甲状腺功能减退症导致的新生儿高胆红素血症临床误诊分析  

Clinical Misdiagnosis of Neonatal Hyperbilirubinemia Caused by Hypothyroidism

作　　者：许冬冬 崔何晴 XU Dongdong;CUI Heqing(Department of Neonatology,the Second People's Hospital of Chizhou City,Chizhou,Anhui 247100,China;Department of Neonatology,the First Affiliated Hospital of Anhui University of Chinese Medicine,Hefei 230031,China)

机构地区：[1]池州市第二人民医院新生儿科,安徽池州247100 [2]安徽中医药大学第一附属医院儿科,合肥230031

出　　处：《临床误诊误治》2025年第6期12-16,共5页Clinical Misdiagnosis & Mistherapy

摘　　要：目的分析甲状腺功能减退症致新生儿高胆红素血症的临床特点及鉴别诊断,以减少临床误诊误治。方法回顾分析2022年3月至2023年7月收治的2例甲状腺功能减退症致新生儿高胆红素血症的临床资料。结果1例患儿出生后1 d因皮肤黄疸半天入院,入院后查溶血三项不支持新生儿ABO溶血性黄疸,查C反应蛋白升高,初步考虑黄疸原因为感染所致,予蓝光照射退黄及抗生素静脉滴注治疗,治疗后患儿总胆红素及炎性指标基本恢复正常,但3 d后黄疸反复再次入院,查感染指标无异常、甲状腺功能三项检查异常,遂考虑为甲状腺功能减退症导致的复发性病理性黄疸,故予左甲状腺素钠片口服和中药药浴治疗,退黄效果显著,上级医院黄疸基因检测结果亦支持诊断。误诊时间1月余。出院后随访3个月患儿生长发育良好,黄疸未再复发。另1例患儿出生后第9天出现皮肤黄疸,初诊为生理性黄疸,予蓝光照射治疗后好转出院,但出院3 d后再次出现皮肤黄疸,行甲状腺功能三项检查异常,遂考虑为甲状腺功能减退症导致的复发性病理性黄疸,故予左甲状腺素钠片口服和中药药浴治疗,患儿痊愈出院,预后良好。误诊时间1个月。结论引起新生儿高胆红素血症的病因较多,甲状腺功能减退症致胆红素升高在临床较少见,临床医生需加强对此类黄疸病因的认识,以减少甲状腺功能减退症致新生儿高胆红素血症误诊。Objective To analyze the clinical features and differential diagnosis of neonatal hyperbilirubinemia caused by hypothyroidism in order to reduce clinical misdiagnosis and mistreatment.Methods The clinical data of two patients with neonatal hyperbilirubinemia caused by hypothyroidism who were admitted from March 2022 to July 2023 were retrospectively analyzed.Results One patient was admitted to the hospital due to skin jaundice for 1 day after birth.After admission,the three tests of hemolysis did not support neonatal ABO hemolytic jaundice,and the C-reactive protein was increased.The jaundice was preliminarily considered to be caused by infection,and blue light irradiation was given to reduce jaundice and intravenous infusion of antibiotics was administered.After treatment,the total bilirubin and inflammatory indicators of the patient basically returned to normal,but jaundice recurred and the patient was readmitted three days afterwards.The infection indicators were normal,but the three thyroid function tests were abnormal,so the recurrent pathological jaundice caused by hypothyroidism was considered.Therefore,oral administration of Levothyroxine Sodium tablets and traditional Chinese medicine bath treatment have shown significant effects in reducing jaundice,and the genetic testing results of jaundice in higher-level hospitals also supported the diagnosis.The misdiagnosis lasted more than 1 month.The child grew and developed well at 3-month follow-up,and jaundice did not recur.The other patient had skin jaundice on the 9th day after birth,which was initially diagnosed as biological jaundice,and after treatment with blue light irradiation,the patient improved and was discharged.However,skin jaundice recurred at 3 days after discharge,and abnormal thyroid hormone was found by the three thyroid function tests.Therefore,the recurrent pathological jaundice caused by hypothyroidism was considered.The child was cured and discharged with a good prognosis.The misdiagnosis lasted 1 month.Conclusion There are many causes o

关 键 词：高胆红素血症 新生儿 误诊 感染 生理性黄疸 游离三碘甲状腺原氨酸 游离甲状腺素 促甲状腺激素 

分 类 号：R722.17[医药卫生—儿科]