以感冒为临床表现的亚急性甲状腺炎的误诊分析

Misdiagnosis of subacute thyroiditis with cold as clinical manifestations

目的：分析亚急性甲状腺炎出现感冒的发病机制以及临床表现,减少临床误诊.方法：选取武警云南总队保山分院2015-02/2015-08收治的20例以感冒为临床表现的亚急性甲状腺炎患者作为研究对象.结果：患者年龄26~52（平均38.4±4.3）岁,以女性多见,男女之比为1∶10,主要临床表现为发热,体温高达38.7℃,咽喉疼痛,同时伴有食欲不振,肌肉酸痛,胸片正常,无甲状腺压痛,甲状腺摄碘率减低,FT3、FT4升高,而TSH减低;本研究患者中,有5例患者颈部甲状腺肿大,且T3、T4增高,被误诊为甲亢,并给与患者他巴唑治疗,1周后,患者症状并未改善,由于亚急性甲状腺炎在发病后甲状腺滤泡会破坏甲状腺,在血液中释放甲状腺激素,因此多数患者会有甲亢表现,为患者进行进一步检查,可发现甲状腺碘131摄取率较低,可一次鉴别.结论：以间断发热、咽喉疼痛为首发临床症状的亚急性甲状腺炎极易被误诊为感冒,考虑常见病因外,还应警惕亚急性甲状腺炎.

AIM： To analyze the pathogenesis of subacute thyroiditis with cold as its clinical manifestations,so as to reduce clinical misdiagnosis. METHODS： 20 cases of subacute thyroiditis with cold as clinical manifestations admitted into Baoshan Branch of Yuannan Armed Police Corps from February 2015 to August 2015 were selected as research objects. RESULTS： The patients were aged 26 ~ 52（ average age 38. 4 ± 4. 3） years old,and male and female ratio was 1∶ 10. The main clinical manifestations were fever,body temperature up to 38. 7 DEG C,sore throat,accompanied by loss of appetite,muscle soreness,normal chest radiograph,thyroid tenderness,thyroid iodine uptake decreased. FT3 and FT4 increased,while TSH decreased; 5 cases presented thyroid enlargement,increased T3 and T4,and were misdiagnosed as hyperthyroidism,and given methimazole treatment. After 1 week,the symptoms did not improve,because of subacute thyroiditis after the onset of thyroid follicular thyroid damage,releasing thyroid hormones in the blood,so the majority of patients will show thyrotoxic manifestation. Patients with further check can be found that thyroid iodine 131 uptake rate was low,identified at a time. CONCLUSION： With intermittent fever,sore throat for starting clinical symptoms,subacute thyroiditis can be easily misdiagnosed as cold,considering the common cause,and should also be wary of subacute thyroiditis.