摘要
目的:总结甲状腺过氧化物酶抗体(TPOAb)阴性的产后甲状腺炎(PPT)合并产后Graves病(PPGD)的特点,提高对该病的认识。方法:收集2021年广西医科大学第一附属医院诊治的1例产后甲状腺炎合并产后Graves病(GD)患者的临床资料并回顾相关文献。结果:患者产后4个月余出现高代谢表现,无GD特征性体征,实验室检查显示游离的三碘甲状腺原氨酸(FT3)、游离的甲状腺素(FT4)明显升高,促甲状腺激素(TSH)降低,促甲状腺素受体抗体(TRAb)阳性,TPOAb阴性,ATD治疗后高代谢症状迅速改善,治疗3个月内甲状腺功能检查骤降甚至出现甲状腺功能减退,超声检查提示PPT合并GD可能性大,行甲状腺细针穿刺确诊为产后甲状腺炎合并PPGD。结论:产后1年内出现的甲状腺毒症,应首先考虑PPT,同时也要考虑PPGD所致的可能;必要时可行甲状腺细针穿刺活检,避免误诊、漏诊。
Objective:To summarize the characteristics of postpartum thyroiditis(PPT)with thyroid peroxidase antibody(TPOAb)negativity combined with postpartum Graves’disease(PPGD)to increase awareness of this disease.Methods:The clinical data of a patient with PPT combined with postpartum Graves’disease(GD)attending the First Affiliated Hospital of Guangxi Medical University in 2021 were collected and relevant literature was reviewed.Results:The patient presented with hypermetabolic symptoms more than 4 months after delivery without characteristic signs of GD.Laboratory tests showed that triiodothyronine(FT3)and free thyroxine(FT4)were significantly elevated,thyroid stimulating hormone(TSH)was lowered,accompanied by TRAb positivity and TPOAb negativity,and the hypermetabolic symptoms improved rapidly after ATD treatment,but the thyroid function was decreased abruptly and even the hypothyroidism appeared within 3 months after treatment.Ultrasound examination indicated that PPT was more likely to be combined with GD,and PPT combined with PPGD was confirmed by the thyroid fine-needle aspiration biopsy.Conclusion:Thyrotoxicosis occurring within 1 year postpartum should be considered firstly as PPT and also due to PPGD.When necessary,the thyroid fine-needle aspiration biopsy is feasible to be performed to avoid misdiagnosis and missed diagnosis.
作者
陈雪兰
傅士恩
丘程程
黄子恩
梁杏欢
冼晶
匡雅琪
杨海燕
马燕
罗佐杰
CHEN Xuelan;FU Shien;QIU Chengcheng;HUANG Zien;LIANG Xinghuan;XIAN Jing;KUANG Yaqi;YANG Haiyan;MA Yan;LUO Zuojie(Department of Endocrinology,the First Affiliated Hospital of Guangxi Medical University,Nanning 530021,China;Department of Ultrasonic Medicine,the First Affiliated Hospital of Guangxi Medical University,Nanning 530021,China)
出处
《广西医科大学学报》
CAS
2024年第1期156-160,共5页
Journal of Guangxi Medical University
基金
国家自然科学基金资助项目(No.82260159,No.81860146)。
