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1例40岁女性甲状腺功能亢进患者,口服甲巯咪唑10mg,3次/d。1个多月后出现高热、肛周疼痛,查白细胞减少,立刻停用甲巯咪唑,用甲硝唑、头孢呋辛抗感染,症状未缓解,并出现心悸、胸闷、食欲不振、少尿,5d后入院。查T40℃,P140次/min,R30次/min,BP60/30mmHg。四肢可见散在瘀斑,肛周可见一1.5cm×1.5cm溃疡,有脓性分泌物。WBC0.4×109/L,N0.16,Hb94g/L,PLT11×109/L。骨髓检查:增生减低,粒细胞与幼红细胞比值(M:E)=0.5:1,粒、红细胞两系罕见,巨核细胞未见,血小板少见,淋巴细胞0.51,浆细胞0.13,网状细胞0.345。血K+2.9mmol/L,Na+134mmol/L,Ca2+1.6mmol/L,AST53U/L,ALT207U/L,白蛋白20g/L,总蛋白48g/L。甲状腺功能检查:FT338.43pmol/L,FT438.36pmol/L,促甲状腺素未测到。尽管进行对症、支持及抗感染治疗,其甲状腺危象仍然存在。次日凌晨患者突然意识丧失,经抢救无效死亡。
One 40-year-old woman with hyperthyroidism received oral methimazole 10 mg 3 times daily. More than 1 month after onset of fever, perianal pain, check leukopenia, immediately disable methimazole, metronidazole, cefuroxime anti-infection, the symptoms did not ease, and palpitations, chest tightness, loss of appetite, oliguria, 5d after admission. Check T40 ℃, P140 times / min, R30 times / min, BP60 / 30mmHg. Scattered limbs visible scattered, perianal visible a 1.5cm × 1.5cm ulcer, purulent secretions. WBC 0.4 × 109 / L, N 0.16, Hb 94 g / L, PLT 11 × 109 / L. Bone marrow examination: reduced hyperplasia, ratio of granulocytes to erythrocytes (M: E) = 0.5: 1, few of erythrocytes and erythrocytes, rare in megakaryocytes, rare in platelets, 0.51 in lymphocytes, 0.13 in plasma cells and 0.345 in reticulocytes. Blood K +2.9mmol / L, Na + 134mmol / L, Ca2 + 1.6mmol / L, AST53U / L, ALT207U / L, albumin 20g / L, total protein 48g / Thyroid function tests: FT338.43pmol / L, FT438.36pmol / L, thyrotropin not detected. Thyroid crisis persists, despite symptomatic, supportive and anti-infective treatment. The patient suddenly lost consciousness the next morning, died after rescue invalid.