【摘要】 目的探讨防止中老年人甲状腺功能亢进症(甲亢)误诊的思维方法。方法统计637例45～59岁和165例≥60岁两组甲亢患者主要症状体征发生率,并将其与同期收治的1680例20～40岁甲亢作比较,以及将这两组甲亢心率≥85次/分钟、体重减轻者的发生率分别与该组的其他主要症状体征发生率比较。结果45～59岁组和≥60岁组甲亢有甲状腺肿大者比率分别占89.4%和79.4%;甲状腺杂音者分别占37.4%和23.6%;食欲亢进者分别占38.0%和27.3%。以上病征均分别明显低于对照组(t>3,P<0.01)。≥60岁组有突眼征、多汗怕热者也均明显少见于对照组(t>3,P<0.01)。全民食盐加碘(USI)后,两组甲亢甲状腺肿大比率分别占85.4%和71.9%;甲状腺杂音者分别占23.9%和9.0%,均明显少见于USI前者(t>3,P<0.01)。两组甲亢心率≥85次/分钟及体重下降者均分别明显高于该组其他主要病征的发生率(t>3,P<0.01)。结论中老年人甲亢,常由于一些特征性表现缺乏或不明显,尤其在USI后甲状腺肿大者变得更少见和隐蔽,更易被误诊。心率增快和体重减轻是中老年人甲亢最多见和重要的病征,也是诊断该病重要的参数。从中老年患者有心率增快(心率≥85次/分钟)伴体重减轻想到有甲亢的可能,可防止本病误诊、漏诊和延迟诊断。更多还原

【Abstract】 Objective To explore the way to prevent misdiagnosis of hyperthyroidism in middle-aged and old patients.Method Make statistics of the incidence of the major symptoms and signs of hyperthyroidism in 637 patients aged 45 to 59 and 165 patients ≥ 60 years,and compare them with the incidence of the same symptoms in another 1 680 patients aged 20 to 40 who were treated concurrently,and compare the incidence of tachycardia ≥ 85 per minutes and weight loss with the incidence of the other major symptoms and signs in these two groups.Result The incidence of thyromegaly is 89.4% and 79.4% in the 45 to 59 aged group and the ≥60 years group respectively and the incidence of thyroid noises in the two groups is 37.4% and 23.6% respectively,and that of boulimia in the two groups is 38.0% and 27.3% respectively.The above symptoms and signs are all obviously lower than in the controls(t>3,P<0.01 in all).In the ≥ 60 years group,the incidence of exophthalmic sign is 13.3% and that of hidrosis and intolerance for hotness is 69.7%,which are all remarkably lower than in the controls(t>3,P<0.01 in all).After the universal salt iodization(USI),the incidence of thyromegaly is 85.4% and 71.9% respectively in the two age groups;and that of thyroid noises is 23.9% and 9.0%,all being significantly lower than before the USI(t>3,P<0.01 in all).In the two groups the incidence of tachycardia ≥ 85/min.is 96.9% and 97.0% respectively and that of weight loss is 97.0% and 99.4%,which are all obviously higher than the incidence of all other main symptoms and signs(t>3,P<0.01 in all).Conclusions In middle-aged and old patients,hyperthyroidism is misdiagnosed easily because some of the characteristic manifestations are lacking or not obvious,especially after the USI,when the incidence of thyromegaly has dropped even further.Tachycardia and weight loss are the commonest and most important signs of hyperthyroidism in middle-aged and old patients;they are also the major parameters for diagnosing this illness.For any middle-aged and old patients with tachycardia(≥ 85 beats per minute)accompanied by weight loss,we should think of the possibility of hyperthyroidism,and only in this way can we prevent misdiagnoses,slipped or delayed diagnoses of this disease.更多还原