摘要
少部分甲状腺功能减退症(甲减)患者发生双手黏液性水肿伴手小关节痛,易误诊为类风湿关节炎。笔者曾收治1例70岁女性患者,入院前10年出现双手弥漫性肿胀,近1年出现双手多个近端、远端指间关节及左手腕桡侧痛。X线摄片检查示上述关节面及关节边缘骨质囊状侵蚀,边缘硬化,关节间隙变窄,RF及抗环瓜氨酸肽抗体均阴性。患者30年前曾行甲状腺同位素治疗,查甲状腺激素水平提示甲减。诊断考虑继发性甲减合并手侵蚀性骨关节炎。予左甲状腺素、盐酸氨基葡萄糖及美洛昔康等治疗后全身症状及关节肿痛明显好转。国外亦有继发性甲减合并侵蚀性骨关节炎的个案报道,但侵蚀性骨关节炎是否继发于甲减值得进一步关注。
Uncommon symptoms e. g. hands myxedema and pain in small joints of hands in hypothyroidism pa- tients might be misdiagnosed as rheumatoid arthritis. We have treated a 70-year-old female patient, who com- plained of diffuse swelling of the hands 10 years before admission and severe pain in multiple proximal, distal inter- phalangeal joints and the radial side of left wrist for 1 year. X-ray showed cystic erosion in the articular surface and edge, marginal sclerosis, narrowed joint space in the related joints. Laboratory findings showed rheumatoid factor and anti-cyclic citrullinated peptide antiboy negative, Free three iodine thyeonine （FT3） normal, free thyroxine （FT4） declined and thyroid stimulating hormone （TSH） rised. She underwent thyroid isotope therapy 30 years ago and the latest thyroid hormone level suggested hypothyroidism. She was diagnosed secondary hypothyroidism and hand erosive osteoarthritis. After treated with thyroxine, glucosamine hydrochloride and meloxicam, her symp- toms were remarkably improved. Several case reports revealed secondary hypothyroidism combined with erosion os- teoarthritis. However their relationships require further research.
出处
《新医学》
2013年第4期285-287,共3页
Journal of New Medicine
