良性甲狀腺結節造成聲帶麻痺致聲音沙啞之個案報告

A Benign Thyroid Nodule with Hoarseness Manifestation: A Case Report

一位47歲男性，甲狀腺在兩週內快速長大至6cm並出現聲音沙啞。因甲狀腺結節造成聲帶麻痺產生聲音沙啞常視為惡性腫瘤之表現，臨床醫師立即幫個案安排進一步檢查。喉頭鏡檢查顯示右側聲帶完全麻痺。然而甲狀腺超音波、甲狀腺細針抽吸細胞化驗，均顯示為良性變化。病人持續聲音沙啞的情形，在接受右側甲狀腺切除術後，聲音沙啞亦逐漸復原。術後病理結果為良性腺瘤樣增生併囊腫性變化。單一或多發性的甲狀腺結節評估著重在：（1）結節良性或惡性，（2）結節有無造成生理功能改變，（3）甲狀腺結節腫大合併生理功能影響甚至產生壓迫症狀如吞嚥困難或聲音沙啞等。甲狀腺結節多為良性腫瘤，但具備下列危險因子時要警覺惡性之可能性：男性、特別年輕族群（小於30歲）、年老族群（大於60歲）、超過2cm大小的結節以及聲帶麻痺。尤以聲帶麻痺致聲音沙啞為惡性甲狀腺腫瘤之表現。本個案因甲狀腺良性結節致聲音沙啞實屬罕見。 47-year-old male visited our outpatient clinic due to a rapidly growing thyroid nodule andthe development of hoarseness within two weeks. Immediate arrangement was made for furtherexaminations as the symptom mimicked malignancy. Flexible fiberoptic laryngoscopy showedright vocal cord paralysis, and thyroid ultrasound indicated multinodular goiter with cystic change.The biggest right thyroid nodule, with mixed solid and cystic components, measured 6.0 cm in itslargest dimension. Fine needle aspiration was performed and yielded 21cc. straw-colored fluid.Cytology revealed as colloid adenoma. The patient underwent right side thyroidectomy and finalpathology confirmed as benign thyroid cyst. Dysphonia improved gradually after operation.Clinical evaluation of thyroid nodules should focus on the following aspects: (1) Nature—benign or malignant—of the thyroid nodule, (2) Presence of any thyroid hormonal dysfunction,and (3) Associated symptoms such as dysphagia or dysphonia. Most thyroid nodules are benign.Risk factors associated with malignancy include: male sex, age younger than 30 years or older than60 years, nodule size greater than 2 centimeter, and dysphonia. Dysphonia especially is often anindicator of a malignant thyroid disease.