不明原因发热中的亚急性甲状腺炎20例临床分析

目的：分析表现为不明原因发热（FUO）的亚急性甲状腺炎的临床特点,立足早期诊断。方法回顾性分析2009年10月至2013年2月按FUO收治,并最终确诊为亚急性甲状腺炎的20例患者的临床表现、实验室检查等资料。结果共收治FUO患者661例,最终临床诊断为亚急性甲状腺炎20例。其中5例（25％）患者发病初期有咽痛或颈前区疼痛;14例（70％）患者体格检查发现甲状腺不同程度肿大伴触痛;17例（85％）患者血清甲状腺激素水平升高伴TSH明显降低;14例（70％）患者甲状腺超声检查可见典型片状不均匀低回声;20例（100％）患者均有甲状腺核素显像（ECT）99mTc摄取功能明显减低。所有患者入院前均接受不同程度的抗感染治疗。结论亚急性甲状腺炎是FUO的病因之一,当其临床表现不典型时,仔细的体格检查结合相关检查有助于早期诊断。临床医师加强对这一疾病的认识可减少误诊、漏诊,同时减少无指征、不必要的抗生素使用。

Clinical analysis of 20 cases of subacute thyroiditis manifested as fever of unknown origin

Objective To analyze the clinical features of subacute thyroiditis （SAT ） manifested as fever of unknown origin （FUO） for early diagnosis .Methods The clinical and laboratory data were retrospectively reviewed for 20 SAT patients manifected as fever of unknown origin from October 2009 to February 2013 .Results A total of 20 patients were finally diagnosed as subacute thyroiditis ,about 3% of the 661 FUO patients .Only 5 SAT patients had complained of angina or pain in the anterior region of neck .Thyroid enlargement and tenderness were observed in 14 SAT cases .Elevated serum thyroid hormone and a very low serum level of thyroid stimulating hormone were seen in 17 patients with SAT .Ultrasound scan of thyroid showed inhomogenous hypoechongenic texture in 14 patients .99m Tc pertechnetate scan of thyroid showed extremely low radiopharmaceutical uptake in all the 20 cases .All patients had received antibiotic treatment prior to admission .Conclusions Subacute thyroiditis is an uncommon but important cause of FUO .Detailed history ,physical examination and laboratory evaluation can help minimize the chance of misdiagnosis and unnecessary antibiotic therapy .