以毛发脱落为首发症状的不典型甲状腺功能亢进症:1例病案报道并文献复习

Atypical hyperthyroidism with hair loss as the first symptom:One case report and literature review

目的:报道1例以毛发脱落为首发症状的不典型甲状腺功能亢进症(简称甲亢)病案,分析以毛发脱落为首发症状的甲亢,查阅文献汇总不典型甲亢的报道,并为中西医结合治疗不典型甲亢提供理论分析与支持。方法:回顾性分析1例中西医结合治疗的不典型甲亢患者的临床资料,检索2012年-2021年Pubmed数据库、中国知网、万方数据库关于不典型甲亢的病案报道,复习总结不典型甲亢的首发症状。结果:不典型甲亢的患者临床首发症状表现多样,除毛发脱落,有些以甲状腺肢端肥大症、全血细胞减少症、完全性房室传导阻滞、心包炎、高钙血症、儿童的言语和语言障碍和癫痫等不同的症状或疾病为首发表现,临床应进行鉴别,当以甲亢病情控制为治疗之根本,中西医结合治疗可获显效。结论:甲亢可累及全身多个系统,对不典型甲亢的罕见病例要有充分的认识,避免漏诊误诊,在临床诊疗时认真深入地询问患者病史和完善相关实验室检查有助于确诊不典型甲亢,西医基础治疗配合中药有助于缩短疗程且预后效果稳定,对提高临床治愈率、防止甲状腺危象等危急情况的发生有重要作用。

Objective:This paper reports a case of atypical hyperthyroidism with hair loss as the first symptom,analyzes the hyperthyroidism with hair loss as the first symptom,reviews the literature and summarizes the reports of atypical hyperthyroidism,and provides theoretical analysis and support for the treatment of atypical hyperthyroidism in the integrative medicine.Methods:The clinical data of one patient with hyperthyroidism who was treated in the integrative medicine was retrospectively analyzed.The case reports of atypical hyperthyroidism in PubMed database,CNKI and Wanfang database from 2012 to 2021 were retrieved,and the first symptoms of atypical hyperthyroidism were reviewed and summarized.Results:Clinical initial symptoms of patients with atypical hyperthyroidism were diverse and it was important to identify real conditions,including hair loss,thyroid acropachy,pancytopenia,complete atrioventricular block,pericarditis,hypercalcemia,speech and language delay in children and epilepsy.Clinical differentiation should be carried out,and the essence of treatment lay in the treatment of hyperthyroidism.The integrative medicine could achieve significant curative effects.Conclusion:Hyperthyroidism can involve multiple systems.The rare cases of atypical hyperthyroidism should be fully understood to avoid missed diagnosis and misdiagnosis.In clinical diagnosis and treatment,serious and in-depth inquiry of the patient’s medical history and improvement of relevant laboratory examinations are helpful for the diagnosis of atypical hyperthyroidism.Basic Western medicine treatment combined with traditional Chinese medicine is helpful to shorten the course of treatment and ensure a stable prognosis,which plays an important role in improving the clinical cure rate and preventing the occurrence of critical conditions such as thyroid crisis.