甲狀腺癌無明顯症狀 奇美醫院：女性較易罹患甲狀腺疾病 應定期檢測
2023-06-21 記者 蘇旋/報導
奇美醫療財團法人奇美醫院一般及消化系外科主治醫師王文慶
根據國民健康署公布的2020年臺灣的癌症登記報告，甲狀腺癌的發生率是十大癌症中發排行位居第七名，是內分泌系統最常見的癌症。根據這份報告提供的性別資料，男性甲狀腺癌並未進入男性癌症發生排行前十名，但女性甲狀腺癌卻在女性十大癌症發生排名第四名，並有逐年上升的趨勢，顯示甲狀腺癌好發於女性，且甲狀腺癌發生率在女性是男性的三倍，高峰期是45至55歲。甲狀腺癌無明顯症狀，奇美醫院指出：女性較易罹患甲狀腺疾病，應定期檢測。
主講者一般及消化系外科主治醫師王文慶及其講題
27歲A小姐，身體一直很健康，並沒有注意到身體有何異狀。最近因為工作去做了健康檢查，體檢醫師提醒她，左邊頸部有腫塊，抬頭時更為明顯。於是她來到奇美醫療財團法人奇美醫院一般及消化系外科主治醫師王文慶門診求診，經過超音波、細針抽吸及細胞學檢查，確定診斷為甲狀腺乳突癌。王醫師幫她進行全甲狀腺根除手術，並且安排放射碘治療。目前持續在門診服藥追蹤。
奇美醫療財團法人奇美醫院一般及消化系外科主治醫師王文慶指出，根據奇美醫院統計2022年門診中，有171人檢測出有甲狀腺癌。其中，甲狀腺癌的女性人數約為131人(占76%)，高於男性40人(24%)，以41歲至50歲的中壯年族群為最多，約有53人(30%)，51歲至60歲的高齡族群則為其次，約有36人(21%)。
奇美醫療財團法人奇美醫院一般及消化系外科主治醫師王文慶說明，甲狀腺癌的發生原因不明，最常見的症狀是頸部腫塊，其他症狀包括聲音沙啞、吞嚥困難、呼吸困難等。高風險的族群包括曾經暴露於高量的放射線、或頭頸部的放射治療者、家族史、自體免疫甲狀腺炎的病史、職業或環境暴露汙染等。
甲狀腺癌的分類，最常見為乳突癌，約佔八成，生長較緩慢，也會停留在局部較久，易導致病人輕忽，也較常轉移到淋巴腺，但不易發生遠端轉移，所以存活率也較其他類型高；其次是濾泡癌(15%)，其他就是更少見的髓質癌、未分化癌、淋巴癌、或其他轉移性癌。
手術前與手術後示意圖
王文慶醫師表示，甲狀腺癌通常會先透過血液檢查來判斷是否功能有無異常後，再進行超音波檢查，並針對懷疑的病灶，透過細針抽吸細胞學檢查來判斷是否為惡性。
而確診為甲狀腺癌後，通常手術是治療甲狀腺癌最主要的方式，並且根據病理報告，可以進一步決定下一步是否須要放射碘治療。放射碘治療是利用甲狀腺細胞會攝取碘的特性，藉由放射線來殺死癌細胞，並需搭配停止服用甲狀腺素及限碘飲食。而對放射碘治療無效者，可以選擇標靶治療及體外放射治療。而甲狀腺全切除的病人，術後必須終身服用甲狀腺素補充，不可貿然停藥，避免甲狀腺功能不足而引起不適，也要定期回門診追蹤及檢查。
王文慶醫師提醒，民眾平時可檢查頸部，若有異常腫塊時，應立即就醫，也可在健康檢查中安排甲狀腺超音波檢查，以便及早發現就能及早治療。若是確定診斷為甲狀腺癌，千萬別逃避，因為大部分的甲狀腺癌生長比較緩慢，藉由積極和適當的治療後，大部分的病人都得到相當好的預後。
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