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甲状腺功能减退症误诊为心包炎 这些经验教训要牢记!

2017-07-24 曾昭耆 刘凤奎 曾昭耆 顾复生 专家临床笔录丛书.内科分册

患者,女,62岁,因胸闷、气短、伴有颜面及下肢水肿三个月就诊。既往有高血压病史10多年,曾诊为高血压性心脏病,给予降压药和利尿药治疗,不见好转。随后胸透示心脏向两侧增大,超声心动图示心包积液,以心包积液原因待查,心包炎?收住院。经一系列诊断后最终确诊为甲状腺功能减退症。从心包炎到甲状腺功能减退症,误诊原因为何?患者,女性,62岁,因胸闷、气短、伴有颜面及下肢水肿三个月就诊,患者近三个月来无明显诱因

患者,女,62岁,因胸闷、气短、伴有颜面及下肢水肿三个月就诊。既往有高血压病史10多年,曾诊为高血压性心脏病,给予降压药和利尿药治疗,不见好转。随后胸透示心脏向两侧增大,超声心动图示心包积液,以心包积液原因待查,心包炎?收住院。经一系列诊断后最终确诊为甲状腺功能减退症。从心包炎到甲状腺功能减退症,误诊原因为何?

患者,女性,62岁,因胸闷、气短、伴有颜面及下肢水肿三个月就诊,患者近三个月来无明显诱因逐渐感觉做家务或行走过多时就感心悸,胸闷,气短,休息后减轻,无胸痛,不咳嗽,无咯血,同时出现水肿,以下肢为重,自觉疲乏无力。既往有高血压病史10多年,曾诊为高血压性心脏病,给予降压药和利尿药治疗,不见好转,因水肿成为突出表现而多次来门诊检查尿常规,肾功能,肝功能均未见异常。入院前一周因受凉后咽痛,轻咳,无痰,低热,胸闷、气短加重再次到医院就诊,胸透示心脏向两侧增大,超声心动图示心包积液,心电图显示低电压,各导联ST段低平,T波倒置,以心包积液原因待查,心包炎?收住院。

查体 轻度贫血貌,表情淡漠,头发稀少,颜面水肿,全身皮肤粗糙,无皮疹及出血点,浅表淋巴结不大,巩膜无黄染,咽充血,扁桃体不大,未见颈静脉充盈,甲状腺不大,无震颤及血管杂音,心界增大,心率60次/分,律齐,心音减弱,各瓣膜区未闻杂音,两肺正常,腹平软,无压痛,肝脾不大,无腹水征,双下肢明显水肿。

辅助检查 血红蛋白100g/L,白细胞6.8 ×109/L,血小板120 ×109/L,尿蛋白阴性,镜下未见红、白细胞及管型,胸片心界向两侧增大,两肺纹理稍重,心电图、超声心动图检查同门诊检查,复查肝肾功能仍正常。

住院经过:入院后按结核性心包炎治疗一个月,水肿仍不减退,后经详细询问病史,得知患者于13年前患有甲状腺功能亢进(甲亢)症,用过放射性核素(同位素)131I治疗,当时为排除甲状腺功能减退的可能,而作甲状腺功能检查,结果T 3,T 4明显降低,TSH升高,血胆固醇,甘油三酯均增高,最后确诊为甲状腺功能减退症。给予甲状腺素治疗后症状很快好转。

误诊原因

1﹒患者水肿的同时有心悸,气短,胸闷等循环系统症状,加之既往有高血压病史,故最初误诊为高血压性心脏病,心功能不全,后出现心包积液而诊为心包炎。

2﹒未能仔细注意患者除水肿表现外,面部的表情、皮肤的粗糙、毛发的脱落、心率减慢等都是甲低的典型表现,未能给予足够的重视。

3﹒既往病史了解不全面,最初未问出患者有甲状腺功能亢进史,特别是用过放射性核素(同位素)治疗,这是引起甲状腺功能减退的常见的原因。

讨论 甲状腺功能减退症多见于中年女性,起病缓慢,多是由甲状腺本身疾病所致,常见的病因有:

1﹒炎症 如自身免疫性甲状腺炎。

2﹒放疗 如131I治疗。

3﹒甲状腺大部或全部切除后。

4﹒缺碘。

5﹒遗传因素或基因突变等。

6﹒其他 如甲状腺内广泛转移癌等。

诊断临床表现外,主要依靠检测TT 4、TT 3、FT 3、FT 4、TSH以及TRH兴奋试验等确立诊断。

甲亢误诊率较高,典型病例虽诊断不难,但目前并不常见,因甲状腺功能亢进可出现全身各系统症状,以不明原因的发热为突出表现,而误诊为感染;以心律失常特别是心房纤颤为突出表现而误诊为心脏病;以失眠、多汗、烦躁易怒、情绪不稳为突出表现而误诊为神经症;以慢性腹泻为突出表现误诊为消化系统疾病;以不明原因消瘦为突出表现而怀疑到肿瘤性疾病等。因此,医生对甲亢可能出现的各种临床表现应该十分熟悉,全面细致的询问病史和进行体格检查,做必要的实验室检查,以免误诊。

甲亢多发生在20~40岁女性,起病多数缓慢,主要由于甲状腺激素分泌过多引起的综合征,常见的临床表现有:

1﹒高代谢综合征 表现为疲乏无力,怕热多汗,皮肤温暖潮湿,体重下降,低热等。

2﹒精神神经症状 神经过敏,多言好动,紧张焦虑,烦躁易怒,失眠,记忆力减退,手震颤,腱反射亢进等。

3﹒心血管系统 心悸、胸闷、气短,严重者可发生甲亢性心脏病,表现为心动过速、心律失常、心音亢进、收缩压升高、脉压增大。

4﹒消化系统 食欲亢进,腹泻。

其他如肌肉骨骼系统、血液系统、生殖系统、内分泌系统都可能受到一定的影响。由于甲亢可有上述多种症状,因而容易造成误诊,必须全面分析临床表现,及时做有关检查

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  1. [GetPortalCommentsPageByObjectIdResponse(id=1204183, encodeId=d1d712041836a, content=因甲状腺功能亢进可出现全身各系统症状,以不明原因的发热为突出表现,而误诊为感染;以心律失常特别是心房纤颤为突出表现而误诊为心脏病;以失眠、多汗、烦躁易怒、情绪不稳为突出表现而误诊为神经症;以慢性腹泻为突出表现误诊为消化系统疾病;以不明原因消瘦为突出表现而怀疑到肿瘤性疾病等。因此,医生对甲亢可能出现的各种临床表现应该十分熟悉,全面细致的询问病史和进行体格检查,做必要的实验室检查,以免误诊。 受教了。。。, beContent=null, objectType=article, channel=null, level=null, likeNumber=81, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=d1b96561006, createdName=ms3000002130676735, createdTime=Sat Mar 19 20:02:12 CST 2022, time=2022-03-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=344374, encodeId=60db3443e42a, content=甲减怎么说甲亢了, beContent=null, objectType=article, channel=null, level=null, likeNumber=112, replyNumber=1, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=0af42337291, createdName=12282355m97暂无昵称, createdTime=Mon Sep 10 15:57:59 CST 2018, time=2018-09-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=227663, encodeId=578122e66305, content=厉害厉害……学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=116, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3zMoyicyo6ia9f4IuLQAwZoxD6Hx4ibd5CMcOCYhStY6oDibbKK6O2X8iaicldO5ib8j1iapOIobIKCGiczU2A/0, createdBy=56251941490, createdName=虈亣靌, createdTime=Sat Jul 29 12:34:56 CST 2017, time=2017-07-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1416146, encodeId=789514161462c, content=<a href='/topic/show?id=f8db509110b' target=_blank style='color:#2F92EE;'>#心包炎#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=50911, encryptionId=f8db509110b, topicName=心包炎)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=e0a83138883, createdName=zhao4617, createdTime=Wed Jul 26 13:51:00 CST 2017, time=2017-07-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=226168, encodeId=720422616812, content=这个患者初看还真是像心血管系统疾病,认真询问病史对疾病诊断确实很关键, beContent=null, objectType=article, channel=null, level=null, likeNumber=1, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/oLAjfB7s1ib06iaV3D9Tg5K5AUIp06ZHYl7A2dPOY0ybQ9bdicIc4f0Y8OcHQpWODqTsgoTW72F0kz3e5SxANBicWMAibrN7nj5y1/0, createdBy=f4ec1960014, createdName=Arya2692, createdTime=Tue Jul 25 13:41:46 CST 2017, time=2017-07-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=226078, encodeId=bf0f2260e8f8, content=学习学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=119, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=93f31631454, createdName=1dd8c52fm63(暂无匿称), createdTime=Tue Jul 25 07:44:13 CST 2017, time=2017-07-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=226040, encodeId=28a2226040d7, content=学习了谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=96, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=00501987275, createdName=130****4638, createdTime=Tue Jul 25 07:21:35 CST 2017, time=2017-07-25, status=1, ipAttribution=)]
    2022-03-19 ms3000002130676735

    因甲状腺功能亢进可出现全身各系统症状,以不明原因的发热为突出表现,而误诊为感染;以心律失常特别是心房纤颤为突出表现而误诊为心脏病;以失眠、多汗、烦躁易怒、情绪不稳为突出表现而误诊为神经症;以慢性腹泻为突出表现误诊为消化系统疾病;以不明原因消瘦为突出表现而怀疑到肿瘤性疾病等。因此,医生对甲亢可能出现的各种临床表现应该十分熟悉,全面细致的询问病史和进行体格检查,做必要的实验室检查,以免误诊。 受教了。。。

    0

  2. [GetPortalCommentsPageByObjectIdResponse(id=1204183, encodeId=d1d712041836a, content=因甲状腺功能亢进可出现全身各系统症状,以不明原因的发热为突出表现,而误诊为感染;以心律失常特别是心房纤颤为突出表现而误诊为心脏病;以失眠、多汗、烦躁易怒、情绪不稳为突出表现而误诊为神经症;以慢性腹泻为突出表现误诊为消化系统疾病;以不明原因消瘦为突出表现而怀疑到肿瘤性疾病等。因此,医生对甲亢可能出现的各种临床表现应该十分熟悉,全面细致的询问病史和进行体格检查,做必要的实验室检查,以免误诊。 受教了。。。, beContent=null, objectType=article, channel=null, level=null, likeNumber=81, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=d1b96561006, createdName=ms3000002130676735, createdTime=Sat Mar 19 20:02:12 CST 2022, time=2022-03-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=344374, encodeId=60db3443e42a, content=甲减怎么说甲亢了, beContent=null, objectType=article, channel=null, level=null, likeNumber=112, replyNumber=1, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=0af42337291, createdName=12282355m97暂无昵称, createdTime=Mon Sep 10 15:57:59 CST 2018, time=2018-09-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=227663, encodeId=578122e66305, content=厉害厉害……学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=116, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3zMoyicyo6ia9f4IuLQAwZoxD6Hx4ibd5CMcOCYhStY6oDibbKK6O2X8iaicldO5ib8j1iapOIobIKCGiczU2A/0, createdBy=56251941490, createdName=虈亣靌, createdTime=Sat Jul 29 12:34:56 CST 2017, time=2017-07-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1416146, encodeId=789514161462c, content=<a href='/topic/show?id=f8db509110b' target=_blank style='color:#2F92EE;'>#心包炎#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=50911, encryptionId=f8db509110b, topicName=心包炎)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=e0a83138883, createdName=zhao4617, createdTime=Wed Jul 26 13:51:00 CST 2017, time=2017-07-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=226168, encodeId=720422616812, content=这个患者初看还真是像心血管系统疾病,认真询问病史对疾病诊断确实很关键, beContent=null, objectType=article, channel=null, level=null, likeNumber=1, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/oLAjfB7s1ib06iaV3D9Tg5K5AUIp06ZHYl7A2dPOY0ybQ9bdicIc4f0Y8OcHQpWODqTsgoTW72F0kz3e5SxANBicWMAibrN7nj5y1/0, createdBy=f4ec1960014, createdName=Arya2692, createdTime=Tue Jul 25 13:41:46 CST 2017, time=2017-07-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=226078, encodeId=bf0f2260e8f8, content=学习学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=119, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=93f31631454, createdName=1dd8c52fm63(暂无匿称), createdTime=Tue Jul 25 07:44:13 CST 2017, time=2017-07-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=226040, encodeId=28a2226040d7, content=学习了谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=96, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=00501987275, createdName=130****4638, createdTime=Tue Jul 25 07:21:35 CST 2017, time=2017-07-25, status=1, ipAttribution=)]
    2018-09-10 12282355m97暂无昵称

    甲减怎么说甲亢了

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  3. [GetPortalCommentsPageByObjectIdResponse(id=1204183, encodeId=d1d712041836a, content=因甲状腺功能亢进可出现全身各系统症状,以不明原因的发热为突出表现,而误诊为感染;以心律失常特别是心房纤颤为突出表现而误诊为心脏病;以失眠、多汗、烦躁易怒、情绪不稳为突出表现而误诊为神经症;以慢性腹泻为突出表现误诊为消化系统疾病;以不明原因消瘦为突出表现而怀疑到肿瘤性疾病等。因此,医生对甲亢可能出现的各种临床表现应该十分熟悉,全面细致的询问病史和进行体格检查,做必要的实验室检查,以免误诊。 受教了。。。, beContent=null, objectType=article, channel=null, level=null, likeNumber=81, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=d1b96561006, createdName=ms3000002130676735, createdTime=Sat Mar 19 20:02:12 CST 2022, time=2022-03-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=344374, encodeId=60db3443e42a, content=甲减怎么说甲亢了, beContent=null, objectType=article, channel=null, level=null, likeNumber=112, replyNumber=1, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=0af42337291, createdName=12282355m97暂无昵称, createdTime=Mon Sep 10 15:57:59 CST 2018, time=2018-09-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=227663, encodeId=578122e66305, content=厉害厉害……学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=116, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3zMoyicyo6ia9f4IuLQAwZoxD6Hx4ibd5CMcOCYhStY6oDibbKK6O2X8iaicldO5ib8j1iapOIobIKCGiczU2A/0, createdBy=56251941490, createdName=虈亣靌, createdTime=Sat Jul 29 12:34:56 CST 2017, time=2017-07-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1416146, encodeId=789514161462c, content=<a href='/topic/show?id=f8db509110b' target=_blank style='color:#2F92EE;'>#心包炎#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=50911, encryptionId=f8db509110b, topicName=心包炎)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=e0a83138883, createdName=zhao4617, createdTime=Wed Jul 26 13:51:00 CST 2017, time=2017-07-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=226168, encodeId=720422616812, content=这个患者初看还真是像心血管系统疾病,认真询问病史对疾病诊断确实很关键, beContent=null, objectType=article, channel=null, level=null, likeNumber=1, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/oLAjfB7s1ib06iaV3D9Tg5K5AUIp06ZHYl7A2dPOY0ybQ9bdicIc4f0Y8OcHQpWODqTsgoTW72F0kz3e5SxANBicWMAibrN7nj5y1/0, createdBy=f4ec1960014, createdName=Arya2692, createdTime=Tue Jul 25 13:41:46 CST 2017, time=2017-07-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=226078, encodeId=bf0f2260e8f8, content=学习学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=119, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=93f31631454, createdName=1dd8c52fm63(暂无匿称), createdTime=Tue Jul 25 07:44:13 CST 2017, time=2017-07-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=226040, encodeId=28a2226040d7, content=学习了谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=96, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=00501987275, createdName=130****4638, createdTime=Tue Jul 25 07:21:35 CST 2017, time=2017-07-25, status=1, ipAttribution=)]
    2017-07-29 虈亣靌

    厉害厉害……学习了

    0

  4. [GetPortalCommentsPageByObjectIdResponse(id=1204183, encodeId=d1d712041836a, content=因甲状腺功能亢进可出现全身各系统症状,以不明原因的发热为突出表现,而误诊为感染;以心律失常特别是心房纤颤为突出表现而误诊为心脏病;以失眠、多汗、烦躁易怒、情绪不稳为突出表现而误诊为神经症;以慢性腹泻为突出表现误诊为消化系统疾病;以不明原因消瘦为突出表现而怀疑到肿瘤性疾病等。因此,医生对甲亢可能出现的各种临床表现应该十分熟悉,全面细致的询问病史和进行体格检查,做必要的实验室检查,以免误诊。 受教了。。。, beContent=null, objectType=article, channel=null, level=null, likeNumber=81, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=d1b96561006, createdName=ms3000002130676735, createdTime=Sat Mar 19 20:02:12 CST 2022, time=2022-03-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=344374, encodeId=60db3443e42a, content=甲减怎么说甲亢了, beContent=null, objectType=article, channel=null, level=null, likeNumber=112, replyNumber=1, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=0af42337291, createdName=12282355m97暂无昵称, createdTime=Mon Sep 10 15:57:59 CST 2018, time=2018-09-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=227663, encodeId=578122e66305, content=厉害厉害……学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=116, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3zMoyicyo6ia9f4IuLQAwZoxD6Hx4ibd5CMcOCYhStY6oDibbKK6O2X8iaicldO5ib8j1iapOIobIKCGiczU2A/0, createdBy=56251941490, createdName=虈亣靌, createdTime=Sat Jul 29 12:34:56 CST 2017, time=2017-07-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1416146, encodeId=789514161462c, content=<a href='/topic/show?id=f8db509110b' target=_blank style='color:#2F92EE;'>#心包炎#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=50911, encryptionId=f8db509110b, topicName=心包炎)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=e0a83138883, createdName=zhao4617, createdTime=Wed Jul 26 13:51:00 CST 2017, time=2017-07-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=226168, encodeId=720422616812, content=这个患者初看还真是像心血管系统疾病,认真询问病史对疾病诊断确实很关键, beContent=null, objectType=article, channel=null, level=null, likeNumber=1, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/oLAjfB7s1ib06iaV3D9Tg5K5AUIp06ZHYl7A2dPOY0ybQ9bdicIc4f0Y8OcHQpWODqTsgoTW72F0kz3e5SxANBicWMAibrN7nj5y1/0, createdBy=f4ec1960014, createdName=Arya2692, createdTime=Tue Jul 25 13:41:46 CST 2017, time=2017-07-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=226078, encodeId=bf0f2260e8f8, content=学习学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=119, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=93f31631454, createdName=1dd8c52fm63(暂无匿称), createdTime=Tue Jul 25 07:44:13 CST 2017, time=2017-07-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=226040, encodeId=28a2226040d7, content=学习了谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=96, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=00501987275, createdName=130****4638, createdTime=Tue Jul 25 07:21:35 CST 2017, time=2017-07-25, status=1, ipAttribution=)]
  5. [GetPortalCommentsPageByObjectIdResponse(id=1204183, encodeId=d1d712041836a, content=因甲状腺功能亢进可出现全身各系统症状,以不明原因的发热为突出表现,而误诊为感染;以心律失常特别是心房纤颤为突出表现而误诊为心脏病;以失眠、多汗、烦躁易怒、情绪不稳为突出表现而误诊为神经症;以慢性腹泻为突出表现误诊为消化系统疾病;以不明原因消瘦为突出表现而怀疑到肿瘤性疾病等。因此,医生对甲亢可能出现的各种临床表现应该十分熟悉,全面细致的询问病史和进行体格检查,做必要的实验室检查,以免误诊。 受教了。。。, beContent=null, objectType=article, channel=null, level=null, likeNumber=81, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=d1b96561006, createdName=ms3000002130676735, createdTime=Sat Mar 19 20:02:12 CST 2022, time=2022-03-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=344374, encodeId=60db3443e42a, content=甲减怎么说甲亢了, beContent=null, objectType=article, channel=null, level=null, likeNumber=112, replyNumber=1, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=0af42337291, createdName=12282355m97暂无昵称, createdTime=Mon Sep 10 15:57:59 CST 2018, time=2018-09-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=227663, encodeId=578122e66305, content=厉害厉害……学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=116, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3zMoyicyo6ia9f4IuLQAwZoxD6Hx4ibd5CMcOCYhStY6oDibbKK6O2X8iaicldO5ib8j1iapOIobIKCGiczU2A/0, createdBy=56251941490, createdName=虈亣靌, createdTime=Sat Jul 29 12:34:56 CST 2017, time=2017-07-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1416146, encodeId=789514161462c, content=<a href='/topic/show?id=f8db509110b' target=_blank style='color:#2F92EE;'>#心包炎#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=50911, encryptionId=f8db509110b, topicName=心包炎)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=e0a83138883, createdName=zhao4617, createdTime=Wed Jul 26 13:51:00 CST 2017, time=2017-07-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=226168, encodeId=720422616812, content=这个患者初看还真是像心血管系统疾病,认真询问病史对疾病诊断确实很关键, beContent=null, objectType=article, channel=null, level=null, likeNumber=1, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/oLAjfB7s1ib06iaV3D9Tg5K5AUIp06ZHYl7A2dPOY0ybQ9bdicIc4f0Y8OcHQpWODqTsgoTW72F0kz3e5SxANBicWMAibrN7nj5y1/0, createdBy=f4ec1960014, createdName=Arya2692, createdTime=Tue Jul 25 13:41:46 CST 2017, time=2017-07-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=226078, encodeId=bf0f2260e8f8, content=学习学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=119, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=93f31631454, createdName=1dd8c52fm63(暂无匿称), createdTime=Tue Jul 25 07:44:13 CST 2017, time=2017-07-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=226040, encodeId=28a2226040d7, content=学习了谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=96, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=00501987275, createdName=130****4638, createdTime=Tue Jul 25 07:21:35 CST 2017, time=2017-07-25, status=1, ipAttribution=)]
    2017-07-25 Arya2692

    这个患者初看还真是像心血管系统疾病,认真询问病史对疾病诊断确实很关键

    0

  6. [GetPortalCommentsPageByObjectIdResponse(id=1204183, encodeId=d1d712041836a, content=因甲状腺功能亢进可出现全身各系统症状,以不明原因的发热为突出表现,而误诊为感染;以心律失常特别是心房纤颤为突出表现而误诊为心脏病;以失眠、多汗、烦躁易怒、情绪不稳为突出表现而误诊为神经症;以慢性腹泻为突出表现误诊为消化系统疾病;以不明原因消瘦为突出表现而怀疑到肿瘤性疾病等。因此,医生对甲亢可能出现的各种临床表现应该十分熟悉,全面细致的询问病史和进行体格检查,做必要的实验室检查,以免误诊。 受教了。。。, beContent=null, objectType=article, channel=null, level=null, likeNumber=81, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=d1b96561006, createdName=ms3000002130676735, createdTime=Sat Mar 19 20:02:12 CST 2022, time=2022-03-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=344374, encodeId=60db3443e42a, content=甲减怎么说甲亢了, beContent=null, objectType=article, channel=null, level=null, likeNumber=112, replyNumber=1, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=0af42337291, createdName=12282355m97暂无昵称, createdTime=Mon Sep 10 15:57:59 CST 2018, time=2018-09-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=227663, encodeId=578122e66305, content=厉害厉害……学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=116, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3zMoyicyo6ia9f4IuLQAwZoxD6Hx4ibd5CMcOCYhStY6oDibbKK6O2X8iaicldO5ib8j1iapOIobIKCGiczU2A/0, createdBy=56251941490, createdName=虈亣靌, createdTime=Sat Jul 29 12:34:56 CST 2017, time=2017-07-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1416146, encodeId=789514161462c, content=<a href='/topic/show?id=f8db509110b' target=_blank style='color:#2F92EE;'>#心包炎#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=50911, encryptionId=f8db509110b, topicName=心包炎)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=e0a83138883, createdName=zhao4617, createdTime=Wed Jul 26 13:51:00 CST 2017, time=2017-07-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=226168, encodeId=720422616812, content=这个患者初看还真是像心血管系统疾病,认真询问病史对疾病诊断确实很关键, beContent=null, objectType=article, channel=null, level=null, likeNumber=1, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/oLAjfB7s1ib06iaV3D9Tg5K5AUIp06ZHYl7A2dPOY0ybQ9bdicIc4f0Y8OcHQpWODqTsgoTW72F0kz3e5SxANBicWMAibrN7nj5y1/0, createdBy=f4ec1960014, createdName=Arya2692, createdTime=Tue Jul 25 13:41:46 CST 2017, time=2017-07-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=226078, encodeId=bf0f2260e8f8, content=学习学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=119, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=93f31631454, createdName=1dd8c52fm63(暂无匿称), createdTime=Tue Jul 25 07:44:13 CST 2017, time=2017-07-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=226040, encodeId=28a2226040d7, content=学习了谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=96, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=00501987275, createdName=130****4638, createdTime=Tue Jul 25 07:21:35 CST 2017, time=2017-07-25, status=1, ipAttribution=)]
    2017-07-25 1dd8c52fm63(暂无匿称)

    学习学习

    0

  7. [GetPortalCommentsPageByObjectIdResponse(id=1204183, encodeId=d1d712041836a, content=因甲状腺功能亢进可出现全身各系统症状,以不明原因的发热为突出表现,而误诊为感染;以心律失常特别是心房纤颤为突出表现而误诊为心脏病;以失眠、多汗、烦躁易怒、情绪不稳为突出表现而误诊为神经症;以慢性腹泻为突出表现误诊为消化系统疾病;以不明原因消瘦为突出表现而怀疑到肿瘤性疾病等。因此,医生对甲亢可能出现的各种临床表现应该十分熟悉,全面细致的询问病史和进行体格检查,做必要的实验室检查,以免误诊。 受教了。。。, beContent=null, objectType=article, channel=null, level=null, likeNumber=81, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=d1b96561006, createdName=ms3000002130676735, createdTime=Sat Mar 19 20:02:12 CST 2022, time=2022-03-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=344374, encodeId=60db3443e42a, content=甲减怎么说甲亢了, beContent=null, objectType=article, channel=null, level=null, likeNumber=112, replyNumber=1, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=0af42337291, createdName=12282355m97暂无昵称, createdTime=Mon Sep 10 15:57:59 CST 2018, time=2018-09-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=227663, encodeId=578122e66305, content=厉害厉害……学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=116, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3zMoyicyo6ia9f4IuLQAwZoxD6Hx4ibd5CMcOCYhStY6oDibbKK6O2X8iaicldO5ib8j1iapOIobIKCGiczU2A/0, createdBy=56251941490, createdName=虈亣靌, createdTime=Sat Jul 29 12:34:56 CST 2017, time=2017-07-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1416146, encodeId=789514161462c, content=<a href='/topic/show?id=f8db509110b' target=_blank style='color:#2F92EE;'>#心包炎#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=50911, encryptionId=f8db509110b, topicName=心包炎)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=e0a83138883, createdName=zhao4617, createdTime=Wed Jul 26 13:51:00 CST 2017, time=2017-07-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=226168, encodeId=720422616812, content=这个患者初看还真是像心血管系统疾病,认真询问病史对疾病诊断确实很关键, beContent=null, objectType=article, channel=null, level=null, likeNumber=1, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/oLAjfB7s1ib06iaV3D9Tg5K5AUIp06ZHYl7A2dPOY0ybQ9bdicIc4f0Y8OcHQpWODqTsgoTW72F0kz3e5SxANBicWMAibrN7nj5y1/0, createdBy=f4ec1960014, createdName=Arya2692, createdTime=Tue Jul 25 13:41:46 CST 2017, time=2017-07-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=226078, encodeId=bf0f2260e8f8, content=学习学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=119, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=93f31631454, createdName=1dd8c52fm63(暂无匿称), createdTime=Tue Jul 25 07:44:13 CST 2017, time=2017-07-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=226040, encodeId=28a2226040d7, content=学习了谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=96, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=00501987275, createdName=130****4638, createdTime=Tue Jul 25 07:21:35 CST 2017, time=2017-07-25, status=1, ipAttribution=)]
    2017-07-25 130****4638

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