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患者女,20岁。因双膝关节疼痛、行走不便8个月,加重2个月,于1994年8月6日住入我院外科。查体:气管居中,甲状腺不大,于甲状腺右内下气管旁扪及一如小指节大小、活动、无波动感的肿物。四肢各关节,除双膝关节活动受限、肿胀、压痛外,其余均正常。无其它异常发现。8月12日抽血用RIA法测血清甲状旁腺素(PTH)中端异常增高,达5.78μg/L(578ng/dl;我院正常参考值<30ng/dl)。同时测血清降钙素(CT)、骨钙素(BGP)均显著增高。结合血钙、血磷的异常及X线检查显示骨质疏松、脱钙、骨软化和鱼骨样变,诊断为原发性甲状旁腺机能亢进症(骨型)。9月2日在颈丛神经麻醉下,手术摘
The patient is 20 years old. Due to pain in both knees and inconvenience in walking for 8 months, he was admitted for 2 months and was admitted to our hospital on August 6, 1994. Physical examination: The trachea is centered, and the thyroid gland is small. It is located near the right inner and lower trachea of the thyroid and is similar to the size, activity, and non-fluctuating tumor of the small phalanx. All joints in the extremities were normal except for the limited activities of the double knee joints, swelling, and tenderness. No other abnormalities found. Blood samples collected on August 12 were detected by RIA and abnormally increased in the middle of PTH, reaching 5.78 μg/L (578 ng/dl; our hospital’s normal reference value was less than 30 ng/dl). At the same time, serum calcitonin (CT) and osteocalcin (BGP) were significantly increased. In combination with abnormalities of serum calcium and phosphorus, and X-ray examination, osteoporosis, decalcification, osteomalacia, and osseous changes were diagnosed as primary hyperparathyroidism (bone type). On September 2 under cervical plexus anesthesia, surgery was performed