以“消瘦、发热”为首发表现的亚急性甲状腺炎(无痛型)合并桥本甲状腺炎1例

One Case of Painless Subacute Thyroiditis with Weight Loss and Fever as Initial Manifestations Complicated with Hashimoto’s Thyroiditis

摘要: 病史摘要：患者，男性，61岁，因“消瘦伴间断发热半月”入院。症状体征：近半月出现食欲下降、怕热、体重短期内明显减轻(约15 kg)，伴大便次数稍增多(约2次/日)。体格检查：T：36.5℃，甲状腺II度肿大，质软，无压痛，未触及结节。心率66次/分钟，心律齐。诊断方法：根据临床表现、甲状腺功能提示破坏性甲状腺毒症、炎症指标显著升高、甲状腺彩超示弥漫性病变、抗甲状腺过氧化物酶抗体阳性，结合随访甲功相位演变及排除其他病因，诊断为亚急性甲状腺炎(无痛型)合并桥本甲状腺炎。治疗方法：予以依托考昔60 mg，每日1次，疗程3周；复查血沉恢复正常，但甲功已进入甲减期，遂予左甲状腺素钠长期替代治疗。推荐阅读人群：内分泌科。

Abstract: Medical History Summary: A 61-year-old male patient was admitted to hospital for half a month of emaciation accompanied by intermittent fever. Symptoms and Signs: The patient had anorexia, heat intolerance, obvious short-term weight loss (about 15 kg) accompanied by slightly increased stool frequency (about 2 times/day) in the recent half month. Physical examination: T: 36.5˚C, thyroid II degree enlargement, soft texture, no tenderness, no nodules touched. Heart rate was 66 beats/min with regular rhythm. Diagnostic Methods: The diagnosis of painless subacute thyroiditis combined with Hashimoto’s thyroiditis was made according to clinical manifestations, destructive thyrotoxicosis indicated by thyroid function, significantly increased inflammatory indicators, diffuse lesions shown by thyroid color Doppler ultrasound, positive anti-thyroid peroxidase antibody, combined with phase evolution of follow-up thyroid function and exclusion of other etiologies. Treatment Methods: Etoricoxib 60 mg was given once a day for 3 weeks. Reexamination showed that erythrocyte sedimentation rate returned to normal, but thyroid function had entered hypothyroidism stage, so long-term replacement therapy with levothyroxine sodium was administered. Recommended Readers: Department of Endocrinology.