甲亢散发型无痛性甲状腺炎的诊断与治疗

Diagnosis And Treatment For Sporadic Type of Painless Thyroiditis in Hyperthyroidism

目的 探讨散发型无痛性甲状腺炎 (SPT)在甲亢中的发病率、临床表现、实验室检查特征及不同治疗方法对其预后的影响。方法 从临床表现为甲亢的 2 76例患者中 ,诊断出 4 3例SPT ,随机分为治疗组 2 2例 ,对照组 2 1例 ,进行临床研究。结果 SPT的发病率为 15 5 8% ,其相关的实验室检查不同于Graves病、毒性甲状腺腺瘤 (Plummer病 )及桥本病 (Hashimoto病 ) ;治疗组 :甲状腺毒症期 (37 2 3± 4 2 8)d ,正常甲状腺血症期 (16 4 3±3 4 2 )d ;低甲状腺毒症期 (18 6 5± 6 31)d ,复发率 4 5 4% (1/2 2 )无永久性甲低发生 ;对照组 :甲状腺毒症期 (6 8 35± 8 2 3)d ,正常甲状腺血症期 (31 4 5± 7 2 3)d ;低甲状腺毒症期 (10 2 4 2± 2 1 34)d ,复发率 14 2 8% (3/2 1) ,永久性甲低发生率 9 5 2 % (2 /2 1)。结论 甲亢中 ,SPT仅次于Graves病而较Plummer病及Hashimoto病多发 ,实验室检查对鉴别诊断意义大 ,相关治疗可较快控制甲亢症状。

Objective To investigate the incidence of sporadic type of painless thyroiditis (SPT),to analyse its laboratory characteristics, and explore the influence of different treatments on prognosis. Methods 43 patients with SPT, who differentiated from 276 patients with typical thyrotoxicosis, were randomly divided into treatment group (n=22) and control group(n=21).Results the incidence of SPT was 15 58%,the laboratory examinations in SPT differed from those of Graves disease, Plummer's disease and Hoshimotos disease. In treatment group the thyrotoxicosis continued(37 23±4 28) days, the euthyroidism continued(16.43±3.42) days and hypothyroxinemia continued(18.65±6.31)days,only one patients(4.54%) showed that repeated episode and had not left lifelong hypothyroidism; In control group the thyrotoxicosis continued(68 35±8 32) days, the euthyroxinemia continued(31 45±7 23) days and the hypothyroxinemia continued(102 42±21 34) days, 3 patients(14 28%)showed that repeated episodes and two patients(9 52%) left lifelong hypothyroidism in following 1 5 years;Conclusions SPT has less incidence than Grave's disease and more incidence than plummer's disease or Hoshimoto's disease in thyrotoxicosis. The laboratory examination could differentiate each other .The therapy of SPT could control thyrotoxicosis quickly,reduce recurrence rate and lifelong hypothyroidism.