最初因精神障碍恶化而出现攻击和破坏行为的青少年被延迟诊断为无痛性甲状腺炎》(Delayed Diagnosis of Painless Thyroiditis in an Adolescent Presenting with Aggression and Disruptive Behavior Initially Attributed to Worseening of a Psychiatric Disorder)。

IF 1.2 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL
Yutaka Furuta, Takahiro Masuoka, Ryuichiro Narishige, Amane Tateno
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引用次数: 0

摘要

无痛性甲状腺炎在儿童中很少见,它具有甲状腺功能亢进症的特征性表现,包括攻击性和破坏性行为。与亚急性甲状腺炎或巴塞杜氏病不同的是,无痛性甲状腺炎症状轻微,体征极少或无体征,因此诊断难度很大。此外,患有精神疾病的儿童的攻击性和破坏性行为可能会被误认为是潜在症状的加重。本例患者是一名 16 岁的男性,患有适应障碍,因易激惹到儿科精神病诊所就诊。4 个月后,他出现了攻击性和破坏性行为,因此开始服用利培酮,但未见改善。1 个月后,他出现心悸和呼吸困难。他的颈部柔软无触痛,无甲状腺肿大。甲状腺检查显示游离 T4 和 T3 水平升高,促甲状腺激素水平降低,提示甲状腺功能亢进。放射性碘摄取试验显示甲状腺几乎不可见,与甲状腺炎一致。诊断结果为无痛性甲状腺炎,无甲状腺压痛。我们描述了一例青少年患者的无痛性甲状腺炎病例,该患者具有攻击性和破坏性行为,最初被认为是潜在的适应障碍恶化所致。即使甲状腺功能亢进的症状很轻微或没有出现,在对有攻击性和破坏性行为的儿童进行鉴别诊断时,也应考虑无痛性甲状腺炎。此外,还建议注意潜在的锚定偏差,以防止此类行为被延误诊断。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Delayed Diagnosis of Painless Thyroiditis in an Adolescent Presenting with Aggression and Disruptive Behavior Initially Attributed to Worsening of a Psychiatric Disorder.

Painless thyroiditis, which is rare in children, exhibits the characteristic sequence of hyperthyroidism, including aggressive and disruptive behaviors. Unlike subacute thyroiditis or Graves' disease, painless thyroiditis is challenging to diagnose because of its mild symptoms and minimal or absent physical findings. Moreover, aggressive and disruptive behaviors in children with psychiatric disorders may be misconstrued as exacerbation of underlying symptoms. The present patient was a 16-year-old male with adjustment disorder who presented to a pediatric psychiatric clinic for assessment of irritability. After 4 months, he developed aggressive and disruptive behaviors that prompted initiation of risperidone but without improvement. After 1 month, he reported palpitations and dyspnea. His neck was supple and non-tender without thyroid enlargement. Thyroid studies revealed elevated free T4 and T3 levels and suppressed thyroid-stimulating hormone level, suggesting hyperthyroidism. A radioactive iodine uptake test revealed a barely visible thyroid gland, consistent with thyroiditis. Painless thyroiditis, without thyroid tenderness, was diagnosed. We describe a case of painless thyroiditis in an adolescent patient with aggressive and disruptive behaviors that were initially attributed to worsening of an underlying adjustment disorder. Even when minimal or no signs of hyperthyroidism are present, painless thyroiditis should be considered in the differential diagnosis of children with aggressive and disruptive behaviors. Awareness of potential anchoring bias is also recommended to prevent its delayed diagnosis of such behaviors.

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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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