不典型甲状腺功能减退症误诊分析.doc

不典型甲状腺功能减退症误诊分析[摘要] 目的 提高对不典型甲状腺功能减退症的认识，总结诊治经验。 方法 对26例不典型甲状腺功能减退症患者的资料进行临床分析。 结果 26例中，误诊为慢性肾炎7例，贫血8例，冠心病3例，慢性胃炎4例，非特异性心包炎1例，抑郁症1例，营养不良1例，OSAS 1例。误诊时间最短1个月，最长5年。 结论 不典型甲状腺功能减退症极易误诊，仔细询问病史，全面综合分析，及时检查甲状腺功能是减少误诊的关键。 [关键词] 甲状腺功能减退症；不典型；误诊 [中图分类号] R581.2 [文献标识码] B [文章编号] 1673-9701（2012）03-0133-02 Analysis on the misdiagnosis of atypical hypothyroidism LI Yayi1 ZHAI Qi2 ZHANG Qianwei3 1.Department of Internal Medicine, Longhua Peoples Hospital of Bao’an District of Shenzhen City, Shenzhen 518109, China; 2. Department of Paediatrics, Longhua People?s Hospital of Bao’an District of Shenzhen City, Shenzhen 518109, China; 3. Department of Internal Medicine, the Second People?s Hospital of Banan District in Chongqing City, Chongqing 400054, China [Abstract] Objective To Enhance the understanding on atypical hypothyroidism and summing up experience of diagnosis and treatment. Methods The clinical analyses were performed on 26 atypical hypothyroidism patients. Results Among the 26 cases, 7 are misdiagnosed as chronic nephritis, 8 as anemia, 3 as coronary heart disease, 4 as chronic gastritis, 1 as nonspecific pericarditis, 1 as depression, 1 as dystrophy, and 1 as OSAS. The misdiagnosis duration is 1 month to 5 years. Conclusion The atypical hypothyroidism is easily misdiagnosed. However, Careful inquest on the medical history, comprehensive analysis, and timely check on the function of thyroid gland is the key to decrease misdiagnosis. [Key words] Hypothyroidism; Atypical; Misdiagnosis 甲状腺功能减退症（甲减）是由于甲状腺激素减少或组织对甲状腺激素抵抗而引起的临床综合征。甲减可累及多系统、多器官，不同的甲减患者可有不同的临床表现。本病起病隐匿，病程发展缓慢，临床表现不典型，缺乏特异性症状，特别是以某一系统的症状为主要表现而其他症状不明显时，极易误诊、漏诊［1］。为了提高对不典型甲状腺功能减退症的认识，总结诊治经验，现将我们2001年1月~2010年12月确诊的26例误诊病例分析报道如下。 1 临床资料 26例患者中，男8例，女18例，年龄12～68岁，平均年龄52岁。误诊情况：26例患者中，误诊为慢性肾炎7例，贫血8例，冠心病3例，慢性胃炎4例，非特异性心包炎1例，抑郁症1例，营养不良1例，OSAS 1例。误诊时间最短1个月，最长5年。 2 临床误诊类型及举例 2.1 误诊为慢性肾炎 例1，男，45岁，因浮肿、腹胀2年，伴纳差、嗜睡2个月就诊。曾在多家医院就医，诊断为“慢性肾炎”，治疗效果不佳且逐渐加重。体格检查：面色苍白，贫血貌，全身虚肿，唇舌厚，甲状腺不肿大，心率72次/min，心音低