甲状腺功能紊乱与慢性阻塞性肺病:病例报告

Q4 Medicine
T. Kalenchic, S. Kabak, E. V. Zaharenko
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引用次数: 0

摘要

慢性阻塞性肺疾病(COPD)患者常见的并发内分泌疾病包括甲状腺结构性和功能性病变。本研究旨在确定甲状腺风暴和慢性阻塞性肺疾病加重的鉴别诊断的具体指标。本文介绍了对一名在市临床医院治疗科接受住院治疗的60岁患者的临床观察。入院诊断为慢性阻塞性肺病,混合型,重度,病情加重,一级呼吸衰竭。在医院里,患者经历了一次持续 45 分钟的呼吸困难。呼吸急促加剧与正常呼吸交替出现,并伴有双手震颤。患者情绪激动,拒绝用面罩吸氧,并出现呼吸暂停。根据伯奇-瓦托夫斯基量表(Burch - Wartofsky scale),患者发病时的状况被评估为 40 分,即甲状腺风暴(TS)的可能性很高。根据螺旋造影结果(1秒内用力呼气量-19%),记录到明显的混合型通气障碍。超声心动图检查没有发现肺心病或肺动脉高压的迹象。记录显示促甲状腺激素浓度较低,游离甲状腺素(T4)水平仍在参考范围内。血清中的甲状腺过氧化物酶抗体水平没有升高,超声波检查也没有发现甲状腺有任何变化。当慢性阻塞性肺病患者出现甲状腺异常时,由于其临床表现相似,因此在鉴别诊断慢性阻塞性肺病加重和TS时可能会遇到一些困难。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Thyroid disfunction and chronic obstructive pulmonary disease: case report
Common concomitant endocrine diseases in chronic obstructive pulmonary disease (COPD) patients include both structural and functional lesions of the thyroid gland.The purpose of the study was to determine specific indicators for the differential diagnosis of thyroid storm and exacerbation of COPD. A clinical observation of a 60-year-old patient who received inpatient treatment in the therapeutic department of a city clinical hospital is presented. The diagnosis upon admission was COPD, mixed form, severe, exacerbation, and respiratory failure of the first degree.Results. In the hospital, the patient experienced an episode of difficulty breathing lasting 45 minutes. Increased shortness of breath alternated with normal breathing and was accompanied by tremor of the hands. The patient was agitated, refused to breathe oxygen through the mask, and was in orthopnea. The patient’s condition during the attack was assessed at 40 points according to the Burch – Wartofsky scale, which corresponds to a high probability of thyroid storm (TS). Pronounced ventilation disturbances of a mixed type were recorded based on the spirography results (forced expiratory volume in 1 second – 19%). Echocardiography revealed no signs of cor pulmonale or pulmonary hypertension. A low concentration of thyroid-stimulating hormone was recorded, the level of free thyroxine (T4) remained within the reference range. Serum levels of thyroid peroxidase antibodies did not increase, and no changes in the thyroid gland were detected during ultrasound examination.Conclusion. When thyroid abnormality manifests in a patient with COPD, certain difficulties may arise with the differential diagnosis of exacerbation of COPD and TS due to the similarity of their clinical manifestations.
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来源期刊
Pulmonologiya
Pulmonologiya Medicine-Pulmonary and Respiratory Medicine
CiteScore
1.40
自引率
0.00%
发文量
70
期刊介绍: The aim of this journal is to state a scientific position of the Russian Respiratory Society (RRS) on diagnosis and treatment of respiratory diseases based on recent evidence-based clinical trial publications and international consensuses. The most important tasks of the journal are: -improvement proficiency qualifications of respiratory specialists; -education in pulmonology; -prompt publication of original studies on diagnosis and treatment of respiratory diseases; -sharing clinical experience and information about pulmonology service organization in different regions of Russia; -information on current protocols, standards and recommendations of international respiratory societies; -discussion and consequent publication Russian consensus documents and announcement of RRS activities; -publication and comments of regulatory documents of Russian Ministry of Health; -historical review of Russian pulmonology development. The scientific concept of the journal includes publication of current evidence-based studies on respiratory medicine and their discussion with the participation of Russian and foreign experts and development of national consensus documents on respiratory medicine. Russian and foreign respiratory specialists including pneumologists, TB specialists, thoracic surgeons, allergists, clinical immunologists, pediatricians, oncologists, physiologists, and therapeutists are invited to publish article in the journal.
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