高。

英文摘要

OBJECTIVE: Thyroid compressive symptoms encompass a range of aerodigestive symptoms including globus sensation, dysphagia, dyspnea, and neck pressure. However, these symptoms can also be caused by other conditions. This study evaluates workup, treatment, and outcomes for patients presenting with "compressive symptoms" attributed to thyroid pathology.
METHODS: Patients referred to Otolaryngology clinic at a single academic center from 2015 to 2025 for compressive symptoms attributed to thyroid nodules, goiter, or cysts were included. Demographics, symptoms, imaging findings, treatment, and pathology were correlated with symptom resolution. Wilcoxon rank-sum test was used to compare nodule size, chi-square tests of independence tested associations, and simple logistic regression assessed causation.
RESULTS: Two hundred fourteen patients (87% female, average age = 50) were included. Eighty-two (38%) patients underwent thyroid surgery; 83% (n = 69) reported improvement post-operatively. Among patients not recommended for surgery (n = 110), globus sensation (n = 18) and dysphagia (n = 21) were the most common symptoms. Gastroesophageal reflux disease (GERD) (n = 39, 36%) and laryngeal muscle tension (n = 39, 23%) were the most common alternate diagnoses. Median thyroid nodule volumes were higher in patients who underwent surgery than those who did not (36.41 vs. 6.38 cm3, p < 0.05). Patients with dyspnea (n = 35, p < 0.01) and orthopnea (n = 29, p < 0.01) were more likely to be recommended for surgery. Patients with orthopnea had the highest rate of symptom resolution after surgery (91%).
CONCLUSIONS: Alternative conditions, including GERD and muscle tension disorders, can cause symptoms attributed to thyroid compression. Patients selected for surgery, particularly those with larger nodules, dyspnea, and orthopnea, demonstrate high rates of symptom improvement after surgery.