以多浆膜腔积液为首发表现的原发性甲减误诊讨论  

Discussion of Misdiagnosis of Primary Hypothyroidism with Polyserous Effusions as Initial Manifestations

作　　者：李福青 方兴国[1] 王红[1] LI Fu-qing;FANG Xing-guo;WANG Hong(Department of Gastroenterology,Affiliated Hospital of Zunyi MedicalCollege,Zunyi,Guizhou 563003,Chin)

机构地区：[1]遵义医学院附属医院消化内科,贵州遵义563003

出　　处：《临床误诊误治》2018年第6期25-27,共3页Clinical Misdiagnosis & Mistherapy

摘　　要：目的探讨以多浆膜腔积液为首发表现的原发性甲状腺功能减退症(甲减)的临床特点及误诊原因。方法对我院收治的以多浆膜腔积液为首发表现的原发性甲减1例的临床资料进行回顾性分析。结果本例因腹胀伴腹痛、发热1月余入院。行胸腹部CT、心脏+泌尿系+腹部+妇科彩色多普勒超声(彩超)、血常规等检查,初步诊断:(1)肿瘤?(2)结核?(3)结缔组织病?(4)其他疾病?暂予诊断性抗结核治疗,效果欠佳。查抗核抗体及抗核抗体谱均阴性,进一步排除结缔组织病,后反复追问病史并完善甲状腺功能检查,诊断为甲减,予左甲状腺素钠25μg/d口服,病情好转出院。随访半年,多浆膜腔积液明显吸收。结论临床遇及以多浆膜腔积液为首发表现的老年患者,需警惕甲减可能,提高认识、结合相关检查有助于早期诊断与治疗。Objective To investigate the clinical characteristics and causes of misdiagnosis of primary hypothyroidism with polyserous effusions as initial manifestations. Methods The clinical data of a patient who was admitted to our hospital for primary hypothyroidism with polyserous effusions as initial manifestations was analyzed retrospectively. Results The patient was hospitalized with abdominal pain and fever for more than one month,and underwent various medical examinations,including CT examinations of the chest and abdomen,color doppler ultrasound（ color ultrasound） of the combined heart,urinary system and abdomen as well as gynecological ultrasound,and blood routine examination. The preliminary diagnosis was as follow：（ 1） Tumor？（ 2） Tuberculosis（ TB） ？（ 3） The connective tissue disease？（ 4） Other diseases？ Anti-tuberculosis treatment was not effective. The anti-nuclear antibody and anti-nuclear antibody spectrum were negative,therefore,the connective tissue disease was further excluded. After repeated questioning of the medical history and improving thyroid function examination,the diagnosis of hypothyroidism was made. Thus,left thyroxine sodium（ 25 μg/d） was taken orally,and the patient was discharged home after the condition was improved. During the 6-month follow-up,polyserous effusions were obviously reduced.Conclusion For the elderly patients with polyserous effusion as initial manifestations,it is necessary to be aware of the possibility of hypothyroidism in clinical practice. Heightened awareness and relevant examinations are helpful for early diagnosis and treatment.

关 键 词：甲状腺功能减退症 误诊 结核 

分 类 号：R581.2[医药卫生—内分泌]