小结
定义
病史和体格检查
关键诊断因素
- 存在的危险因素
- 甲状腺肿
其他诊断因素
- 怕热、食欲亢进、或体重减轻
- 抑郁症
- 神经紧张或者心悸
- 月经稀发
- 排便次数增多
- 目光凝视或睑后退
- 皮肤温热、潮湿
- 心动过速
- 脉搏不规则
- 震颤
- 肌无力
- 呼吸短促或哽噎感
- Pemberton征
危险因素
- 碘缺乏
- 年龄＞40 岁
- 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
- 促甲状腺素 (TSH)
需考虑的检查
- 游离 T4（或总 T4加结合量的测定）
- 总 T3 加结合量的测定（或游离 T3）
- I-123 甲状腺扫描和摄取
- Tc-99 高锝酸盐扫描
- 甲状腺超声
- 生化检查
- 全血细胞计数 (FBC）
- 甲状腺过氧化物酶抗体
- TSH 受体抗体
- 心电图 (ECG)
- 颈部 CT（非增强）
治疗流程
无占位效应或怀疑患有癌症的非妊娠非哺乳期成年人
占位效应或者怀疑患有癌症
无占位效应或怀疑患有癌症的妊娠或哺乳期患者
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, a previous contributor to this topic. SF was previously employed by BMJ.
同行评议者
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.
Ronald Merrell, MD, FACS
Professor of Surgery
Virginia Commonwealth University
Richmond
VA
利益声明
RM declares that he has no competing interests.
鉴别诊断
- Graves 病
- 毒性腺瘤
- 无痛性/淋巴细胞性甲状腺炎甲状腺毒症期
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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