甲状腺功能减退危象十例误诊分析

Clinical Analysis of Misdiagnosis of 10 cases of Myxedema Coma

目的分析甲状腺功能减退危象(简称甲减危象)的临床特点及误诊原因、防范措施。方法对10例曾误诊的甲减危象的临床资料进行回顾性分析。结果本组确诊前出现食欲不振、反应迟钝10例,咳嗽、咳痰及呼吸困难5例,胸闷、心悸及全身水肿各4例,头晕、晕厥3例,抽搐2例。因食欲不振、反应迟钝及呼吸困难等分别被误诊为肺性脑病、II型呼吸衰竭、重症肺炎及心包积液2例,心功能不全、多浆膜腔积液及低血糖2例,脓毒症休克、多浆膜腔积液、急性胰腺炎及低血糖1例,肺部感染、电解质紊乱及脑梗死1例,脑血管意外并发癫痫2例,心房颤动及缓慢型心律失常2例。本组平均误诊时间36 h。本组按误诊疾病治疗后均效果不佳,后根据病史、临床表现及甲状腺功能检查结果明确诊断甲减危象,给予相应治疗,治疗2~3周后患者症状缓解、生命体征平稳出院;门诊随访6~12个月,7例预后好,3例死亡。结论甲减危象临床表现多样,容易漏误诊。临床接诊寒冷季节发生意识障碍的老年女性时,应考虑此病。早期诊断和优化治疗可以降低甲减危象病死率。

Objective To analyze the clinical characteristics, causes of misdiagnosis and preventive measures of myxedema coma. Methods The clinical data of 10 cases of myxedema coma misdiagnosed were analyzed retrospectively. Results Before diagnosis, there were 10 cases of anorexia and unresponsiveness, 5 cases of cough, expectoration and dyspnea, 4 cases of chest distress and palpitation, 4 cases of edema, 3 cases of dizziness and syncope, and 2 cases of convulsions. Two cases were misdiagnosed as pulmonary encephalopathy, type II respiratory failure, severe pneumonia and pericardial effusion due to anorexia, unresponsiveness and dyspnea;2 cases of heart failure, polyserous effusions and hypoglycemia;1 case of septic shock, polyserous effusions, acute pancreatitis and hypoglycemia;1 case of pneumonia, electrolyte disturbance and cerebral infarction, 2 cases of cerebral stroke complicated with epilepsy, and 2 cases of atrial fibrillation and bradyarrhythmia. The average duration of misdiagnosis was 36 h. The results were far from satisfactory after treatments of the misdiagnosed diseases. According to the case history, clinical manifestations and laboratory examination results of thyroid function, myxedema coma was diagnosed and the corresponding treatments were given. After 2-3 weeks of treatments, the symtoms of the patients were relieved, and they were discharged from hospital with stable vital signs, and the outpatients were followed up for 612 months. The prognosis was favorable in 7 cases and death in 3 cases. Conclusion Given diversity of clinical manifestations and clinical features, myxedema coma is more likely to be missed and misdiagnosed initially.As for elderly women with a disturbance of consciousness during the cold seasons, this disease should be suspected. Therefore, early diagnosis and optimal treatment can reduce the mortality of myxedema coma.