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目的分析临床中针对原发性甲状腺功能减退症(甲减)的常见误诊原因,以提高诊断水平,减少误诊、漏诊率。方法选取2012年1月~2013年3月期间我院误诊的原发性甲状腺功能减退症患者3 7例作为研究观察对象,将患者资料进行回顾性分析,总结患者的临床表现以及误诊原因。结果在37例误诊患者中,临床表现以胃痛、恶心、呕吐、便秘、乏力、胸闷、气短、记忆力减退、反应迟钝、嗜睡等为主;分别被误诊为冠心病1 3例,胃炎7例,心包积液6例,抑郁症3例,慢性肾炎5例,贫血2例,老年痴呆1例;在给予系统治疗后均没有明显效果,后进行甲状腺功能检查确诊为甲减,并给予左甲状腺素片替代治疗,临床症状均得到不同程度的缓解。结论原发性甲状腺功能减退症能够对机体的重要系统造成损害,而且临床症状复杂,极易误诊为消化、神经、泌尿、循环、内分泌等系统疾病,耽误治疗最佳时机。因此,在临床诊断过程中,对于缺少明确原因的乏力、贫血或浮肿等症状的患者,要及时进行甲状腺功能检查,以降低误诊率。
Objective To analyze the causes of common misdiagnosis of primary hypothyroidism (hypothyroidism) in clinical practice in order to improve the diagnostic level and reduce the misdiagnosis and misdiagnosis rate. Methods Totally 377 patients with primary hypothyroidism who were misdiagnosed in our hospital from January 2012 to March 2013 were selected as the study objects. The data of patients were retrospectively analyzed, and the clinical manifestations and causes of misdiagnosis were summarized. Results Of the 37 cases misdiagnosed, the clinical manifestations included stomach pain, nausea, vomiting, constipation, fatigue, chest tightness, shortness of breath, memory loss, unresponsiveness and drowsiness. Pericardial effusion in 6 cases, 3 cases of depression, 5 cases of chronic nephritis, anemia in 2 cases, 1 case of Alzheimer’s disease; no significant effect after systemic treatment, after thyroid function tests confirmed hypothyroidism, and given levothyroxine Substitute for treatment, clinical symptoms have been different degrees of relief. Conclusions Primary hypothyroidism can damage the important system of the body. Moreover, the clinical symptoms are complicated and easily misdiagnosed as systemic diseases such as digestive, neurological, urological, circulatory and endocrine diseases, and the best time for treatment is delayed. Therefore, in the clinical diagnosis process, for lack of a clear cause of fatigue, anemia or edema and other symptoms in patients with timely thyroid function tests to reduce the misdiagnosis rate.