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作 者:杨进红 陈华玲 Yang Jinhong;Chen Hualing(Department of Endocrinology,the People's Hospital of Honghu City,Jingzhou City,Hubei Province,Hubei Honghu 433200)
机构地区:[1]湖北省荆州市洪湖市人民医院内分泌科,湖北洪湖433200
出 处:《中国社区医师》2021年第19期65-66,69,共3页Chinese Community Doctors
摘 要:目的:探讨在基层医院如何正确识别、诊断、治疗亚急性甲状腺炎。方法:2015年1月-2020年1月收治亚急性甲状腺炎患者120例,回顾临床资料,从病史询问、查体、实验室检查、超声检查、甲状腺穿刺病理学等方面展开鉴别和讨论。结果:120例患者中,男女比例为1:3.6,就诊时间为2~45 d,内分泌科首诊比例为20%,病前有明确上呼吸道感染史占67.5%。有颈部疼痛(包括主诉颈咽部痛及体检甲状腺区压痛)114例(95%)、发热90例(75%)、甲状腺肿大102例(85%)。96例行甲状腺细针穿刺,82例提示可见特征性病理改变。结论:要提高亚急性甲状腺炎的早期诊断率,减少误诊率,需要结合病史、体检、临床症状特点及辅助检查,如白细胞计数(WBC)、红细胞沉降率(ESR)、C反应蛋白(CRP)、促甲状腺激素(TSH)、血清游离三碘甲腺原氨酸(FT3)和血清游离甲状腺素(FT4),超声图像特点,特别是摄碘率、甲状腺细胞穿刺病理做出综合分析判断。在基层不能做甲状腺摄碘率的情况下,甲状腺细胞穿刺病理学检查重要性进一步提高。非甾体类解热镇痛药及糖皮质激素是治疗亚急性甲状腺炎主要的药物,使用糖皮质激素时需要注意不良反应。亚急性甲状腺炎为自限性疾病,患者甲状腺功能一般均能恢复正常,少数可发生永久性甲状腺功能减退。Objective:To investigate how to correctly identify,diagnose and treat subacute thyroiditis in primary hospitals.Methods:From January 2015 to January 2020,120 cases of patients with subacute thyroiditis were enrolled.The clinical data were reviewed and identified from medical history inquiry,physical examination,laboratory examination,ultrasound examination,thyroid puncture pathology and so on.Results:Of the 120 patients,the ratio of male to female was 1:3.6,the time of visit was 2-45 d,the proportion of the first visit in endocrinology department was 20%,and the history of upper respiratory tract infection was 67.5%before the disease.There were 114 cases(95%)had neck pain(included the main complaint of cervical pharynx pain and tenderness in the thyroid area of physical examination),90 cases(75%)had fever and 102 cases(85%)had goiter.96 cases underwent thyroid fine needle aspiration,and 82 cases showed characteristic pathological changes.Conclusion:In order to improve the early diagnosis rate and reduce the misdiagnosis rate of subacute thyroiditis,doctors need to combine the history,physical examination,clinical symptom characteristics and auxiliary examination,such as WBC,ESR,CRP,TSH,FT3,FT4 and ultrasound features,especially the iodine uptake rate and the pathology of thyroid cell puncture should make a comprehensive analysis and judgment.In the case that the thyroid iodine uptake rate cannot be done in primary hospitals,the importance of pathological examination of thyroid cell puncture is further increased.Non-steroidal antipyretic analgesics and glucocorticoids are the main drugs in the treatment of subacute thyroiditis,attention should be paid to adverse reactions when using glucocorticoids.Subacute thyroiditis is a self-limiting disease.The thyroid function of patients can generally return to normal,and a few may have permanent hypothyroidism.
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