慢性肾功能衰竭合并原发性甲状腺功能减退症的临床诊断

Clinical Diagnosis of Chronic Renal Failure with Primary Hypothyroidism

本文报告 CRF 合并甲减10例,入院前9例甲减被漏诊。10例中8例合并严重心脏损害,其中3例合并心包积液;合并腹水和/或胸水4例。8/10例测血清钙、磷、结果血钙均降低,除1例血磷轻度升高外,余7例均正常。本组病例均经血清 T_3、T_4和/或 TSH 结果证实,其中1例经 TRH 兴奋试验后诊断。本文重点讨论 CRF 合并甲减的临床特征。

Ten cases of chronic renal failure(CRF)with primary hypothyroidism werereported 8 females,2 males aged 35～69 years average 51.5 years.Serum T_3,T_4 of allcases were obviously below normal,serum TSH was examined in 7 cases,6 of themwere obviously above normal,another case completed TRH excited test in which TSHsecretion was increased.In 8 cases serum Ca,P were examined,serum Ca levels of all8cases were below normal,serum P of 7 cases were normal,the hemoglobin of 8cases<100g/L(average 67g/L),BUN of all cases were above normal(average 15.35mmol/L),ECG of 6 cases indicated coronary atherosclerosis,UCG of three casessuggested pericardial effusion,4 cases complicated pleural effusion and or abdominaleffusion.It was suggested that CRF patients,especially those over 50 years of age,with diverse damage cardiac function,frequently occurring subserous cavity effusion,low serum Ca and normal serum P levels,and severe anemia,etc,that couldnot be explained by renal failure,hypothyroidism should be suspected and thyroidfunction be tested.