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目的:探讨甲状腺激素抵抗症(resistance to thyroid hormone,RTH)的临床特点及诊治要点。方法:分析我院2008年6月—2015年5月确诊的5例甲状腺激素抵抗症患者的临床表现、诊治经过。结果:2例属于全身抵抗型(general resistance to thyroid hormone,GRTH),给予三碘甲状腺素片(L-T3)替代治疗;3例患者属于选择性垂体抵抗型(pituitary resistance to thyroid hormone,PRTH),给予三碘甲状腺乙酸联合溴隐亭治疗。两组不同类型RTH治疗前后对比,差别有显著性,P<0.05。结论:甲状腺激素抵抗症临床表现相对复杂,不宜单纯采用抗甲状腺药物治疗。临床症状不明显的GRTH患者不需要特殊治疗,可甲状腺素制剂或联合中成药调节免疫功能、消肿、散结等治疗,对有严重甲减表现的GRTH、perRTH,给予超生理剂量的L-T3;三碘甲状腺乙酸可单独应用或联合溴隐亭为PRTH最理想的治疗。
Objective: To investigate the clinical features and diagnosis and treatment of thyroid hormone resistance (RTH). Methods: The clinical manifestations, diagnosis and treatment of 5 patients with thyroid hormone resistance diagnosed in our hospital from June 2008 to May 2015 were analyzed. Results: Two cases were general resistance to thyroid hormone (GRTH) and were treated with triiodothyronine (L-T3) replacement therapy. Three of them were patients with selective pituitary resistance to thyroid hormone (PRTH) , Give triiodothyronine acetic acid combined with bromocriptine treatment. Before and after treatment of two groups of different types of RTH, the difference was significant (P <0.05). Conclusion: The clinical manifestations of thyroid hormone resistance are relatively complex and should not be treated with antithyroid drugs alone. Clinical symptoms of GRTH patients do not need special treatment, thyroid hormone preparations or combined with traditional Chinese medicine regulation of immune function, swelling, Sanjie and other treatment, the performance of a serious hypothyroidism GRTH, perRTH, to give a super-physiological dose of L- T3; Triiodothyronine acetate can be used alone or in combination with bromocriptine for PRTH the best treatment.