产后甲状腺炎39例误诊讨论

Misdiagnosis Analysis of 39 Patients with Postpartum Thyroiditis

目的分析产后甲状腺炎(postpartum thyroiditis,PPT)的误诊原因,探讨避免误诊的措施。方法对我院收治并误诊的39例PPT的临床资料进行回顾性分析。结果本组于分娩或流产后以甲状腺功能亢进症(甲亢)症状就诊17例,以甲状腺功能减退症(甲减)症状就诊15例,以颈部肿物为主诉就诊5例,以产后抑郁症状就诊2例;误诊为Graves病17例,桥本甲状腺炎15例,单纯性甲状腺肿5例,产后抑郁症2例。明确诊断后均予治疗。12例甲亢期患者痊愈;27例甲减期(包括甲亢期进入甲减期的8例)于分娩或流产后的6～12个月停药可维持甲状腺正常功能,4例随访至产后2年,仍需左甲状腺素维持甲状腺功能。结论对PPT认识不足是导致误诊的主要原因。加强临床医生对该病的了解,详细询问病史及查体,完善医技检查并注意鉴别诊断,可避免或减少PPT的误诊。

Objective To analyzed the misdiagnosis cause of postpartum thyroiditis（PPT）,and explore strategies to avoid misdiagnosis.Methods The clinical data of 39 patients with PPT misdiagnosed in our hospital were retrospectively analyzed.Results 17 had hyperthyoidism after labor or abortion,15 had hypothyrea,5 had collar mass,and 2 had postnatal depression.17 were misdiagnosed as having graves disease,15 hashimoto thyroditis,5 simple goiters,and 2 postnatal depressions.All the patients were diagnosed as having PPT.After treatment,12 patients with hyperthyoidism were cured,27 patients with hypothyrea maintained normal thyreoid function during 6-12 months after labor or abortion.4 had to use levothyroxine to keep normal thyreoid function during 2 years after labor.Conclusion The major misdiagnosis cause of PPT is due to lack of understanding of the disease.Physicians should improve knowledge of PPT,and checking medical history and physical check-up,and improvement of medical technology and differential diagnosing can avoid and reduce misdiagnosis.