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目的提高对儿童桥本甲状腺炎(HT)的认识,达到早期诊断及治疗的目的,进而改善其预后。方法本研究对55例HT患儿的临床资料进行回顾性分析,包括临床症状、体征、辅助检查、并发症及治疗方案。辅助检查方面,患儿均完善游离甲状腺素(FT4)、游离三碘甲状腺氨酸(FT3)、促甲状腺激素(TSH)、甲状腺球蛋白抗体(TGAb)、甲状腺过氧化物酶抗体(TPOAb)及甲状腺彩超检查,患儿行血常规(45例)、肝功能(35例)、血脂系列(29例)、下丘脑垂体增强磁共振(9例)等检查。结果 55例患儿中,男10例,女45例。临床表现复杂多样。其中发现甲状腺大38例、身材矮小15例、乏力20例,另有患儿存在纳差、便秘、学习成绩差、贫血等改变。34例在首次就诊时处于甲状腺功能减低(甲低)期,12例处于亚临床甲低期,7例处于甲状腺功能亢进期,2例处于甲状腺功能正常期。甲状腺彩超的典型改变是甲状腺弥散性改变,轻中度增大,峡部增厚明显,甲状腺回声粗糙、不均匀、减弱,8例呈网格样改变,9例内有结节。患儿心脏(11例)、垂体(5例)、肌肉(2例)、肝功能(2例)、血脂(18例)等存在异常。结论 HT患儿可表现出多种多样的症状和体征,多以颈部增粗、身材矮小为主诉就诊,就诊时大部分患儿处于甲低期,临床医师应详细询问患儿病史,仔细查体,完善辅助检查,做到早期诊断及治疗以改善预后。
Objective To improve the cognition of children with Hashimoto’s thyroiditis (HT) and to achieve the purpose of early diagnosis and treatment, and to improve their prognosis. Methods The clinical data of 55 cases of HT children were retrospectively analyzed, including clinical symptoms, signs, auxiliary examinations, complications and treatment regimens. In the auxiliary examinations, all patients had perfect FT4, FT3, TSH, TGAb, TPOAb and Thyroid ultrasonography, routine blood tests (45 cases), liver function (35 cases), blood lipid series (29 cases), hypothalamic pituitary enhancement (9 cases) and other tests. Results 55 cases of children, 10 males and 45 females. Complex and diverse clinical manifestations. Among them, 38 cases of thyroid gland, 15 cases of short stature and 20 cases of weakness were found. In addition, there was anorexia, constipation, poor academic performance and anemia. Thirty-four patients were in hypothyroidism at first visit, 12 in subclinical hypothyroidism, 7 in hyperthyroidism, and 2 in normal thyroid function. A typical thyroid color Doppler ultrasound changes diffuse thyroid, mild to moderate increase, thickened isthmus, thyroid echo rough, uneven, weakened, 8 cases were grid-like changes, nodules in 9 cases. There were abnormalities in children’s heart (11 cases), pituitary (5 cases), muscle (2 cases), liver function (2 cases) and blood lipid (18 cases). Conclusion HT children can show a variety of symptoms and signs, mostly to the neck thickening, short stature as the main complaint treatment, the majority of children at treatment is in a low stage, clinicians should ask in detail the history of children, carefully check Body, improve the auxiliary examination, early diagnosis and treatment to improve the prognosis.