甲状腺功能减退性心脏病误诊分析

目的:探讨甲减心的临床特征并对其误诊原因进行分析,以提高诊断率,降低病死率。方法:回顾分析20例甲减心误诊患者的临床材料。结果:本组20例误诊为冠心病7例,误诊为心包积液、心衰3例,误诊为慢性肾病6例,扩张性心肌病2例,贫血性心脏病2例。误诊时间在2个月～3.5年。明确甲状腺功能减退性诊断后即给予甲状腺片或L(左旋)-甲状腺素治疗。治疗1～3个月病情明显改善,经3～6个月甲状腺制剂达稳定维持量。TSH控制在4.0～7.0mU/L,FT4基本恢复正常。随访1～4年,病情控制良好,症状和体征消除,心电图心律失常消失,B超检查心包积液吸收。结论:甲减心起病隐匿,进展缓慢,易于误诊,临床医生应提高对本病的认识,及时检查甲状腺功能等有助于明确诊断,减少误诊。

Misdiagnosed analysis of hypothyroidism heart disease

Objective：Exploring clinical features of the hypothyroid heart disease and analyzing the causes of misdiagnosis,in order to improve the diagnostic rate and reduce mortality.Methods：Retrospective analysis the clinical material of 20 hypothyroidism heart disease misdiagnosed patients.Results：In the 20 cases,7 cases was misdiagnosed as coronary heart disease,3 cases was misdiagnosed as pericardial effusion,heart failure,6 cases was misdiagnosed as chronic kidney disease,2 cases was misdiagnosed as dilated cardiomyopathy,2 cases was misdiagnosed as ischemic heart disease.Misdiagnosis time in 2 months～3.5years.After a clear diagnosis,patients who were misdiagnosed as hypothyroidism heart disease were given thyroid tablets or L （L）-thyroxine treatment.After 1 to 3 months treatment,condition improved significantly,after 3 to 6 months,thyroid preparations up to a stable maintenance.TSH control 4.0～ 7.0mU/L,FT4 basically back to normal.Follow-up 1～4 years,disease under good control and elimination of symptoms and signs,ECG arrhythmia disappeared,B-ultrasound absorption of pericardial effusion.Conclusion：The hypothyroidism heart disease has been slow,easy to misdiagnosis,the clinician should raise awareness of this disease,such as thyroid function be checked in time contribute to a clear diagnosis,reduce misdiagnosis.