老年人甲状腺功能减退症误诊3例经验总结

Misdiagnosis of elderly hypothyroidism:a summary of 3 cases

目的 通过病例分析总结老年人甲状腺功能减退症易致误诊的原因,以提高其诊治水平。方法 整理分析陕西省人民医院2020年1月至2022年1月收治的3例老年甲状腺功能减退症患者的临床表现及诊治经过。结果 3例患者中1例以多浆膜腔积液为首发症状,曾误诊为泌尿系疾病;1例表现为心血管系统症状,曾误诊为扩张型心肌病;另1例表现为神经精神症状,曾误诊为老年痴呆、抑郁。3例均行多种检查,最后经甲状腺功能检测,确诊甲状腺功能减退症,给予左甲状腺素片口服治疗,临床症状有效控制。结论 老年性甲状腺功能减退症发病常为隐匿性,临床症状无特异性。在老年患者多种症状并存、疗效不理想时,要拓展诊疗思路,注意排除甲状腺功能减退症的可能性。

Objective To summarizes the causes of misdiagnosis of hypothyroidism in the elderly to improve its diagnosis and treatment.Methods The clinical manifestations,diagnosis and treatment of 3 elderly patients with hypothyroidism admitted to Shaanxi Provincial People’s Hospital from January 2020 to January 2022 were analyzed retrospectively.Results One case was misdiagnosed as a urinary system disease with multiple serous cavity effusion as the first symptom.One case presented cardiovascular symptoms and was misdiagnosed as dilated cardiomyopathy.Another case presented neuropsychiatric symptoms and was misdiagnosed as senile dementia and depression.After being confirmed as hypothyroidism with thyroid function test,all 3 cases were treated with levothyroxine tablets orally,and the clinical symptoms were effectively controlled.Conclusion As the clinical symptoms of hypothyroidism are diverse and nonspecific with occult onset,the possibility of hypothyroidism should be concerned when multiple symptoms occurred in the elderly patients.