误诊为原发性甲状腺功能减退症的干燥综合征34例临床分析

Clinical analysis of 34 cases of primary Sjogren syndrome （pSS） misdiagnosed as primary hypothyroidism

目的通过分析误诊为原发性甲状腺功能减退症（甲减）的原发性干燥综合征（pSS）患者的临床资料，探讨误诊原因。方法回顾分析34例误诊为甲减的pss患者的临床资料，分析误诊原因。结果34例患者中，共14例患者存在原发甲状腺功能减退不能解释的临床症状及体征，包括口干、眼干，反复腮腺肿大，双手雷诺现象，双下肢紫癜样皮疹及关节痛。共20例患者存在原发甲状腺功能减退不能解释的辅助检查异常，包括红细胞沉降率增快，IgG、IgM或IgA升高，白细胞、血小板下降，低血钾，肺部cT提示肺间质病变，ANA（＋）（〉1：40），RF（＋）（〉1：20）。结论pSS误诊为甲减并不少见，内分泌科医师应特别重视甲减不能解释的症状和辅助检查异常，进行必要的鉴别诊断从而降低误诊率。

Objective To explore the causes of misdiagnosis through clinical data analysis of primary Sjogren syndrome （PSS） patients misdiagnosed as primary hypothyroidism disease. Methods The clinical data of 34 cases with primary Sjogren syndrome （pSS） who were misdiagnosed as primary hypothyroidism were retrospectively analyzed. The misdiagnosis reason was analyzed. Results In 34 patients,a total of 14 patients with primary hypothyroidism could not explain the clinical signs and symptoms, included dry mouth, dry eyes, recurrent parotid gland enlargement,both hands reynolds phenomenon, purpura like rash and joint pain in the lower extremities. A total of 20 patients with primary hypothyroidism could not be explained by an auxiliary examination abnormality, including ESR, IgG, IgM or IgA increased, white blood cells and platelets ,low blood potassium, pulmonary CT suggest interstitial lung disease,ANA （ ＋ ） （ 〉 1 ： 40） ,RF（ ＋ ） （ 〉 1 ： 20）. Conclusion pSS misdiagnosis for hypothyroidism is not uncommon. Department of Endocrinology physicians should pay special attention to hypothyroidism can not explain the symptoms and auxiliary examination abnormal, make the necessary differential diagnosis to reduce the misdiagnosis rate.