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亚急性甲状腺炎的诊断及治疗 |
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马毅 吴佩 夏祥厚
【摘 要】 目的 探讨亚急性甲状腺炎(SAT)的病因、诊断及治疗。方法 回顾性总结分析1980～1998年经治的SAT的临床资料。结果 女性多于男性，发病年龄30～50岁者占78%；全部病人均有甲状腺肿大及触痛，17例呈T3、T4与甲状腺摄碘率分离现象；29例予强的松治疗，效果良好；误行手术3例，2例出现术后甲状腺机能减退且需替代治疗。结论 确立SAT的诊断应重视详细询问病史，并进行必要的辅助检查，核医学检查是诊断本病的重要方法，必要时可行诊断性治疗及穿刺细胞学检查。肾上腺糖皮质激素是本病最有效的药物，SAT不宜手术治疗。
【关键词】 甲状腺炎 亚急性 诊断 治疗
Diagnosis and treatment of subacute thyroiditis
Ma Yi,Wu Pei,Xia Xianghou
(Department of General Surgery,the Affiliated Hospital of Wannan Medical College,Wuhu 241001)
【Abstract】 Objective To study the causes,diagnosis and treatment of subacute granulomatous thyroiditis(SAT).Methods Clinical data of 32 cases with SAT were analyzed retrospectively.Results It was much more common in women than men,and 78% cases with SAT occurred during 30～50 years old.All these cases were characterized by enlargement of the thyroid with pain and tenderness,17 of which showed that radioiodine uptake was low with increased serum thyroid hormone levels.29 cases were treated by prednisone and recovered well,and the rest 3 cases underwent operation incorrectly.Conclusion Confirmation of SAT should put emphasis on a complete history and physical examination and obtain necessary tests.Nuclear medicine tests play an important role in diagnosis,and the diagnostic drug treatment or needle aspiration biopsy may be performed in suspected cases.Glucocorticoid is the best therapy to this kind of disease.There is no need for operation.
【Key words】 Thyroiditis Subacute Diagnosis Treatment
亚急性甲状腺炎(SAT)，又称巨细胞性甲状腺炎、肉芽肿性甲状腺炎。在甲状腺疾病中发生率为0.5%～2.0%。因其临床表现多样，很易漏诊、误诊。我们自1980～1998年收治SAT病人32例，现结合有关文献，分析报告如下。
1 临床资料
1.1 一般资料
本组32例，男7例，女25例。年龄23～62岁，平均43.6岁，其中30～50岁25例(占78%)。
1.2 病史及临床表现
发病前有上呼吸道感染病史者18例；发热17例，体温在37.5℃～39℃；32例均有甲状腺肿大和触痛，Ⅰ度肿大18例，Ⅱ度肿大14例，其中19例伴有单侧或双侧甲状腺结节，质中或硬(手术3例)；心悸13例；怕热、多汗9例；食欲亢进5例，食欲减退8例；乏力7例；月经异常6例。
1.3 辅助检查
入院时血沉(ESR)增快23例；白细胞总数和分类仅8例轻度增高，其余均在正常[1] [2] 下一页
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