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目的探讨老年甲状腺功能亢进(甲亢)患者临床表现及甲状腺激素、血糖、血脂代谢特点,从而引出临床诊断及治疗的注意事项。方法随机抽取甲亢Graves’病患者146例。根据年龄分为老年组(年龄≥60,n=56)和非老年组(年龄<60,n=90),对病例行回顾性分析。结果 (1)老年组临床症状不典型发生率较非老年组高,差异有统计学意义(χ2=36.12,P<0.05)。老年组甲状腺结节、心律失常、房颤、心衰的发生率较非老年组明显升高,而弥漫性甲状腺肿大、突眼的发生率明显低于非老年组,差异有统计学意义(χ2=41.67,P<0.05);(2)老年组血清总三碘甲状腺原氨酸(TT3)、血清总甲状腺素(TT4)、游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)较非老年组低,而促甲状腺素(TSH)、空腹血糖、总胆固醇、甘油三酯、低密度脂蛋白、载脂蛋白-B、载脂蛋白-α比非老年组高,差异有统计学意义(P<0.05)。结论 (1)老年甲亢患者临床症状不典型,甲状腺结节、心律失常、房颤、心衰的发生率高,而甲状腺弥漫性肿大、突眼的发生率较低;(2)老年甲亢患者TT3、TT4的测定没有FT3、FT4敏感,TSH明显高于非老年患者;(3)老年甲亢患者易出现糖、脂代谢紊乱,且临床易误诊、漏诊。
Objective To investigate the clinical manifestations of elderly patients with hyperthyroidism (Hyperthyroidism) and thyroid hormone, blood glucose, lipid metabolism characteristics, leading to clinical diagnosis and treatment considerations. Methods A total of 146 patients with hyperthyroidism Graves’ disease were randomly selected. The patients were divided into the elderly group (age≥60, n = 56) and the non-elderly group (age≤60, n = 90) according to their age. The cases were retrospectively analyzed. Results (1) The incidence of atypical clinical symptoms in the elderly group was higher than that in the non-elderly group (χ2 = 36.12, P <0.05). The incidence of thyroid nodules, arrhythmia, atrial fibrillation and heart failure in the elderly group was significantly higher than that in the non-elderly group, while the incidence of diffuse goiter and exophthalmos was significantly lower than that in the non-elderly group (the difference was statistically significant χ2 = 41.67, P <0.05); (2) The levels of total triiodothyronine (TT3), total thyroxine (TT4), free triiodothyronine (FT3), free thyroxine ) Were lower than those in the non-elderly group, while TSH, fasting blood glucose, total cholesterol, triglyceride, low density lipoprotein, apolipoprotein-B and apolipoprotein- Significance (P <0.05). Conclusions (1) The clinical manifestations of elderly patients with hyperthyroidism are not typical, thyroid nodules, arrhythmias, atrial fibrillation, high incidence of heart failure, and diffuse thyroid enlargement, the incidence of exophthalmos is low; (2) elderly patients with hyperthyroidism TT3, TT4 determination without FT3, FT4 sensitive, TSH was significantly higher than non-elderly patients; (3) elderly hyperthyroidism prone to sugar and lipid metabolism, and clinical misdiagnosis, missed diagnosis.