甲状腺功能亢进合并重症肝损害20例临床特点及治疗

Clinical Analysis of Hyperthyroidism with Severe Liver Damages:Report of 20 Cases

目的对甲状腺功能亢进(甲亢)合并重症肝损害患者的治疗进行临床分析。方法回顾性分析甲亢合并重症肝损害患者的临床表现、治疗方法及转归。结果20例甲亢合并重症肝损害患者中,甲亢后急性药物性黄疸性肝炎8例,各种肝炎和肝硬化合并甲亢12例。临床表现以黄疸、心悸、消瘦为主,肝功能和甲状腺功能明显异常。首先根据患者肝损害的不同病因行对症的肝病治疗,待肝功能明显好转后及时行131Ⅰ治疗甲亢,并继续保肝治疗至临床治愈。死亡2例,甲亢治愈8例,好转6例,甲状腺功能减退4例。18例重症肝损害患者均临床治愈。结论甲亢合并重症肝损害患者的治疗原则是先保肝,肝功能出现好转后行131Ⅰ治疗甲亢。

Objective To analyze clinically the treatments of hyperthyroidism （HT） with severe liver damages. Methods Among 20 HT patients with severe liver damages, 8 was afflicted with post - HT acute medical jaundice, 12 with HT in combination with various hepatitis and liver cirrhoses. The main clinical manifestations were jaundice, eardiopalmus and marasmus, and obvious abnormality of liver and thyroid functions. Suitable liver treatments in accordance with different causes were first performed, and then ^131I was used to treat HT after a marked improvement of liver function. Hepatoprotection treatment continued till clinical cure. Results Two patients died, 8 with HT were cured, 6 improved, 4 presented with hypothyrosis. Eighteen patients with severe liver damage were clinically cured. Conclusion The treatment principles of HT with severe liver damage are that hepatoprotection goes in advance and then HT treatment follows, that is to say, HT treatment with ^131I should be given following an obvious improvement of liver function.