巴塞杜氏病的非典型临床病程混淆了甲状腺机能亢进症的鉴别诊断。

IF 1.2 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Journal of Nippon Medical School Pub Date : 2024-03-09 Epub Date: 2023-12-08 DOI:10.1272/jnms.JNMS.2024_91-104
Yuji Yamaguchi, Fumitaka Okajima, Hitoshi Sugihara, Masato Iwabu, Naoya Emoto
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引用次数: 0

摘要

研究背景本研究探讨了当前甲亢患者无痛性甲状腺炎和巴塞杜氏病(GD)鉴别诊断范式的适宜性:我们回顾性评估了2011年1月至2017年12月在我院连续接受Tc-99m过硫酸盐甲状腺摄取率(TcTU)检测确诊的343例甲亢患者的临床病程:在263例TcTU水平正常或偏高(≥1.0%)的患者中,255例(97%)为明确GD,5例为自发缓解GD或不典型GD。在 10 名 TcTU 水平较低的患者中(结论:TcTU 水平较低的患者可能是非典型 GD:鉴于非典型 GD 可能会混淆甲亢的诊断,因此无论诊断结果如何,都必须将患者作为初步诊断进行随访。这是第一份报告,它清楚地表明,迄今为止还没有诊断 GD 的金标准。因此,当务之急是就 GD 的定义达成共识,以便确定未来诊断测试的特异性和敏感性。
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Atypical Clinical Courses of Graves' Disease Confound Differential Diagnosis of Hyperthyroidism.

Background: This study examined the appropriateness of the current paradigm for differential diagnosis of painless thyroiditis and Graves' disease (GD) in patients with thyrotoxicosis.

Methods: We retrospectively evaluated the clinical course of 343 consecutive patients with hyperthyroidism diagnosed by Tc-99m pertechnetate thyroid uptake (TcTU) testing at our hospital from January 2011 to December 2017.

Results: Of the 263 patients with normal or high TcTU levels (≥1.0%), 255 (97%) had unequivocal GD and 5 had spontaneous remission GD or atypical GD. Of the 10 patients with low TcTU levels (<1.0% and ≥0.5%), 7 had GD, while others had subclinical GD, spontaneous remission GD with later relapse, and painless thyroiditis. Of those with very low TcTU levels (<0.5%), most had thyroiditis (painless thyroiditis, 33/67 [49%]; subacute thyroiditis, 29/67 [43%]), and some were positive for anti-TSH receptor antibodies.

Conclusion: Given that atypical GD may confound the diagnosis of thyrotoxicosis, it is essential to follow the patient as a tentative diagnosis, whatever the diagnosis. This is the first report clearly demonstrating that so far there is no gold standard for the diagnosis of GD. It is therefore urgent to establish a consensus on the definition of GD so that the specificity and sensitivity of future diagnostic tests can be determined.

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来源期刊
Journal of Nippon Medical School
Journal of Nippon Medical School MEDICINE, GENERAL & INTERNAL-
CiteScore
1.80
自引率
10.00%
发文量
118
期刊介绍: The international effort to understand, treat and control disease involve clinicians and researchers from many medical and biological science disciplines. The Journal of Nippon Medical School (JNMS) is the official journal of the Medical Association of Nippon Medical School and is dedicated to furthering international exchange of medical science experience and opinion. It provides an international forum for researchers in the fields of bascic and clinical medicine to introduce, discuss and exchange thier novel achievements in biomedical science and a platform for the worldwide dissemination and steering of biomedical knowledge for the benefit of human health and welfare. Properly reasoned discussions disciplined by appropriate references to existing bodies of knowledge or aimed at motivating the creation of such knowledge is the aim of the journal.
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