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患者女性,33岁,护士。因心悸多汗,体重下降3年余,于1977年4月29日住院。患者从1974年4月起开始感到心悸,脉率110～160次/分,同时伴有多汗,手颤,失眠,胃纳减退,体重下降等症。甲状腺I~(131)吸收率3小时为68.8%,24小时为68.2%。基础代谢率为+32%。诊断为甲状腺机能亢进。用他巴唑治疗,自觉症状逐渐消失,但颈部反见增粗,并出现全身非凹陷性水肿,尤以经期前后明显,白细胞降低。治疗1年后被迫停药,停药后心慌、心悸、手颤、多汗等症又见明显。后用小量他巴唑加激素,血像上升后,用甲基硫氧嘧啶、甲状腺素、心得安等综合治疗,因症状控制不理想而入院。检查:甲状腺呈弥漫性肿大,右侧为甚,无结节。颈围36.5厘米,局部有震颤感,血管杂音较响。心尖部可闻Ⅱ级吹风样收缩期杂音。肝于肋
Patient female, 33 years old, nurse. Sweating due to palpitations, weight loss more than 3 years, in April 29, 1977 hospitalization. Patients began to feel heart palpitations since April 1974, pulse rate of 110 to 160 beats / min, accompanied by hyperhidrosis, hand tremor, insomnia, decreased appetite, weight loss embolism. Thyroid I ~ (131) absorption rate was 68.8% in 3 hours and 68.2% in 24 hours. Basal metabolic rate was + 32%. Diagnosis of hyperthyroidism. Treatment with methimazole, subjective symptoms gradually disappear, but the neck anti-thickening, and systemic non-pitting edema, especially before and after menstruation, leukopenia. After 1 year of treatment was discontinued, palpitation after withdrawal, palpitations, hand tremor, sweating embolism see also obvious. After a small amount of methimazole plus hormones, blood rose, with methylthiouracil, thyroxine, propranolol, and other comprehensive treatment, due to poor symptoms and admission. Check: thyroid was diffuse enlargement, right side is even, no nodules. 36.5 cm neck circumference, a sense of tremor locally, vascular murmur ring. Apex can smell Ⅱ grade systolic murmur. Liver in the ribs