原发性甲状腺功能减退症77例临床分析

Clinical analysis of 77 cases with primary hypothyroidism

目的探讨原发性甲状腺功能减退症的临床特点。方法回顾性分析海南医学院附属医院住院诊断的77例原发性甲状腺功能减退症的临床资料。结果本研究原发性甲状腺功能减退症的病因主要有131I治疗、甲状腺手术和慢性自身免疫性甲状腺炎。贫血32例(41.6%)。69例行血脂检查,总胆固醇升高26例(37.7%),低密度脂蛋白胆固醇升高34例(49.3%),甘油三酯升高14例(20.3%),高密度脂蛋白胆固醇升高27例(39.1%),高密度脂蛋白胆固醇降低9例(13.0%)。64例行肌酶检查,肌酸激酶增高29例(45.3%),乳酸脱氢酶增高21例(32.8%)。心电图检查发现窦性心动过缓13例(16.9%)。39例行心脏彩超检查,8例(20.5%)发现心包积液。结论本病临床表现复杂,窦缓、贫血、高脂血症、肌酶增高的患者应注意排除甲减。原发性临床甲状腺功能减退症的诊断主要根据低FT4、高TSH。甲减的治疗简单且有效,多数患者需要终身甲状腺激素替代治疗。

Objective To study the clinical characteristics of primary hypothyroidism.Methods The clinical data of 77 inpatients with primary hypothyroidism were retrospectively analyzed.Results The major causes were as follows：131I therapy,previous thyroid surgery and chronic autoimmune thyroiditis.Anemia was found in 32 patients（41.6%）.Serum lipids were measured in 69 patients.Serum total cholesterol concentrations were increased in 26 patients（37.7%）.Serum LDL cholesterol concentrations were increased in 34 patients（49.3%）.Serum triglycerides concentration were increased in 14 patients（20.3%）.Serum HDL cholesterol concentrations were increased in 27 patients（39.1%）.Serum HDL cholesterol concentrations were decreased in 9 patients（13%）.Serum creatine kinase and lactate dehydrogenase concentrations were measured in 64 patients.Serum creatine kinase concentrations were increased in 29 patients（45.3%）.Serum lactate dehydrogenase concentrations were increased in 21 patients（32.8%）.The electrocardiogram showed bradycardia in 13 patients（16.9%）.39 patients underwent echocardiography.Pericardial effusion were detected in 8 patients（20.5%）.Conclusion To avoid misdiagnosis,clinicians should be alert to the manifestations related to primary hypothyroidism,such as bradycardia,anemia,hyperlipidemia,the high serum creatine kinase and/or lactate dehydrogenase concentrations and pericardial effusion.The diagnosis of overt primary hypothyroidism is confirmed by an elevated TSH level and a reduced free T4.Treatment of primary hypothyroidism is simple and effective.For most patients,lifelong thyroid hormone replacement therapy is required.