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患者女,43岁。发现前颈肿大并心悸、消瘦,食欲亢进且易饥、怕热多汗2月余就诊。既往健康。体检:无突眼征,巩膜轻度黄染。甲状腺肿大Ⅱ度,可闻及血管杂音。心率106次/分,律齐,各瓣膜听诊区未闻病理性杂音。肺(-)。腹软,肝脾肋下未触及。检验:白细胞8×10~9/L,中性0.69,淋巴0.31。红细胞4.3×10~(12)/L,血红蛋白120g/L,网织红细胞0.01,尿、粪常规(-)。肝功能:麝香草酚浊度5u,谷丙转氨酶<25u(正常值:赖氏法25单位以下),总胆红素29.6μmol/L,直接胆红素<6μmol/L。血清T_36.8nmol/L,T_4255nmol/L。胸透(-)。诊断:(1)甲状腺功能亢进症(下称甲亢);(2)黄疸原因待查。于1992年4月3日入院。 入院后详细询问病史,患者巩膜黄染自青年时期已出现,但无任何自觉症状。黄疸时隐时现,酒后或疲劳时黄疸加重。2月前发现前颈肿大、心悸时巩膜黄染明显。否认肝炎及黄疸家族史。入院后复查肝功能(结果与门诊检验一致),乙型肝炎表面抗原(HB-sAg)阴性。尿常规正常,二胆(-)。硷性磷酸酶9.2金氏单位,甲胎蛋白正常。血清铁16.7μmol/L。
Female patient, 43 years old. Found before the neck swelling and palpitations, weight loss, appetite hyperthyroidism and easy to hunger, afraid of hot sweating more than 2 months treatment. Past health. Physical examination: no prominent eye sign, scleral mild yellow dye. Goiter Ⅱ degree, can be heard and vascular murmur. Heart rate 106 beats / min, law Qi, the valve auscultation area is not heard pathological murmur. lung(-). Abdominal soft, liver and spleen ribs did not touch. Test: white blood cells 8 × 10 ~ 9 / L, neutral 0.69, lymph 0.31. Erythrocyte 4.3 × 10-12 / L, hemoglobin 120g / L, reticulocyte 0.01, urine, feces routine (-). Liver function: Thymol turbidity 5u, alanine aminotransferase <25u (normal: Lai’s method of 25 units or less), total bilirubin 29.6μmol / L, direct bilirubin <6μmol / L. Serum T_36.8nmol / L, T_4255nmol / L. Chest throat (-). Diagnosis: (1) hyperthyroidism (hereinafter referred to as hyperthyroidism); (2) the cause of jaundice to be investigated. Admitted to hospital on April 3, 1992. After admission to ask a detailed history, the patient scleral yellow dye has emerged since youth, but without any symptoms. Jaundice when the hidden, drunk or fatigue jaundice increased. 2 months ago found the anterior neck enlargement, palpitations scleral yellow dye obvious. Denied hepatitis and jaundice family history. After admission, recheck liver function (results consistent with outpatient examination), hepatitis B surface antigen (HB-sAg) negative. Urinary routine normal, two gallbladder (-). 9.2 alkaline phosphatase units, alpha-fetoprotein normal. Serum iron 16.7μmol / L.