甲状腺功能亢进症合并低热、高钙危象1例

A case of hyperthyroidism complicated with low fever and hypercalcemia crisis

本文报道1例中年女性患者,因“反复低热2月余”入院,伴有纳差、恶心、呕吐,查找发热病因检测甲状腺功能提示甲状腺功能亢进症(以下简称“甲亢”),同时合并高钙危象,给予生理盐水扩容、呋塞米利尿及唑来膦酸紧急处理后血钙快速下降,甲状旁腺激素(PTH)由测不出升至大于500 pg/ml,造成很多不必要的检查,随访发现随着甲亢控制,体温逐渐恢复正常,血钙水平亦稳定下降并维持正常水平。提示临床上如遇甲亢合并低热、高钙危象患者,进行鉴别诊断排除其他病因后,积极控制甲亢,短期内给予扩容、利尿、降钙素等治疗方案,后续随访观察即可。

This paper reports a middle-aged female patient who was admitted to the hospital for"repeated low fever for more than two months",accompanied by anorexia,nausea,and vomiting.Thyroid function was tested to find out the cause of the fever,indicating hyperthyroidism,accompanied by a hypercalcemia crisis.After administrations of normal saline for volume expansion,furosemide for diuresis and zoledronic acid for emergency treatment,blood calcium rapidly decreased,and parathyroid hormone(PTH)increased from undetectable to over 500 pg/ml,resulting in many unnecessary examinations.Follow-up was conducted to find that as hyperthyroidism was controlled,body temperature gradually returned to normal,and blood calcium levels steadily decreased and maintained normal levels.It is suggested that if we encounter patients with hyperthyroidism with low fever and hypercalcemia crisis in clinical practice,we should actively control hyperthyroidism after differential diagnosis and exclusion of other causes,and give volume expansion,diuresis,calcitonin and other treatment protocols in a short period of time,accompanied by follow-up observation.