摘要
关于难治性甲状腺功能亢进症(简称甲亢)患者反复发作并发游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)分离的研究报告较少见。贵州中医药大学第一附属医院门诊有1例9年多难治性甲亢反复发作的女性患者,长期口服小剂量丙基硫氧嘧啶(PTU),在治疗过程中复发率高且发生了FT3、FT4分离,表现为FT3检测数值升高,接近甲亢水平,FT4检测过程中出现数值性甲减的异常低值,两者极度不匹配。而目前关于难治性甲亢尚无国内外专家共识,可狭义地认为甲亢遵循国内外诊疗指南进行规范化治疗后情况缓解不佳或容易复发。毒性弥漫性甲状腺肿和桥本甲状腺毒症临床上常二者合并存在,但合并FT3、FT4分离少有报告,发病机制目前尚不清楚。通过对病例的回顾性研究及文献资料学习,总结影响甲亢复发的因素、FT3、FT4分离的发病机制及诊疗。鉴于此临床可通过提高甲亢患者对疾病的认知水平,从而对同类疾病患者进行更规范化的治疗。
Studies on recurrent episodes of refractory hyperthyroidism(abbreviated as hyperthyroidism)patients with concomitant free triiodothyronine(FT3)and free thyroxine(FT4)detachment have been reported less frequently.In the outpatient clinic of the First Affiliated Hospital of Guizhou University of Traditional Chinese Medicine,there was a case of refractory hyperthyroidism with recurrent episodes for more than 9 years in a female patient,who had been taking small-dose propylthiouracil(PTU)orally for a long time,with a high rate of recurrence and separation of FT3 and FT4 in the course of treatment,which was manifested by the elevated values of FT3 test close to the level of hyperthyroidism,and abnormally low values of numerical hypothyroidism during the process of FT4 test,with an extreme mismatch of the two.At present,there is no domestic and international expert consensus on refractory hyperthyroidism,which can be narrowly considered as poor relief or easy recurrence after standardized treatment of hyperthyroidism following domestic and international diagnostic and therapeutic guidelines.Toxic diffuse goiter and Hashimoto's thyrotoxicosis are often combined in clinics,but combined FT3 and FT4 separation is rarely reported,and the pathogenesis is still unclear.Through the retrospective study of cases and literature study,we summarize the factors affecting the recurrence of hyperthyroidism,the pathogenesis of FT3,FT4 separation and diagnosis and treatment.In view of this,the clinic can improve the level of awareness of hyperthyroidism patients about the disease,so as to provide more standardized treatment for patients with similar diseases.
作者
郑悦
谢乃佳
刘祥秀
Zheng Yue;Xie Naijia;Liu Xiangxiu(Guizhou University of Traditional Chinese Medicine1,Guiyang 550025,Guizhou Province,China;Chongqing Hospital of Traditional Chinese Medicine2,Chongqing 400000,China;Guizhou University of Traditional Chinese Medicine3,Guiyang 550025,Guizhou Province,China)
出处
《中外医药研究》
2023年第21期12-14,共3页
JOURNAL OF CHINESE AND FOREIGN MEDICINE AND PHARMACY RESEARCH
