女性中枢性甲状腺功能减退的临床分析

Analysis of etiological factors in 35 female patients with central hypothyroidism

目的探讨女性中枢性甲状腺功能减退的临床特点。方法回顾性分析甲状腺功能减退患者的临床症状、体征及实验室检查的结果,并进行统计分析。结果女性患者中,席汉综合征(Sheehan综合征)占40.0%(14/35),下丘脑-垂体处占位性病变占28.6%(10/35),鞍区手术和放射照射占25.7%(9/35),缺血性脑病和特发性中枢性甲状腺功能减退仅占5.7%(2/35)。女性患者促甲状腺激素水平下降较男性患者显著,男性皮质醇、睾酮、孕酮水平下降较女性显著。结论 Sheehan综合征是女性中枢性甲状腺功能减退最多见的病因;女性甲减患者合并Sheehan综合征、鞍区和鞍上占位性病变、颅脑手术和(或)放疗史、其他下丘脑-垂体轴异常表现、难以纠正的贫血以及三酰甘油异常增高,应考虑诊断中枢性甲减。

Objective To analyze the clinical features in females with central hypothyroidism.Methods The clinical symptoms,signs and laboratory results of all the patients were analyzed retrospectively.Results 40.0% of these cases were caused by Sheehan syndrome,28.6% were by hypothalamus-pituitary mass lesions,25.7% were by surgery and radiation therapy,and only 5.7% were by ischemic encephalopathy and idiopathic central hypothyroidism.FSH levels of females decreased more than those of males,while cortisol,testosterone,progesterone levels of males decreased more than those of females.Conclusion Sheehan syndrome was the most common cause of central hypothyroidism in females,and some clinical manifestations were significantly different from males.