小结
定义
病史和体格检查
关键诊断因素
- 存在的危险因素
- 可触及的甲状腺结节
- 较小的年龄
其他诊断因素
- 食欲亢进
- 体重减轻
- 出汗/怕热
- 烦躁
- 心悸
- 月经稀发
- 排便次数增多
- 呼吸困难
- 目光凝视或睑后退
- 心动过速
- 震颤
- 皮肤温热潮湿
- 肌无力
- 声嘶
- 吞咽困难
- 窒息
- 情绪变化
危险因素
- 青年年龄段
- 碘缺乏
- 头颈部放射治疗
- 甲状腺结节家族史
- 女性
诊断性检查
首要检查
- 促甲状腺激素 (TSH)
- 甲状腺超声
需考虑的检查
- 游离甲状腺素（T4；或总 T4 加结合测定）
- 总 T3 加结合量的测定（或游离 T3）
- 甲状腺扫描和摄取
- 生化检查
- 全血细胞计数 (FBC）
- TSH 受体抗体
- 甲状腺过氧化物酶抗体
- 心电图 (ECG)
- 颈部 CT（非增强）
治疗流程
无占位效应的非妊娠非哺乳期成年人
有占位效应的非妊娠非哺乳期成年人
妊娠或哺乳
撰稿人
作者
Elizabeth N. Pearce, MD
Professor of Medicine
Boston University Medical Center
Boston
MA
利益声明
ENP is a member of the Management Council of the Iodine Global Network. She was the 2018-2019 President of the American Thyroid Association (ATA) and served on its board and executive committee until 2020. She is a current member of the ATA's thyroid in pregnancy guidelines writing task force. She is currently a Deputy Editor at the Journal of Clinical Endocrinology and Metabolism and has previously served as an Associated Editor for the journals Thyroid, Endocrine Practice, and Clinical Thyroidology. She is an author of a number of references cited in this topic.
鸣谢
Dr Elizabeth N. Pearce would like to gratefully acknowledge Dr Sheila Feit, the previous contributor to this topic.
同行评议者
John C. Morris, MD
Professor of Medicine
Mayo Clinic
Rochester
MN
利益声明
JCM declares that he has no competing interests.
Petros Perros, BSc, MBBS, MD, FRCP
Consultant Endocrinologist
Freeman Hospital
Newcastle-Upon-Tyne
UK
利益声明
PP declares that he has no competing interests.
鉴别诊断
- Graves 病
- 毒性多结节性甲状腺肿
- 无痛性淋巴细胞性甲状腺炎的甲状腺毒症期
更多 鉴别诊断指南
- 甲状腺结节算法工具白皮书
- 疑似癌症：识别和转诊
更多 指南
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