新生儿甲状腺功能亢进症7例临床分析  

Neonatal hyperthyroidism:clinical analysis of 7 cases

作　　者：孙敏 冯丽娟[1] 焦建成[1] 蒲伟丛[1] 孟灵芝[1] 贾超 房军臣 马莉[1] Sun Min;Feng Lijuan;Jiao Jiancheng;Pu Weicong;Meng Lingzhi;Jia Chao;Fang Junchen;Ma Li(Department of Neonatology,Hebei Provincial Children's Hospital,Shijiazhuang 050031,China)

机构地区：[1]河北省儿童医院新生儿科,石家庄050031

出　　处：《中华新生儿科杂志（中英文）》2022年第2期162-165,共4页Chinese Journal of Neonatology

摘　　要：目的探讨新生儿甲状腺功能亢进症(简称甲亢)的临床特点。方法选取河北省儿童医院新生儿重症监护室2013年9月至2020年9月收治的新生儿甲亢患儿为研究对象,对其临床表现、治疗及预后进行回顾性分析。结果共纳入新生儿甲亢患儿7例,胎龄(35.8±2.3)周,5例为早产儿,确诊日龄中位数16 d(7~18 d)。主要临床表现包括心率增快、易激惹、低热、多汗、食欲亢进、体重不增、腹泻、黄疸等。7例均有游离三碘甲状腺原氨酸(FT_(3))、游离甲状腺素(FT_(4))升高,促甲状腺素(TSH)降低,2例甲状腺B超提示甲状腺增大伴血流丰富。仅4例患儿母亲主动提供了甲亢病史,其余3例系新生儿疑诊后追查母亲甲状腺功能发现异常后确诊。7例均给予抗甲状腺药物治疗,2例给予β受体阻滞剂降低心率。抗甲状腺药物使用时间中位数40 d(7~58 d),2例(系早产儿)用药过程中出现轻度FT_(4)减低,7例FT_(4)均在TSH之前恢复正常。结论新生儿甲亢临床表现多样,缺乏特异性,无论母亲是否提供甲状腺疾病史,临床医生均应及时对疑诊者完善甲状腺功能检查并监测,早期诊断和治疗,以防止不良结局发生。Objective To study the clinical features of neonatal hyperthyroidism.Methods From September 2013 to September 2020,clinical data of neonates with hyperthyroidism admitted to the neonatal intense care unit of our hospital were retrospectively collected and analyzed.Results A total of 7 neonates were included.The average gestation age was(35.8±2.3)weeks with 5 cases had GA<37 weeks.The median age of diagnostic was 16 d(7~18 d).The common clinical manifestations included tachycardia,irritability,low-grade fever,hyperhidrosis,bulimia,poor weight gain,diarrhea and jaundice.The levels of serum free triiodothyronine(FT_(3))and thyroxine(FT_(4))were elevated in all 7 cases and thyroid stimulating hormone(TSH)were decreased.The Doppler ultrasound of thyroid gland in two neonates revealed enlarged thyroid gland with abundant blood flow.All 7 mothers had hyperthyroidism with 4 mothers provided the history of hyperthyroidism and the other 3 were also confirmed after their infants were diagnosed.All 7 infants were treated with anti-thyroid drugs(ATD)and 2 were additionally givenβ-blockers to control heart rate.The median ATD duration was 40 d(7~58 d).2 cases(both preterm infants)had slight decrease in FT_(4)during medication.FT_(4)of all 7 cases returned to normal before TSH.Conclusions Neonatal hyperthyroidism has various and nonspecific clinical manifestations.Early diagnosis and timely treatment are important to prevent short-term and long-term adverse outcomes.Whether their mothers provide definite history of thyroid disorder or not,the thyroid function of the suspected neonates should be carefully monitored.

关 键 词：甲状腺功能亢进症 婴儿 新生 甲状腺功能 临床分析 

分 类 号：R722.1[医药卫生—儿科]