伴发热亚急性甲状腺炎的诊断及误诊分析

Diagnosis and Misdiagnosis of Subacute Thyroiditis Patients with Fever

目的 总结伴发热亚急性甲状腺炎的临床特点,并对误诊和误治原因进行分析。方法 回顾性分析2020年2月—2021年7月首诊误诊伴发热亚急性甲状腺炎6例的临床资料。结果 本组误诊率为33.3%。6例均因发热就诊于发热门诊,均有不同程度甲状腺区疼痛,其中伴咽喉疼痛4例,伴右上腹痛1例,伴较重头痛1例,误诊为急性上呼吸道感染2例、肺部感染2例、急性胆囊炎1例、脑膜炎1例,误诊时间2-10 d。经对症治疗后症状不能完全缓解。在完善特异性检查后,确诊为亚急性甲状腺炎。确诊后均使用泼尼松治疗,3例甲状腺毒症表现较明显者加用普萘洛尔治疗,泼尼松共使用8周,期间逐渐减量,停药时红细胞沉降率、C反应蛋白正常,无发热及甲状腺疼痛,且未出现病情反复。结论 亚急性甲状腺炎常合并发热,但同时具有甲状腺特异性体征及实验室检查异常,如发热门诊医生对该病缺乏认识,易误诊为其他发热性疾病。

Objective To summarize clinical characteristics of subacute thyroiditis patients with fever, and to analyze misdiagnosed cause and mistreatment. Methods Clinical data of 6 subacute thyroiditis patients with fever who had been misdiagnosed in the initial misdiagnosis between February 2020 and July 2021 was retrospectively analyzed. Results The misdiagnosed rate in this group was 33.3%. All the 6 patients visited doctors for fever in the fever clinic. All of them had pain in the thyroid area of varying degrees, including 4 patients associated by throat pain, 1 associated by right upper quadrant pain, and 1 associated by severe headache. Two patients were misdiagnosed as having acute upper respiratory tract infection, and 2 as having pulmonary infection, 1 as having acute cholecystitis and 1 as having meningitis, and the misdiagnosed duration was 2-10 d. Symptoms were not completely relieved after symptomatic treatment. Subacute thyroiditis was confirmed after performing the specific examination. After confirming diagnosis, all patients were treated with Prednisone, and 3 patients with more obvious symptoms of thyrotoxicosis were added with Propranolol. Prednisone was used for 8 weeks, and the dose was gradually reduced during the period. The erythrocyte sedimentation rate and C-reactive protein were normal when the drug was withdrawn. No fever or thyroid pain, and no recurrence of the disease were reported. Conclusion Subacute thyroiditis is often associated with fever, but it also has thyroid-specific signs and abnormal results of laboratory tests. It is more likely to be misdiagnosed as other febrile diseases if the clinicians in fever clinic lack the relevant knowledge of the disease.