药物导致孟乔森综合征患者严重外源性甲状腺毒症1例报告

Severe exogenous thyrotoxicosis caused by medication in Munchausen syndrome:a case report

本文报道1例孟乔森综合征患者因服药导致严重外源性甲状腺毒症的诊治过程。患者17岁女性,因"心悸、手颤4个月,间断高热3个月"入院,无甲状腺肿、突眼及胫前黏液性水肿体征;辅助检查示高甲状腺激素血症,正常甲状腺自身抗体水平,低血清甲状腺球蛋白(Tg)水平,甲状腺摄锝功能下降,盆腔核磁示无占位。在患者多次否认应用甲状腺激素类药物或保健品后,母亲发现患者偷偷服用成分不明药物,经质谱分析为左甲状腺素钠。最终诊断孟乔森综合征,外源性甲状腺毒症。确诊后患者拒绝精神心理治疗,2年随访中仍应用多种药物反复就诊于不同医院。孟乔森综合征临床表现多样,预后差,解决患者的潜在情感需求是重要的治疗策略。

We reported a case of a patient with Munchausen syndrome who developed severe exogenous thyrotoxicosis due to medication.A 17-year-old female patient was hospitalized because of palpitation and hands tremor lasting for 4 months and intermittent hyperpyrexia lasting for 3months.There were no signs of goiter,exophthalmos or pretibial myxedema.And the laboratory tests showed hyperthyroxinemia,normal thyroid autoantibodies and low serum thyroglobulin level.In addition,the imaging studies revealed decreased uptaking of radionuclides Te-99 in thyroid static imaging and no abnormal mass of pelvic in MRI.However,the patient denied using any medication of thyroid hormone or health products.Later her mother discovered that the patient was secretly taking unidentified substances.The mass spectrometry analysis showed the unknown medications contained levothyroxine sodium.So the final diagnosis were Munchausen syndrome and exogenous thyrotoxicosis.Unfortunately,the patient refused mental and psychological treatment.In the following two years,she had always taken diverse medications and visited many different hospitals.In summary,Munchausen syndrome has various clinical manifestations and poor prognosis.To address the underlying emotional needs of the patient may be an important measure of the treatment.