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甲状腺功能亢进的诊断

Author
Douglas S Ross, MD
Section Editor
David S Cooper, MD
Deputy Editor
Jean E Mulder, MD
Translators
王转锁, 副主任医师

引言

有明确甲状腺功能亢进(简称“甲亢”)的临床和生化表现的患者，诊断通常很明显。其他患者临床体征较少且不太明显，但有甲状腺功能亢进的确切生化表现。还有一些患者没有或几乎没有临床甲状腺功能亢进，而唯一的生化异常是血清促甲状腺激素(thyroid-stimulating hormone, TSH)浓度低，这时被称为亚临床甲亢。

本文将首先简要讨论甲状腺功能亢进的临床表现，之后介绍甲状腺功能亢进患者的诊断和评估。甲亢临床表现的概述、引起甲亢的疾病、妊娠期甲亢的诊断，以及亚临床型甲亢将会单独详细讨论。 (参见“成人甲状腺功能亢进症临床表现概述”和“引起甲状腺功能亢进症的疾病”和“妊娠期甲状腺功能亢进：临床表现、诊断和病因”和“亚临床甲状腺功能亢进症”)

临床表现

症状

显性甲亢 — 大多数显性甲亢的患者有一系列显著的症状。典型情况下，这些症状包括焦虑、情绪不稳、虚弱、震颤、心悸、不耐热、出汗增加，以及尽管食欲正常或增加仍出现的体重减轻[1,2]。

虽然合并体重减轻和食欲增加是一个特征性表现，但也有些患者由于过度食欲刺激导致体重增加，尤其是较年轻患者[1]。其他可能出现的症状包括便次增多(不是腹泻)、尿频、女性月经稀发或闭经、男性乳房发育和阴茎勃起功能障碍[3,4]。 (参见“成人甲状腺功能亢进症临床表现概述”)

较轻的症状 — 轻度甲亢和年龄较大的患者常有涉及一个或仅几个器官系统的症状[5]。对于任何年龄的患者，若出现孤立的症状和体征时也需要对甲亢进行评估，包括无法解释的体重减轻、新发的心房颤动、肌病、月经失调和男性乳房发育。

                        

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Literature review current through: 2017-06 . | This topic last updated: 2017-04-10.
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