散发性无痛性甲状腺炎46例临床分析

Clinical analysis of 46 cases of dispersion of painless thyroiditis

目的提高对散发性无痛性甲状腺炎(SPT)的认识,以防误诊。方法对2012年6月—2014年6月期间我院收治的46例SPT患者的临床表现、实验室检查、治疗及预后进行回顾性分析。结果甲状腺毒症期临床表现与Graves病相似;6例患者游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)水平在正常范围,40例患者FT3和或FT4均有不同程度的升高,所有患者促甲状腺激素(TSH)水平下降;红细胞沉降率平均(28±3.5)mm/1h;22例甲状腺球蛋白抗体(TGAb)、甲状腺过氧化物酶抗体(TPOAb)正常,24例TGAb和(或)TPOAb升高;41例促甲状腺激素受体抗体(TRAb)正常,5例轻度升高;46例摄碘率均明显降低;15例甲状腺彩色多普勒超声示实质回声不均,多发片状低回声区,46例彩色多普勒超声均未提示血流增加。结论 SPT临床表现复杂,需结合实验室检查加以判断,摄碘率及TRAb测定有助于SPT的诊断及鉴别。

Objective To improve the sporadic painless thyroiditis （SPT） understanding to prevent misdiagnosis. Methods The clinical manifestations, laboratory examination, treatment and prognosis of 46 patients with SIT from June 2012 to June 2014 were retrospectively analyzed. Results The clinical manifestations of thyroid toxicity are similar to that of Graves disease. The level of FF3 and FT4 in 6 patients was normal, 40 patients with FT3 and or FT4 had different degrees of elevation, and the level of TSH was decreased in all patients.The average erythrocyte sedimentation rate （ESR） （28 ±3.5 mm/h）.22 cases of thyroid globulin antibody （TGAb） and thyroid peroxidase antibody （TPOAb）were normal, 24 cases of TGAb and TPOAb were elevated.41 cases of thyroid stimulating hormone receptor antibody （TRAb） were normal, 5 cases of TRAb mild elevated.46 cases of iodine uptake rate were significantly decreased.15 cases of thyroid ultrasound showed parenchymal echo uneven, patchy low echo area.46 cases of color Doppler ultrasound were not indicate flow increased. Conclusion The clinical manifestations of SPT are complex, and need to be combined with labemtory tests to determine.The iodine uptake rate and TRAb assay are helpful for the diagnosis and differential diagnosis of SPT.