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目的提高对甲状腺功能减退症的重视和认识,减少误诊漏诊。方法回顾性分析5年来本科室接诊的被误诊漏诊的19例甲状腺功能减退症(甲减)患者的临床资料。结果 19例患者中误诊16例,其中冠心病4例,神经系统疾病4例,肾病肾炎5例,营养不良1例,贫血1例,缺碘1例,误诊时间1月~13年不等,漏诊3例,均为住院的神经科患者,漏诊时间3~11 d。误诊漏诊原因分析:①对甲减复杂多样的临床表现重视认识不够,满足于常见病、多发病的诊断而忽视了鉴别。②病史采集与体格检查和综合分析不够认真。③专科医生的片面性、专科性、局限性限制。结论原发性甲减好发于中老年女性,极易被误诊漏诊,临床应注意鉴别,尤其与心脏疾病、肾脏疾病、神经科疾病、贫血等相鉴别,临床医生应详问病史,认真体检、全面综合分析,专科医生应克服片面性、局限性,重视鉴别诊断,是减少误诊漏诊的关键。
Objective To raise the awareness and understanding of hypothyroidism and reduce misdiagnosis and missed diagnosis. Methods The clinical data of 19 patients with hypothyroidism (hypothyroidism) who were misdiagnosed and missed during the past 5 years were retrospectively analyzed. Results Of the 19 patients, 16 cases were misdiagnosed, including 4 cases of coronary heart disease, 4 cases of neurological disease, 5 cases of nephritis, 1 case of malnutrition, 1 case of anemia and 1 case of iodine deficiency. The misdiagnosis time ranged from 1 to 13 years. Misdiagnosis in 3 cases, are hospitalized neurology patients, missed the diagnosis of 3 ~ 11 d. Misdiagnosis and missed diagnosis Analysis: ① hypothyroidism complex clinical manifestations of insufficient attention to meet the common, frequently-occurring disease diagnosis and ignore the identification. ② history collection and physical examination and comprehensive analysis is not serious enough. ③ one-sided specialist doctors, specialties, limitations. Conclusion Primary hypothyroidism occurs in middle-aged and elderly women, easily misdiagnosed and missed diagnosis, clinical should pay attention to identify, especially with heart disease, kidney disease, neurological diseases, anemia, phase identification, clinicians should be detailed medical history, serious physical examination Comprehensive and comprehensive analysis of specialists should overcome the one-sidedness, limitations, emphasis on differential diagnosis is to reduce the misdiagnosis of the key.