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目的探讨儿童桥本甲状腺炎(HT)伴甲状腺功能亢进(甲亢)的临床特点、诊断方法、治疗及预后。方法对56例HT伴甲亢患儿的临床特征、合并症等临床资料,甲状腺激素、甲状腺抗体、甲状腺超声检查、甲状腺细针吸取细胞学检查等辅助检查,以及诊断、治疗、随访结果进行回顾性分析。结果 56例HT伴甲亢患儿男女比例1 6,年龄(9.95±2.09)岁。其中88%的患儿有甲状腺大,甲状腺球蛋白抗体(TGAb)阳性率为93%,甲状腺过氧化物酶抗体(TPOAb)阳性率为98%,1例合并重症肌无力眼肌型。治疗随访1～26个月,甲亢持续时间3～24个月,56例患儿中14例转化为甲状腺功能低下,8例甲状腺功能恢复正常。结论儿童HT伴甲亢多见于青春期女性,TGAb和TPOAb是HT诊断的重要指标,HT伴甲亢应首选药物治疗。HT伴甲亢是HT的一个临床过程,随着病程延长,有转化为甲状腺功能低下的趋势。
Objective To investigate the clinical features, diagnosis, treatment and prognosis of Hashimoto’s thyroiditis (HT) with hyperthyroidism (Hyperthyroidism). Methods The clinical features, complications and other clinical data of 56 HT patients with hyperthyroidism were retrospectively analyzed with the help of thyroid hormone, thyroid antibody, thyroid ultrasonography, thyroid fine needle aspiration cytology and other diagnostic, therapeutic and follow-up results analysis. Results 56 cases of HT patients with hyperthyroidism male to female ratio of 16, age (9.95 ± 2.09) years. 88% of them had thyroid gland, the positive rate of thyroglobulin antibody (TGAb) was 93%, the positive rate of thyroid peroxidase antibody (TPOAb) was 98%, and one patient had myasthenia gravis type. Treatment followed up for 1 to 26 months, duration of hyperthyroidism 3 to 24 months, 56 cases of children converted to hypothyroidism in 14 cases, 8 cases of thyroid function returned to normal. Conclusions HT hyperthyroidism is more common in adolescent women than in adolescent girls. TGAb and TPOAb are important indicators in the diagnosis of HT. HT with hyperthyroidism should be the drug of choice. HT with hyperthyroidism is a clinical course of HT, with the extension of the course, there is a trend of conversion to hypothyroidism.